For the past seven weeks, Dr. Simona Neliubsiene has struggled to focus on her patients' charts, distracted by images of bombed cities flashing in her head.
At night, she lies awake in bed, her heart thumping, frantically doom-scrolling through the latest news about Russia's war in Ukraine.
"I never had anxiety attacks before," said Neliubsiene, a family physician in Kaunas, Lithuania. "But after the first week of the war, I started thinking that maybe I should take some of the pills that I am prescribing to my patients."
Many Eastern Europeans feel intimately connected to the conflict in their region.
Although the violence has not yet spilled outside Ukraine, some people in neighbouring countries said they were making detailed war contingency plans — just in case.
They complained that they were unable to escape the relentless news coverage.
Some even said they were afraid to fall asleep.
Their anxiety may be deeply rooted, and even prompted by generational trauma.
Because of the proximity of the war in Ukraine, some Eastern Europeans are afraid of getting pulled into the fight. Images of the bloodshed only hundreds of kilometres away are dredging up painful memories of atrocities committed by Russian soldiers during World War II and the Soviet occupation in this part of the world years ago.
And there are about 4 million Ukrainian refugees now in the region, whose suffering is a constant reminder of how real — and how close — this war is.
The images of atrocities attributed to Russian soldiers in the Ukrainian town of Bucha, pouring out of news media outlets, have only compounded these feelings.
"When I saw those images, I was not able to move," Neliubsiene said. "My family did not get supper that evening."
According to interviews with more than a dozen mental health professionals and patients from Eastern Europe, there has been a surge in profound anxiety, as well as in requests for sleeping pills and calls to crisis hotlines.
"This is a raw existential crisis," said Sara Koszeg, a psychologist from Budapest, Hungary, who started a project documenting people's nightmares about the war. "And it has a biological effect: You are alert all the time, and this affects your sleep."
Katarzyna Skorzynska, 34, a fashion designer from Warsaw, said she kept waking up at 4am, hours before she normally starts her day.
"I have been feeling overwhelmed and helpless," she said. "Once I wake up, it is very difficult to fall back asleep. My thoughts are racing."
And it does not help that she starts her day by looking at the news.
"Wake up, check on Zelenskyy, coffee: This has been my morning routine," she said, referring to President Volodymyr Zelenskyy of Ukraine, whose face has dominated Polish news media since the war began in February.
Staying updated on the latest war developments has become a bit of an obsession for some, who hope that doing so will make them feel like they are more in control. But the reality is that it has had the exact opposite effect.
Vytenis Deimantas, 29, a social scientist from Vilnius, Lithuania's capital, said that he had trouble falling and staying asleep, but that even when he takes sleeping pills, he wakes up after only about five hours. Then, he rolls over, grabs his phone and scrolls through news websites.
"There is a feeling of powerlessness," he said. "And the more you think about it, the stronger it is."
Deimantas said he had never had trouble sleeping before, but now he lies awake worrying about the possibility of a nuclear strike — and of a nuclear cloud drifting over from Ukraine.
These worries may have been passed down. After the Chernobyl disaster in 1986, communist authorities sent Deimantas' father to the nuclear site to clean up and guard the area surrounding the damaged reactor. The episode has left a grave and long-lasting mark on his mental and physical health.
On the night that Russian forces took over the nuclear plant, at the start of the war, Deimantas kept obsessing about his bedroom windows, which he usually leaves open.
"I kept thinking: If I don't close them, what happens if the Russian army does something?" he said.
Psychologists say that the challenge of anxiety is that people worry about things that are out of their control. And one of the most frequent symptoms of anxiety is insomnia.
Neliubsiene has been swamped with requests from patients experiencing insomnia and anxiety. She has been prescribing them muscle relaxants for short-term use and has been recommending physical activity, reduced screen time and fixed routines. One of her patients, a woman in her 50s, told her she was afraid to fall asleep.
"She said, 'What if Putin invades while I am sleeping?'" Neliubsiene recalled, referring to Russian President Vladimir Putin.
Of course, many people have already been on tenterhooks for more than two years amid the coronavirus pandemic, psychologists said, making made them all the more vulnerable to anxiety attacks in reaction to what is happening in Ukraine.
"We are definitely getting many more phone calls," said Tomasz Gorecki, a psychologist and the coordinator of Poland's main crisis hotline.
The entirety of Eastern Europe seems to be enveloped in the war. In Warsaw, which has seen an influx of Ukrainian refugees, it is as likely to hear Polish as it is Ukrainian. Shops and restaurants display Ukrainian flags. Cultural venues have been transformed into aid centres and shelters.
Mental health professionals say that one way to feel more in control and ease anxiety is to help someone else.
But even as helping those directly affected by the war diminishes feelings of powerlessness, it also brings people face to face with the refugees' suffering — and exposes them to vicarious trauma.
Skorzynska, the fashion designer from Warsaw, described a feeling of profound sadness after assisting refugees.
"You genuinely realise that it could have been us," she said. "That this is all happening just next door."
That sort of realisation has led many people to seriously consider the possibility that they might have to flee their homes.
Families in Poland and Lithuania said they discussed which art pieces were valuable enough to take with them and which routes would quickly get them to safer countries.
And then there are those across Eastern Europe who have already witnessed the savageries of war.
Dr. Irena Dziewonska, 82, a pediatrician living in Warsaw, said that one of her earliest memories was of hiding in a basement with her parents during World War II. As a young child, she said, she saw people being shot at and heard women being assaulted.
Since the war began in Ukraine, all of those memories have come rushing back, Dziewonska said, and she has been struggling to sleep, eat or think of anything else.
"This is just dreadful to have to experience this for the second time in a lifetime," she said.
Research suggests that trauma can be passed down generation to generation. Bodies retain physiological imprints of traumatic memories, which can be reactivated by stressful events.
"I realised I can be afraid of things that my ancestors experienced," said Neliubsiene, the Lithuanian physician.
A member of her family was raped during World War II, she said, and she described "a terrible, gut-rotating feeling" when she saw news reports of Ukrainian women being sexually assaulted by Russian soldiers during this war.
This personal experience of war has made the violence in Ukraine particularly vivid and painful across generations of Eastern Europeans.
Whenever Dziewonska closes her eyes, she sees the burning Warsaw of her childhood.
"I am trembling all the time," she said. "I keep on thinking: They will come here again, and I will be in that basement again."
This article originally appeared in The New York Times.
Written by: Monika Pronczuk
Photos by: Maciek Nabrdalik
© 2022 THE NEW YORK TIMES