This is the title of Jonathan Safran Foer’s New York Times Bestseller about a young Jewish writer on a journey to Ukraine to find his grandfather’s hometown and the woman who saved his life during World War II. The story is filled with colorful characters who beg your forgiveness and earn your affection. It is a story of uncovering personal histories that have shaped his family for generations.
I have spent the past week in Poland and Ukraine with my International Advisory Board on our annual mission for mental health. Passionate about advancing mental health and committed to having fun along the way, we have shared conversations and discovered light in places we could not have anticipated.
1. European Psychiatric Association Annual Congress. From suicide prevention to the legalization of cannabis to novel ketamine treatments, we participated in sessions that explored research that is shaping policy and practice of mental health around the world across a wide range of topics. This is the first time that the Congress has been held in Warsaw, and over 4200 delegates attended. Professors Geoffrey Reed (Columbia University), Wolfgang Gaebel (University of Dusseldorf) and I had the opportunity to conduct a training session on the new diagnostic guidelines that will be utilized around the world as countries adopt the WHO ICD-11.
2. POLIN Museum. Built on land that was once part of the Warsaw Ghetto, POLIN Museum provides a social and political narrative of the 1000-year history of Polish Jewry. For centuries, Poland was home to one of the largest and most significant Jewish communities. In stark contrast, between 1939-1945, approximately 90% of Polish Jews (3,000,000 people) perished during the German occupation of Poland and the ensuing Holocaust. We know that violence, trauma, dislocation, loss, grief, and betrayal increase risk for a vast array of mental disorders. Our conversations with members of today’s Jewish community in Poland made it eminently clear that all these issues are intimately woven into their journeys. As they expressed in one way or another, they are doing the work of discovering a history they did not inherit because it had been kept in darkness till now.
3. Inherited Trauma. The possibility of transmitting mental ill health to succeeding generations is something that commonly arises in discourse about the Holocaust. How can that happen? The nascent field of epigenetics explores how marks of trauma can be passed from one generation to the next. There are many questions, data are inconsistent and largely limited to animal models, but many believe this area of science will shed light on transmission of illness in ways that have been impossible to date. Listening to the Jewish and non-Jewish Poles grapple with understanding a time before they were born, I do not know how, but I have no doubt that this history of past generations shapes their lives in profound ways today. Many Jewish and non-Jewish Poles are engaged in explorations about what their history means to their current psychological state in terms of trust, security, responsibility and guilt, for example.
4. Open Doors Center of Psychological Counseling. Located in Kiev, Ukraine and directed by Dr. Oksana Syvak, this fledgling community mental health center is a testament to the indefatigable human spirit. Prejudice and discrimination related to mental illness and limited professional training present challenges both in terms of getting people to treatment and having appropriately trained professionals available for those who do manage to get there. With great ambitions and partnering with Project Kesher, Open Doors Center aims to change the narrative on mental health by advocating for greater funding for mental health services and partnering with international organizations to build workforce capacity.
5. National Medical University, Ukraine. This afternoon, I had the honor of giving a lecture to a standing room only assembly of medical school faculty and students about mental health priorities across the female developmental lifespan. From adverse experiences of childhood (ACES) to eating disorders, mood disorders, anxiety, perinatal depression, and risks of mental health problems for women in menopause and later in life, my lecture prompted a lively discussion about the challenges getting treatment in Ukraine and the opportunities to conduct research that will provide data specific to this region.
Jonathan Safran Foer’s journey was driven by a desire to shed light on the past in a way that would illuminate his path forward. His story ends mid-sentence. “I will walk without noise, and I will open the door in darkness, and I will…” Our journey took us to other destinations in the region. As we attempt to change the narrative on mental health, I am not sure we should walk without noise; I am sure we should open the door and bring light where there is darkness; and I will…