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How Trauma Causes Premature Aging — With Fresh Evidence From Ukraine

The war in Ukraine has been going on for a year. Many have died, fled or been traumatized — day after day and night after night. Such harrowing experiences leave deep wounds. But there are ways to overcome traumatic experiences.

Image of an elderly woman in the countryside wiping hear tears with her hand, under a sky filled with smoke due to the bombing of a train station

Under the smoke of a bombed train station in the background in Siversk, Ukraine.

Gerlinde Felix

BERLIN — For Nathalia, New Year’s Eve was never good. The loud bangs of the fireworks shocked her so much that she ran as fast and as far as she could. She ran as if in a trance, not even realizing that she had left behind her husband, who was older and had a heart condition.

Nathalia — her name has been changed in this article — is almost 50 years old. About six months ago, her and her husband ran as fast as their feet could carry them, with just a few belongings they had quickly gathered. Away from the border with Russia, to Donbas, in the direction of Kyiv. Behind them, the sounds of Russian artillery bombardment, and bombs that seemed so close.

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They arrived in Poland on an overcrowded train from Kyiv, surrounded by exhausted people with fearful, desperate faces. In Poland, relatives waited to take them to Germany, and safety. But for their children, there was no escape from their fear.

Nathalia has nightmares. Like in a movie, the same scenes play, again and again. The moment when she ran away. When such a flashback happens, triggered by noises or images on TV, she is panic-stricken. She sweats, shakes. The diagnosis is post-traumatic stress disorder (PTSD).

She has been receiving treatment for about five months from Meryam Schouler-Ocak, senior physician at the Psychiatric Outpatient Clinic at the Charité University Psychiatric Clinic in the Alexian St. Hedwig Hospital in Berlin. "What happened on New Year's Eve is that she was relieving the war trauma that she experienced," explains the Berlin-based physician.

Flashbacks and PTSD

According to the U.S. Diagnostic and Statistical Manual (DSM-5), trauma is present when a confrontation with death, injury, loss or sexual violence has happened. "And that's the case even if it didn't happen to the person themselves, but they witnessed someone experiencing it," says Schouler-Ocak.

During a war, she says, you don't just experience one trauma, but a string of traumatizing experiences — new traumas every day. That describes what Nathalia went through.

Flashbacks are the result of faulty storage of memories of the traumatic experience in the brain. Two brain areas play a central role here: the amygdala, where emotions are formed, and the hippocampus, the memory of place and time — effectively the brain's navigation system for space and time. Normally, emotions and navigation data are stored simultaneously. For this to succeed, the amygdala must not be too strongly activated.

The shock phase happens in the first few days after the trauma, and is often characterized by the impression of not being able to sense or feel anything. "Whether this later develops into post-traumatic stress disorder or you get back on your feet depends very much on whether you can process what you have experienced in the first two to four weeks after the shock phase, in a so-called impact phase," says Schouler-Ocak. This is the time when the brain decides how to process events, and whether it has developed strategies to deal with the stress.

Coping strategies

The key often lies in childhood. People who have experienced emotional security are better able to cope with later traumatizing experiences. In a good 40% of cases, the symptoms improve on their own. But those who have not learned coping strategies to calm their troubled souls, and who do not receive support, are at risk of losing control of their emotions. With every experience of abuse from childhood and adolescence, the lack of a sense of security, and the risk of falling ill, increases disproportionately.

In addition to PTSD, it is often depression or anxiety disorder, or both.

Then the amygdala can inhibit the storage of memory content at a place and time in the hippocampus. As a result, memories of feelings are stored without temporal and local classification — as individual fragments, but not the memory of the experience as a whole.

If these memory fragments are later activated by a trigger, in Nathalia's case by the New Year's Eve bangs, then the affected person experiences the situation as if it had just happened. Each flashback means a new trauma. Feelings of fear, defenselessness, helplessness and loss of control reoccur. This is often compounded by additional suffering, such as addiction or eating disorders. "Nearly 70% of those affected have not one but even two of these trauma-induced disorders," Schouler-Ocak reports. "In addition to PTSD, it is often depression or anxiety disorder, or both."

Image of two sisters along with their mother, luggage on the floor, waiting for an emergency evacuation bus

Donetsk, Ukraine: two sisters along with their mother, luggage on the floor, waiting for an emergency evacuation bus to Dnipro, as the city is under heavy attack.

Alex Chan Tsz Yuk/SOPA Images via Zuma

Trauma and the body: a deep connection

Not only the psyche, but the whole body also suffers. Physical complaints such as abdominal pain, shortness of breath, a pounding heart and unsteadiness are often felt — sometimes only as a slight disturbance, and other times as a pronounced illness. "Traumatized people often appear physically prematurely aged," says psychologist and psychotraumatologist Iris-Tatjana Kolassa, who heads the Department of Clinical and Biological Psychology at the University of Ulm. She says a traumatized person is permanently at an elevated stress level and constantly on alert.

"Chronic, excessive and traumatic stress always leave traces in the cells of our body," Kolassa says.

Particularly affected, he says, are those cell types that require a lot of energy, such as brain, heart, and liver cells. Under very high stress, these cells' metabolism must perform at peak levels. To do this, they need energy, which their tiny cellular power plants produce. However, there is then also an "excess" of oxidative stress, which can damage the genetic material, fats and proteins.

As a result, more inflammatory processes occur. "If this condition persists for a long time, a normally well-functioning system can become overwhelmed," says the Ulm researcher. One then feels lacking in energy, is listless, has concentration and has thinking disorders. "In addition, post-traumatic stress leads to changes in the immune system of those affected, which would otherwise only occur later in life." Even their risk of developing type 2 diabetes, cardiovascular disease, cancer or immunological diseases such as rheumatism earlier increases.

EMDR psychotherapy

Starting a psychotherapeutic treatment can help to significantly reduce the symptoms, according to Kolassa. The negative effects caused by stress could be improved, and inflammatory processes possibly reduced to normal levels again. Nathalia's psychiatrist Schouler-Ocak agrees. Her patient's PTSD has already improved, she says. And that's despite the fact that she can only communicate with her through an interpreter. Often, even non-specific help and support measures suffice. Nevertheless, she would like to see more for people who have to flee war and violence. The methods to do so already exist.

The patient keeps their head still and looks at the therapist's hand.

Eye Movement Desensitization and Reprocessing (EMDR) is a special form of psychotherapy for the treatment of trauma disorders. It was developed in 2001 by Francine Shapiro of the Mental Research Institute in Palo Alto. EMDR is a therapeutic journey into the past: following a precise protocol, the therapist asks questions in eight phases about what the patient has experienced and the feelings, thoughts and body sensations that were felt during the experience. The patient keeps their head still and looks at the therapist's hand. The eye movements address and connect both hemispheres of the brain simultaneously. They are intended to divert the patient's attention from the traumatic experience. The situation suffered through is re-evaluated and seen as something past.

But for Nathalia and other Ukrainian refugees, it is used far too rarely. "Because, for this, an interpreter not only has to know the language but should also have a good trauma-specific knowledge," says Schouler-Ocak.

EMDR is not easy for the patient: they are confronted with memories, which can be exhausting and lead to nightmares, and sometimes previously unknown traumas surface. For Nathalia, despite the recovery, the trauma is far from over. She can talk to her daughter almost every day, but her son is often unavailable for days at a time, leaving her filled with crushing uncertainty.

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FOCUS: Israel-Palestine War

Why The U.S. Lost Its Leverage In The Middle East — And May Never Get It Back

In the Israel-Hamas war, Qatar now plays the key role in negotiations, while the United States appears increasingly disengaged. Shifts in the region and beyond require that Washington move quickly or risk ceding influence to China and others for the long term.

Photograph of U.S Secretary of State Antony Blinken  shaking hands with sraeli Defense Minister Yoav Gallant.

November 30, 2023, Tel Aviv, Israel: U.S Secretary of State Antony Blinken shakes hands with Israeli Defense Minister Yoav Gallant.

Chuck Kennedy/U.S State/ZUMA
Sébastien Boussois


PARIS — Upon assuming office in 2008, then-President Barack Obama declared that United States would gradually begin withdrawing from various conflict zones across the globe, initiating a complex process that has had a major impact on the international landscape ever since.

This started with the American departure from Iraq in 2010, and was followed by Donald Trump's presidency, during which the "Make America Great Again" policy redirected attention to America's domestic interests.

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The withdrawal trend resumed under Joe Biden, who ordered the exit of U.S. forces from Afghanistan in 2021. To maintain a foothold in all intricate regions to the east, America requires secure and stable partnerships. The recent struggle in addressing the Israeli-Palestinian conflict demonstrates that Washington increasingly relies on the allied Gulf states for any enduring influence.

Since the collapse of the Camp David Accords in 1999 during Bill Clinton's tenure, Washington has consistently supported Israel without pursuing renewed peace talks that could have led to the establishment of a Palestinian state.

While President Joe Biden's recent challenges in pushing for a Gaza ceasefire met with resistance from an unyielding Benjamin Netanyahu, they also stem from the United States' overall disengagement from the issue over the past two decades. Biden now is seeking to re-engage in the Israel-Palestine matter, yet it is Qatar that is the primary broker for significant negotiations such as the release of hostages in exchange for a ceasefire —a situation the United States lacks the leverage to enforce.

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