Graphic images of the Russian invasion of Ukraine broadcast around the clock and available on the Internet may finally answer a long-debated question among neuropsychiatrists: Does PTSD by proxy exist? In other words, can people suffer serious mental health consequences when exposed to depictions of the horrors inflicted on others? And if so, what are the implications?

According to the current definition of PTSD, the affected person must actually experience the traumatic event. A picture or someone else’s description of the event is not enough. But does that really make sense? Imagine a man driving home one day. As he gets out of his car, a distraught neighbor runs up to him and details how the man’s five-year-old son was hit by a car moments before. The neighbor says that the man’s wife left with their son in the ambulance. He hadn’t had time to call her. Worse still, the neighbor awkwardly blurts out that she overheard an EMS crew member say “little guy might not make it.”

Now, if this boy dies, could the father experience the same acute stress reaction (the first prodromal symptoms leading to PTSD) as the mother, who saw her son running down the street and being dragged under the wheels of a car ? I think he might. The same risk exists if he later viewed a video taken at the time of the accident.

Which brings us back to television images from Ukraine. Not everyone agrees that witnessing carnage on a TV screen rather than “in real life” would be enough to lead to PTSD. As journalist Hannah Fearn, for example, writes in a recent article by The Independent, “You might be tempted to look away from the photos of Ukraine, don’t.” When the pictures become hard to watch, she writes, “resist the temptation, share those pictures, talk about what you see.”

While his advice may be appropriate for professionals trained to carry on in the face of sometimes horribly explicit representations of trauma, other people may be traumatized to the point of PTSD in response to these explicit representations. For them, looking away or turning off their television may be the best solution.

We know that PTSD produces distorting effects on judgment or executive function, as neurologists call it. It is probably no coincidence that demands for the establishment of a no-fly zone over Ukraine have increased in parallel with the increase in vividness of the images. The decision by NATO and the United States not to establish a no-fly zone seemed reasoned and within reason only a few days ago, but now that judgment is being harshly criticized not only by members of the public but also by some of our leaders who, presumably, are also viewing these images. More and more people are expressing the opinion that this suffering must be stopped at all costs. Could this reversal result from the influence of the emotional centers of our brain (the amygdala and its connections) on the areas devoted to judgment (the frontal lobes)?

In some cases, gruesome war images are deliberately targeted at certain populations. Like Washington Post Journalists Drew Harwell wrote on March 4 that Ukraine’s Foreign Ministry released “a steady stream of extremely graphic images showing the horrors of war and urging Russians to examine them to determine if the images feature a missing loved one. “. In many images, he adds, “you can see corpses of soldiers burned, shredded, mutilated in rubble or left in the snow; in some, their faces are depicted in bloody close-ups, frozen in pain.”

So, if horrifying images can be used to deliberately traumatize a population, why wouldn’t accidental or occasional exposure (eg channel surfing) lead to the same result? Or how about the effect of a single photograph? On the front page of the March 7 edition of the New York Times is a large color image of a family of three (a mother and two children – a teenager and a girl who appears to be about eight years old) lying dead on a road in Kyiv, Ukraine. Moments earlier, they had been killed as they tried to flee.

In terms of visual representations, this is a war like no other. Thanks to advances in the resolution of the images obtained and the availability of the Internet, we can see the fighting and the suffering with a clarity never seen in any previous military engagement or war. Most historians agree that television footage of the fighting in Vietnam served as a spur to the anti-war movement and ultimately to the end of the war. This happened before the superpowered images of today and, of course, long before the Internet. One wonders what the mental health outcome would have been had large numbers of people been glued to streaming videos of Auschwitz or Treblinka. Even the grainy, low definition photographs of these death camps that we have today are deeply disturbing.

Given my experience in diagnosing and treating PTSD, I fear that a significant proportion of people exposed to these images of the Russian-Ukrainian war are suffering from some form of mental distress. I admit that even as a trained neurologist and psychiatrist, I find them troubling. We cannot yet know whether seeing images of other people’s suffering, maiming, and death can portend grave consequences to our mental health, sensibilities, and common sense of humanity. At the current rate of exposure, however, we will soon have our answer.

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