As Ukrainian President Volodymyr Zelenskyy toured the devastation in Bucha this month — where bodies of civilians lay in the street and buildings were destroyed — his haunted face seemed to show the toll of Russia's war in Ukraine.
The 44-year-old's normally shaved face was bearded and lined, his forehead scrunched in distress and his eyes with heavy bags underneath.
They are the hallmark physical signs that can appear on anyone who is going through intense trauma and stress — particularly in wartime, according to Glenn Patrick Doyle, a psychologist who specializes in trauma.
Trauma and stress wreak havoc on the human body after prolonged exposure, Doyle told NPR. Over time, sleep, attention, memory, mood, physical appearance and so much else are impacted.
The people of Ukraine, particularly Zelenskyy, are likely experiencing these symptoms as they struggle against the Russian invasion and constant air raid sirens and as many flee their homes, he says.
"The thing to understand about trauma and the body is that stress responses kind of hijack every otherwise 'normal' function of our body," he says. "The bodily processes that keep us focused and regulated on a normal day get kind of suspended for the duration of the stressor and replaced with processes designed to help us just get through the stressful experience."
As head of his country, Zelenskyy is in a particularly unique position and one that can leave long-term health impacts.
The impact war has on presidents
Doyle says presidents and other leaders of nations, like Zelenskyy, are often in an even lonelier and stressful place that can manifest itself in a physical transformation while they are in office.
Much has been written about the way U.S. presidents seem to age while in office. Often, images from the time they entered office and those from their final days at the White House are compared. The presidents often display more lines, much more gray hair or heavier bags under the eyes than they did on their first days in the White House.
Being the leader of any country is a high-pressure gig. But add the toll of conflict into the job and the stress is compounded, experts told NPR.
Doyle says, "Presidents are in a uniquely lonely position."
Few people around them understand the pressures they're under, and there are few people they can confide in to take some of the pressure off, he says.
"They don't get to lay down their leadership roles or responsibilities, especially in crisis times," he told NPR via email. "Imagine what would happen to even the best constructed, best maintained race car if it was NEVER allowed to slow down or refuel--that car WILL cease functioning well, the longer it's red-lined."
President Abraham Lincoln is a perfect example of this, says Jonathan W. White, a professor of American studies and the author of A House Built by Slaves: African American Visitors to the Lincoln White House.
"I think the presidency aged Abraham Lincoln more than anyone else who has ever held the office. Lincoln's four years in the White House took a toll on him that is painfully visible in photographs," he told NPR. "In 1860, he appeared young and powerful. By 1865, he looked almost like a different person — haggard and worn down."
During his presidency, the U.S. was torn in two by the Civil War.
"Lincoln faced almost unfathomable pressure during his presidency," White says. "Not only was he responsible for waging a war to save the Union — a war that cost hundreds of thousands of lives — but he also was involved in the minutiae of running the federal government."
Toward the end of his first term in late 1864, White says, Lincoln reportedly got more short-tempered and lashed out.
White told NPR via email: "One of his private secretaries, William O. Stoddard, said that the never-ending work of the presidency placed a 'perpetual strain upon his nervous system' and 'began to tell seriously upon his health and spirits . . . . Even his temper suffered, and a petulance entirely foreign to his natural disposition was beginning to show itself as a symptom of an overtasked brain.' "
The science behind trauma
When we experience physical or emotional stress, the human body produces cortisol, the primary stress hormone. It contributes to the physical changes of the body under long-term stress, Dr. Nicole Colgrove, a specialist in otolaryngology at Virginia Hospital Center, told NPR.
Cortisol accelerates the loss of elasticity in skin, leading to a sagging or sunken appearance, she says. It also contributes to hair turning gray or white under intense stress.
"There are many other systemic effects of cortisol, such as increased blood sugar, elevated blood pressure and heart rate, altered metabolism and decreased immunity," she says.
A person undergoes more changes outside of just the physical, the longer they are exposed to stress and trauma, Colgrove and Doyle say.
"Over time, it's as if our actual personality or values systems get replaced by trauma responses, which can make living a life and having relationships almost impossible," Doyle says.
That transformation happens similarly regardless of age, according to Colgrove.
"Many trauma survivors come through their experiences with negative beliefs about their worth or their efficacy," he says. They often believe the world is dangerous, unpredictable and not worth living in.
Long-term psychological disorders can also develop from this time.
But there is hope with the right care.
"Psychologically, as people begin to heal, I've seen people regain their sense of humor and ability to connect and trust others, both of which are signs that healing is actually starting to happen," Doyle says. "But it can be a long road. A long, long road."
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