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.
"We have changed and adapted to the realities of the war," Hleba wrote. "Psychologists say it is required to accept the current reality of war because remaining in constant tension and states of shock and stress is counterproductive in the long run."
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
The wife of President Volodymyr Zelenskyy, Olena Zelenska, leads this national How Are You? campaign.
In a recent podcast, she said, "I am very pleased with the words and the tone of this program — kindly and friendly. It's not a paternalistic approach."
She notes 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."
More Ukrainians are seeking help, said psychologist Oksana Korolovych, 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, Anima, is trying to nudge this process forward.
"I just wanted to bring it to the wider public and to diagnose depression and anxiety as widespread problems," said Roman Havrysh, one of the co-founders.
Havrysh and his business partner, neuroscientist Sergiy Danylov, have created a rapid online test 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."
There's also a multiple choice questionnaire. The visual test and the questionnaire each provide a score from zero to 100. They say the higher the scores, the more likely a person may have anxiety or depression.
The founders emphasize this is not a diagnosis. They compare it to a blood pressure monitor you might use at home. If you consistently get high readings, you may want to seek treatment.
"People can Google us easily and come to the platform and test themselves," Havrysh said. "We also distribute it through military psychologists and hospitals working with military personnel to help them diagnose incoming patients."
In one battalion, the test has been used for several months to help screen troops. During this time, 40 of the 600 soldiers were temporarily taken out of combat roles.
Most returned after several days, though a few were reassigned to non-combat positions.
Danylov, the neuroscientist, said troops need an elevated level of vigilance while in combat. However, he added, "You can't be in this state of hypervigilance for a long time."
Troops who remain in combat for too long become vulnerable to an anxiety disorder, he said.
"When they return home, two or three months later they may start having panic attacks," he said.
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 Dr. Vladyslav Syniagovskyi, 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 percent of Ukrainian troops suffer from Post-Traumatic Stress — a figure roughly in line with studies of U.S. troops who served in Iraq and Afghanistan.
Oksana Korolovych, the psychologist, believes the figure is even higher for Ukraine's civilians. But she also sees some encouraging changes as the war grinds on.
"Last year, people were asking how to live through the war. Now people ask about how to live after the war. We already have a sense of victory in our consciousness," said Korolovych.
Ukrainians, she said, are learning "how to defend borders. They're defending physical borders on the front-line of the war, and defending personal borders in their own lives."
Kateryna Malofieieva contributed to this report.
Greg Myre is an NPR national security correspondent. Follow him @gregmyre1.
