Country Without a Rear: The Ukrainian Experience of Continuous Traumatic Stress in the Context of Global Wars

Introduction:  

A morning you won’t find in textbooks

Olena wakes up at 5:47 a.m. — thirteen minutes before the air‑raid siren goes off. She no longer knows whether her nerves have learned to outrun the sound, or the sound has learned to catch up with her nerves. She lies still and waits. Then she gets up, makes coffee, puts on her uniform — she is an emergency doctor in Kharkiv, and today she has a twelve‑hour shift. She steps outside. The sky is still dark, but the city is not asleep — it has not truly slept since February 2022. In fact, since 2014. And if we are honest, much longer than that.

This book begins with Olena. But Olena is not just one person. She is millions of people who do the same thing every morning: they get up, function, and call it “normal,” even though they know it is not. They simply no longer remember anything else.

The problem of words

When we look for language for what is happening to us, we run into a wall.

“Stress” sounds like something a vacation can fix. “Anxiety” like something that passes after good news. “Trauma” like something that has already happened and now needs to be “processed.” And above all these words hovers the most common, most overused, most imprecise one — “post‑traumatic stress disorder,” PTSD. Post. After.

But there is no “after” for us.

What we have is now — a missile flying in at three in the morning. Now — a draft notice delivered to the neighbor. Now — an electricity bill when there has been no power for three days. Now — the news you read without knowing whether to rejoice or cry. Now — and then now again — and again, and again.

PTSD is built on one principle: first something terrible happens, then it becomes safe, and only then does the psyche begin to “digest” what it has been through. If you compare it with the body, it is like a broken bone: once the sharp pain subsides, it can begin to heal. PTSD is when that healing goes wrong — painfully, with complications.

But what happens when the bone breaks again — every time it tries to heal? When there is no moment of “after,” because the next “now” is already here?

For this situation there is still no word in official diagnostic classifications. And yet the word — and the framework, and the concept — already exist. This book is about them.

Where this word comes from

In 1987, in South Africa, a group of psychologists working with victims of apartheid ran into the same problem. The people they were trying to help did not fit the PTSD diagnosis: they were not living “after” the violence — they were living inside it. The police could come again. A neighbor could be killed tomorrow. The law did not protect them. The state was the enemy.

Gail Straker and her colleagues at the Sanctuaries Counselling Team proposed a new term — Continuous Traumatic Stress. Not “after,” but “ongoing.” Not “after,” but “for as long as it lasts.”

Later, similar language emerged in Gaza, where researchers wrote bluntly: “There is no ‘post’ in our PTSD, because the trauma has not stopped.” It appeared in work with refugees, with survivors of chronic domestic violence, and with communities where danger is not an exception but the background of everyday life.

We are part of this global conversation. But the scale, duration, and visibility of our experience to the rest of the world are our own, and unique.

What CCTSD is and why this book is about it

In this book, CCTSD — Complex Continuous Traumatic Stress Disorder— is used to mean a continuous collective traumatic stress disorder: a state in which an entire country lives under a long, unfinished threat without any clear “after.” We speak of collective because this is not just Olena’s individual story; it is the shared experience of millions of people who wake up every morning inside the same danger.

Unlike PTSD and CPTSD, which describe a person “after trauma,” CCTSD describes life inside trauma — when there is no guarantee that tomorrow will be any safer than today.

CCTSD is not an official diagnosis — it does not appear in DSM‑5 or ICD‑11. But it is the most accurate description of where Olena, Sergiy, Mykola, Inna, millions of Ukrainians — and millions of people in other parts of the world living through war, violence, or occupation for years — actually are.

CCTSD differs from PTSD and CPTSD not only in symptoms, but in where the person is standing. PTSD and CPTSD describe someone after trauma, trying to return to normal life. CCTSD describes someone inside trauma, trying to survive today with no solid promise of tomorrow.

That is why CCTSD requires a different kind of help. Different words. A different lens.

This is where what this book says openly begins — the thing most books about trauma prefer to leave unsaid:

How we help today — during CCTSD — directly determines what PTSD will look like after victory.

If, in the midst of continuous trauma, a person receives support, recognition, and a language for their pain, then after victory their psyche will have some resources left to heal. If not — if the years of CCTSD are lived in silence, isolation, without recognition or help — peace will not bring relief. On the contrary: the wave of PTSD and CPTSD that follows the end of active hostilities may be far heavier than what people felt during the war itself. That was the case after Vietnam. After the Balkans. After every war in which the psyche was not given words before the guns fell silent.

This book is an attempt to give those words now. Not after.

Who this book is for

This book is for those living through the war who recognize themselves in phrases like “I don’t feel anything anymore” or “I don’t allow myself to make plans.” It is for psychologists and psychiatrists holding sessions under air‑raid sirens, unsure whether classical PTSD and CPTSD protocols even apply in such conditions. It is for doctors, teachers, chaplains, journalists — everyone who faces other people’s pain every day and carries it inside themselves. It is for volunteers who have been “holding on” for a fifth year and no longer understand why suddenly they cannot go on. It is for politicians and officials — if they are ready to hear that the mental health of a nation is not charity, but security.

And it is for those who think about the future: what will become of us when all this ends? This book argues — and tries to show — that the answer to that question depends on what we do right now.

How to read this book

The book moves from experience — to language — to science — to action.

The first part immerses the reader in reality: what life in a country without a rear looks and feels like, where front line and “rear” have long since blurred. It will resonate most with those living under shelling, commuting to and from the front, or existing in a so‑called “rear” that has never truly been safe.

The second part explains why PTSD and CPTSD are not enough to describe our experience. It speaks both to those trying to make sense of their own states with familiar words like “stress” or “burnout,” and to those who work with people professionally — psychologists, psychiatrists, physicians.

The third part shows that we are not alone: South Africa, Gaza, and refugee communities have walked this same path of searching for language for continuous trauma. It offers a wider context: Ukraine is not an exception “in a vacuum,” but part of a global conversation about societies living without an “after.”

The fourth part builds the concept of CCTSD: what it is, how it feels in the body and in everyday life, and what current research says about it. It will be useful for anyone seeking a clear definition and wanting to “locate” their own experience on the map.

The fifth part is the most uncomfortable and perhaps the most important: what will happen to our psyche after victory, how CCTSD may crystallize into PTSD and CPTSD, and how to make that transition less destructive. Here there is particularly much to consider for those thinking about policy, security, and long‑term recovery.

The sixth part is about how to help right now, in imperfect conditions: which approaches actually work under continuous trauma, and which promises of help can, on the contrary, do harm. It is addressed to clinicians, volunteers, community leaders, and everyone who is “carrying” others on their shoulders.

The seventh part is about language, ethics, and responsibility: who creates the conditions under which societies live in continuous trauma, and how to speak about this without turning other people’s pain into a tool. It matters for everyone who has power over words and decisions — from journalists to politicians.

Through all the chapters walk living people — Olena, Sergiy, Mykola, Inna and others. They are fictional, but recognizable. Their stories are woven from thousands of real ones and remind us that behind every term in this book stands someone’s particular morning coffee, siren, train ride, or shift.

One word at the end of the introduction

There is a temptation to write a book about trauma in the hope that it will help “afterwards.” That someday someone will read it in a peaceful Ukraine and say: “So this is what was happening to us.” We are not writing that kind of book.

This is a book for those who are reading it now. In the pauses between air‑raid alerts. On a train heading somewhere away from the shelling. On duty. In the moment when it has become so quiet that the silence itself feels suspicious. For you — right now — this book is written.

Olena finishes her coffee. It is already getting light outside. Today, once again, the siren did not match her internal clock. She leaves for work. That, too, is a form of resilience. But resilience that is not seen and not named slowly eats a person from within. The aim of this book is to notice it. To name it. And to begin to help — while there is still no “after.

More about this topic can be found in our book "Country Without a Rear: The Ukrainian Experience of Continuous Traumatic Stress in the Context of Global Wars" on Our Books on Google Play.

Mykola Iabluchanskyi together with Andriy Yabluchanskiy