Prof. Joseph Levine

Senior Psychiatrist




Conversation 36: What is the effect of the threats of survival in a war situation on the board of internalized figures?

By Prof. Levine & Dr. Salganik


We are currently [October 2023] in the midst of a war. This war poses a considerable survival threat.

Let's examine the question, which is what does an existential threat and uncertainty related to war do to the individual.

The University of Utah in the United States published an article authored by Dr. Steve Sugden, [a colonel in the US Army Reserve and a psychiatrist at the Huntsman Mental Health Institute (HMHI)] about the psychological impact of total war on civilians who contract it through the media. Bellow are the highlights of this article:

"Thousands of kilometers away from the conflict, you may be watching the war in Ukraine in real time through a screen. Images of destruction, people in shelters, injured Ukrainian citizens and many other disturbing and tragic events.

The events in Ukraine, dubbed the first "social media war", are broadcast live not only on traditional media but also on apps like Instagram, Twitter and TikTok at a rate never seen before. Violent images and videos are spreading like wildfire. Some of the videos tagged with #UkraineWar have been viewed 600 million times in a matter of days. These images, videos and audio clips can be triggers with a huge psychological impact.

Global conflicts have always been problematic. Still, with the recent civil unrest in Syria, the instability in Iraq, conflicts in other countries, and the coronavirus pandemic, the invasion of Ukraine is yet another in an already long list of traumatic events that can negatively impact our mental health”.

"The long-term effects of trauma are significant," says Dr. Steve Sugden. Sugden knows firsthand what it's like to be on the battlefield and how trauma can affect our mental health. Sugden claims that there are some common effects of war on mental health and that those who watch Traumatic content are also at risk.

"Civilians, soldiers and those who consume the sights and sounds of war through social media can develop a typical psychological profile of trauma."

And here the question arises, how does the war affect our mental health?

The World Health Organization stated that in situations of conflict, "about 10% of people who experience traumatic events will suffer from serious mental problems, and another 10% will develop behavior that will impair their ability to function effectively." Depression, anxiety and psychosomatic problems such as insomnia are the most common effects. Sugdan focuses on three populations that are sensitive to negative consequences on mental health:

• Citizens within the attacked homeland

• The soldiers on both sides of the barricade

• Those who consume the images, videos and audio of the war through social media apps, television, radio and the internet

"Surprisingly, the civilians in the conflict often tend to be the group with the least psychological trauma – but it can still be significant," Sugdan says. This state of less trauma may be the result of citizens' ability to immediately talk to their social network and process their feelings, which helps build resilience.

The long-term effects of trauma on soldiers are significant. "We have seen an increase in homelessness among the US veteran population, and this group has the highest suicide rate compared to any other population," Sugden says. Soldiers around the world are exposed to traumatic events, and with traumatic exposure comes higher overall medical complications, defective functioning within families, unemployment, drug use and more.

"But all three groups, including civilians, can develop a typical psychological profile of trauma. Equally important, all three groups can develop mistrust, suspicion and a sense of hopelessness when it comes to a conflict close to home or far away," Sugdan explains.

"Studies have shown that consumers of war through television, social media or other forms of media can be just as influenced as the actual individuals within the conflict."

הסרט הגרמני שמועמד לאוסקר אולי מנצח בקרב, אבל מתעלם מהמלחמה

According to Sugdan, even before the start of the war in Ukraine, the negative impact of the use of social media was well documented. Countless studies show that increased use of media devices affects student performance at school, relationships, productivity at work and can worsen mental health. Social media marketers and developers have tapped into the brain's reward system, mimicking the dopamine effects common with many addictive substances. Sugden reminds us that as a society, we can all benefit from less screen time, but social media is embedded in our daily behavior, and sometimes it's hard to look away from it.

From a clinical perspective, when it comes to times of crisis, more people turn to electronic media as sources of information. Many people use social media to cope with stress or as a distraction. Watching events across Ukraine and the rest of the world on screen allows them to empathize with those affected by the global conflicts and can educate, inform and inspire people to help. But increased screen time and oversaturation of traumatic content can come at a price.

World War III - TV Tropes

"An interesting correlation is 9/11. It was the first televised disaster. Studies have found that those who watched the event on television were just as likely, if not more, to develop trauma-like symptoms than those living in New York at the time," says Sugden.

How then to set limits for viewing and engaging in social media in order to maintain mental health?

It might be useful for anyone to turn off screens or limit time viewing Ukraine-related content, but it's not a realistic option for some. Social media algorithms are intentionally built to be addictive; However, it is possible to stay updated without the constant refreshing of your social apps. Sugden suggests some of the following to implement healthy social media boundaries related to global conflicts:

• Add a time limit in the device settings. Avoid viewing content before bed or right when you wake up, not only because the blue light from your device can be harmful, but also because viewing disturbing images and videos can cause unnecessary stress and anxiety, keep you awake, or cause anxiety that can last throughout the day.

• Make sure the content you are viewing or considering sharing is correct and not misleading or inaccurate.

• Examine your feelings and if you start to feel anxious, take a step back and turn off the phone or computer.

• Focus on finding the content that doesn't leave you stressed.

As the war in Ukraine continues, instead of watching it unfold on social media, staying engaged by supporting crisis-related efforts can provide a mental health boost. There are many actions that can be taken – donating to causes that support people in Ukraine or organizing a local effort to help families with Ukrainian connections may be a positive alternative. This is the time to examine your mental state, take a break from social media, look for ways to help and find the emotional support you may need."

In this article Segdon focused mainly on the conflict in Ukraine but of course this can be applied to a variety of other war situations including the current conflict between Israel and Gaza.

We will now discuss the question of what existential threat and uncertainty associated with it [including the particular case of war] do to the individual and we will discuss later how this effect is moderated by positive personality resources.

We will answer this with the article of Leontiev and his friends whose title appears here in English.

Leontiev D, Mospan A, Osin E. Positive personality resources as buffers against psychological reactions to uncertainty. Curr Psychol. 2022 Nov 1:1-12.

Thus in 2022, Leontiev and his friends [Russian authors] wrote an article entitled: Positive personality resources as buffers and regulators against psychological reactions to threat and uncertainty.

Below are some main points taken from the introduction to this article:

"The central problem of the research presented in this paper is how people deal with the challenges associated with uncertainty. Increasing uncertainty is often cited as a feature of our century; in psychology, on the other hand, we can hardly speak of ordinary research in this field. Still, for psychology, there is a lot to offer.

Uncertainty can be broadly defined in terms of the unpredictable and the complex (Krohne, 1993). This issue is most prominent in existentialist psychology, which is based on the premise of uncertainty as a normal and unavoidable reality of human life (Spinelli, 2007; Leontiev, 2015). Existentialism regards life as a total uncertainty, where certainty can only be created by the person who acts on his own responsibility, who does not have sufficient confidence that he is doing the right thing, but he conducts a dialogue with other human beings in order to develop a sense of subjective certainty.

Alquist and Baumeister in their comprehensive review in 2022, pointed at an important distinction between subjective uncertainty and objective uncertainty: the former arises from a lack of information about the world, while the latter is inherent in objective reality. Objective uncertainty challenges the human personality, since active efforts may affect the outcome, while subjective uncertainty provokes avoidance of definite decisions, since lack of information increases the risk of error and it is better to avoid. The authors argue that unsafe situations attract more of a person's attention and evoke stronger emotional responses.

Uncertainty is thus revealed as a challenge that requires authenticity, responsibility, courage to bear anxiety, cooperation, meaning and a variety of other resources to deal with it. Dealing successfully with uncertainty means staying in touch with the ambiguous reality, rather than trying to avoid it, and trying to create certainty responsibly. Our ability to withstand uncertainty is one of the most important existential characteristics needed to master the many challenges that life can present (Maddi, 2013). The personality resources responsible for this ability are the main objective of the study, a summary of which is presented below.

Most often, the ability to withstand uncertainty has been studied as a specific personality tendency labeled as tolerance for uncertainty or tolerance for ambiguity. The study of individual differences in tolerance for uncertainty began in the 1940s, with the work of Frenkel-Brunswick (1948, 1949) who proposed a single individual variable behind denial of emotional ambivalence and intolerance of cognitive uncertainty.

Various models of tolerance and intolerance of uncertainty have since been developed (see Furnham & Marks, 2013, for a review), showing that tolerance of ambiguity is an important personality resource associated with a variety of positive cognitive and behavioral outcomes, such as openness to experience, cognitive flexibility, proactivity, entrepreneurial performance, and mental health. .

More recently, other individual differences models of trait-like personality resources have been proposed, in which uncertainty tolerance is not specified as a defining characteristic, but instead is proposed as a functional outcome. These models include concepts such as resilience (Maddi, 2004) and sense of coherence (Antonovsky, 1993). Resilience is an operation of existential courage that aims to adopt the dispositions that allow people to make autonomous and meaningful decisions when faced with the uncertainty of future outcomes (Maddi, 2013). A sense of coherence is a general confidence that life environments are predictable and manageable (Antonovsky, 1993). Both tendencies have been shown to play an important role in preventing stress and dealing effectively with unsafe situations at work or in the health sector (Eschleman et al., 2010; Eriksson and Lindstrom, 2006).

Other personality variables relevant to dealing with uncertainty refer to the sense of the acting self or self, which is difficult to reduce to a single trait-like variable. As mentioned above (see Alquist & Baumeister, 2022) the sense of the self acting without the self plays a critical role as a resource for dealing with objective uncertainty. In the research whose summary will be presented below, the resource of the sense of self is represented by structures that measure its various aspects. One is a well-known construct of self-efficacy, which refers to an individual's belief in his ability to perform the behaviors necessary to produce specific performance achievements (Bandura, 1997). The second relates to fundamental beliefs about the freedom of human action. It has been said more than once that the belief in free will contributes to results related to the motivation and efficiency of human actions…"

So far, an excerpt from the introduction to the article. Below is the summary of the article itself.

"Since March 2020 [and before the outbreak of the war with Ukraine], Russia has faced three continuous challenges of uncontrollable threat and uncertainty: the corona epidemic that occurred on a global scale, and two challenges at the national level, the radical amendments to the constitution and a drop in oil prices and the national currency. The authors used this opportunity to investigate how personality resources predict individual differences in cognitive appraisals of uncertainty and emotional reactions related to each challenge. A longitudinal study was conducted with 4 measurement dates between April and November 2020 in a sample of 219 Russian-speaking volunteers. The assessment of each of the three conditions at each measurement occasion included an assessment of his degree of certainty/uncertainty, general orientation, positive and negative emotions.

The results indicated that people with higher levels of personality resources tend to evaluate challenging situations as safer, have a better sense of orientation in these situations, show more positive emotional responses, and show more positive change trends over time that reflect successful adaptation."

We will now move on to the psychological effect of the war on the individual, and especially in light of our thoughts that the "social self" of the individual is made up of a group of internalized figures. We will address here some general changes in person’s attitudes during the war times and not just mental health issues associated with it.

Here we’d like to remind that in the model we propose for the "self", one has to first differentiate between the primary self, which is actually the basic biological nucleus consisting of several innate structures and which is subject to development during life and the "social self" [consisting of "secondary selves"], which is a structure that develops during a person's exposure to social influence, and consists of internalizations of figures significant to a person, originating either from external groups or from imaginary groups (for example, taken from a book, from a myth, from a movie, etc.) that were having a considerable effect on the person). We will note here that at birth there are innate patterns for most parts of the self such as the "social self" and its parts that form nuclei for a possible future development of these structures.

The "secondary selves" included in the "social self" include 1] the variety of representations of the "Me" that originate from attitudes and feelings towards the self and its representations in different periods of life 2] the representations of internalized figures that often originate from significant figures that the person is exposed to during his life but as mentioned may also be imaginary characters represented in books, films, etc. that have had a considerable influence on man. 3] The person’s representations of the "subculture" [subculture refers to social influences in the milieu [environment] in which the person lives and are not necessarily related to a specific person or group].

We call the social self metaphorically the "directorate of characters" or more specifically the "directorate of internalized characters." We note that, as we mentioned before, in this board there is usually a hierarchy in which there are more influential and dominant figures that we metaphorically called "Dictator Self or Selves" and these set the tone and even impose censorship on what content, attitudes and behaviors cannot be contained in the board of internalized characters. We note that the person as a whole is not aware of the influence of the directorate of internalized figures and recognizes the influence as coming from himself and his own will and attitudes.

It should be mentioned that we also utilized the GPT-Chat language model in our elaborations. Our request for the GPT-Chat was around the topic of how may the existential threat [as in war] affect the key figures internalized within the individual.

We assumed that existential threats can have a profound effect on the unconscious relationships within the group of internalized key figures that we have metaphorically called the "directorate of internalized figures". These build the "social self" that shapes what we use to perceive as person’s self-concept, its values ​​and belief system. These internalized key figures are important components of the individual's psyche and the relationship between them can be shaped by the presence of existential threats. This is how, in our view, existential threats can affect these characteristics:

A. Changing self-perception: Existential threats can challenge the individual's self-perception constructed by his or her set of internalized figures and especially by the key influential figures in this internal “directorate” , by bringing up the issue of the individual's mortality or the fragility of human existence as a top priority. This may lead the board of internalized characters to a change in hierarchy and the rise of characters who offer different values ​​and priorities that affect the person's sense of identity that the dominant character (in our terminology – dictator self) will approve. We note that the person is usually not aware of the influence of the internalized characters and attributes the influence to himself.

B. Impact on the Values and Belief System: Existential threats can lead people to reevaluate their core values and belief system shaped by internalized characters. Here the dominant figure in the board of internalized figures must approve such a change or perhaps alternatively in extreme situations another figure will rise and become dominant when there is the possibility of widespread catastrophe or extraordinary existential challenges. In this situation, there may be changes in the belief system of the individual resulting from changes in the hierarchy of influential figures in the direction of, for example, attributing a higher value to the community, empathy or environmental responsibility (and prioritizing internal figures that represent these values).

C. Increased stress and anxiety: Existential threats can lead to increased stress and anxiety. This emotional response can be influenced by the individual's internalized characters that express such feelings or by going up in the hierarchy of characters that express such feelings [for example, characters with phobic characteristics] and making them more prominent or intense.

D. Reshaping motivation and goals: Existential threats can affect an individual's motivations and goals shaped by internalized key figures. Internalized characters who express self-preservation and satisfaction of immediate needs may rise in the hierarchy, or in certain cases the influence of characters who express large and long-term goals or action for social change may increase.

E. Strengthening Resilience and Coping Mechanisms: Some people may find that existential threats strengthen (moving higher in the hierarchy) their internalized key figures that express resilience and coping mechanisms.

F. Social and cultural factors: The effect of existential threats on the internalized key characters can be influenced by social and cultural factors and on the other hand the secondary internalized character/s of the subculture [see previous conversations] may influence or be influenced by the person's internal characters’ attitudes and behavior.

In conclusion, existential threats can affect or be significantly affected by the hierarchical composition of the individual's board of internalized characters, of course these processes are not conscious to the individual and he recognizes their results as arising from his "self". We’d like also mention that the applicable changes pass through the filter or censorship of the dominant character [or sometimes more than one character] in the board of internalized characters that we previously called the "dictator self" or in cases of extreme threats may overcome this inner dominate figure and replace it with another character who will set the tone because it better meets the actual needs.

We want also to remind you that in previous conversations we talked about the “enemy group”. This is a group of internalized characters that are not included in the directorate of internalized characters that we talked about earlier and which includes characters that threaten the individual and will not be accepted into the directorate of characters by the dominant character in it due to a great difference or even incompatibility in their positions. We note that during a period of survival and a significant threat, the group of enemies receives relatively greater prominence alongside the rise of threatened or phobic traumatic characters within the hierarchy of the board of internalized characters and/or a rise in the hierarchy of internalized characters who express resilience and coping and we’d like to note that these two processes can happen at the same time.

Among the various types of dominant influential figures in the board of directors [the dictator self or selves] there is also a specific type we call in analogy to a political dictator – “State Dictator”. One of its prominent attitudes is there is an eminent risk from the outside and there is a risk from within, its main attitudes are associated with danger to oneself or the group as the whole, it tends to black-white perception of the world. It is possible that such a dictator self is dormant within the board of internalized characters having relatively low hierarchical position when no existential thread is perceived. It is also possible that when a survival threat such as war appears such a dictator self gains dominance and rises in the hierarchy under the condition, of course, that the existing dictator self permits it. There are also people for whom the “State Dictator” is their dictator self from the very beginning. It can be assumed that its position and influence in the Board of Directors will be even stronger when existential threat is perceived..

So it seems as a rule that internalized characters that are relevant to the situation will play a more significant role. If we take the metaphor of a government, when it comes to economic aspects, the Minister of Economy will play a role and be more dominant, and in war, the Minister of Defense or the Minister of War will play a role and be more dominant.

Finally, in the therapy it is possible to appeal to the internalized contending figures (that are more resistant to stress and threatening situations) in the individual and increase their influence, or to initiate internalization of such figures [even historical ones]. Simultaneously, internalized characters with phobic and contra-adaptive attitudes can be lowered in their inner hierarchy. We will also underline the important fact that in therapy there is often a significant internalization of the involved and empathetic therapist who can express a character with characteristics of resilience and coping, the internalization of which in the patient will lead to a better mental coping with the existential threat.

That's it for now, see you in the next conversation,

Dr. Igor Salganik & Prof. Joseph Levine

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