“In every dream he tries to crawl to some bush”
On the road they were ambushed. Seryozha searched for shelter for a long time, crawling past the bodies of fellow soldiers, torn off arms and legs. Now he can't eat meat. The neighbors in the ward are annoyed that music is constantly playing from his phone. But in a different way, Serezha simply cannot fall asleep. And in a dream, over and over again, he tries to crawl to some bush, some tree on the side of that road.
This is one of our most difficult patients. He has no family, no loved one. I would like to find a lever that could be pulled, but there is simply no lever in the case of Serezha. He wants to go to war. He thinks he's just wasting his time in the hospital. While his comrades are fighting, he drinks some pills here.
He wants to go to war. Thinks he's just wasting time in the hospital
And it happens that Seryozha gives up and he says to me: “It would be better if I went to war, died there, that’s all.” And these phases of activity and passivity replace each other. We have already told his commander that if we cannot do anything in a month, we will have to leave Serezha in the hospital for a long treatment. Maybe forever.
The commander sent him to us. It happens that a fighter says to an officer: “I need to urgently see a doctor, because something is wrong in my head.” Our commanders are quite young and understanding. They will not say: “You made it all up, go fight.” They listen to the soldier and send him for examination to us.
And our very first task is to pick up all the dirt that is hidden from us. This is unpleasant for a person, he can become violent, aggressive, simply insane. Many even have to take a sedative. They then come to their senses and say: "I remember the moment of the injection and I'm very sorry." We say, “You don't have to apologize. We just gave you the opportunity to relax and forget, so that you do nothing. Here one word or careless action can provoke aggression. For example, fighters are pathologically afraid of the phone in their pocket. They are afraid that we will start recording the conversation. They have a clear policy: to keep military secrets and not to tell citizens about the progress of operations. So I just give them my phone at the beginning of the conversation. They can click to them, understand that the recorder is turned off, and become more relaxed.
Then psychotherapy begins – the biggest layer of work. Your task is to constantly talk to a person, to show that you are a friend. After all, many are afraid of the very word "psychiatrist." And when a classic, as from a picture, doctor in a white coat comes to them, they cannot open up to him. And we build relations of equality. We treat each patient like a friend. Of course, this looks a little hypocritical, but it allows you to work.
At first you just talk, then you start a friendly lecture. You explain to the person what he has and how it can be healed. For example, a fairly common case is that a soldier dreams of dead colleagues who tell him: you are alive, but we are not. He berates himself. And we explain that it was his brain that came up with that his colleagues did not call him. Positive dynamics is observed in about 60% of our patients.
Imaginary Sasha
Sasha's dad was a policeman in the 1990s. He often took his son with him and showed that if a criminal was beaten on the fingers with a club, he became more obedient. That is, in childhood he was taught that physical violence is a normal method. And the father raised his son in much the same way. He is afraid of his dad. When he comes to the hospital to visit him and walks down the corridor, Sasha literally begins to get hysterical. The pupils expand as much as possible, the person is grouped, the shoulders are straightened, the arms are at the seams, the fists are clenched. Sasha, who is already wounded by the war, also has this trigger in the form of a father.
PTSD has such a nasty quality that it exacerbates old traumas. It's like artificial intelligence that looks for weaknesses in a person and puts pressure on them. As a child, Sasha developed an imaginary friend. Also Sasha, but angry and able to stand up for himself. In war, people are different. On the front line, if you hesitate, they can say it rather rudely to you, with the addition of all sorts of obscene language. This offends, and this evil Sasha wakes up.
At one such moment, my patient asked the commander to take away his weapon. He later recalled: “I felt worthless, and then the angry Sasha woke up, who said: you need to be bolder, you just need to go and fill the face of this commander.”
Sasha is not cruel at all. He is infantile and does not know how to communicate with women. Therefore, it was difficult for us to talk to him at first. On the other hand, he is afraid of the doctor. So I had to visit him not in a bathrobe, but in ordinary clothes. As a result, Sasha and I became friends.
Our hospital complex is located in the forest, we are quiet. And having lived here, Sasha calmed down a bit. With the permission of the chief medical officer, we can take patients outside the hospital if it is useful for them. Once Sasha and I went to the city to the museum. He liked it there, but to get to the museum, he had to go to the center of Kyiv by minibus. It was noisy, full of people, and he squeezed my hand so that it seemed that he was about to break. And at some point, Sasha saw a destroyed building, which, unfortunately, is now in the center of Kyiv. His brain immediately told him: we saw it, it's not safe here. He made me duck down and began to lead me away from there.
Sasha saw a destroyed building in the center of Kyiv, made me duck and began to lead me away from there
In the first days, when Sasha joined us, he wanted to become a commando. Because special forces are cool. And now she dreams of being a programmer. He goes to the library, reads history books.
He doesn't want to go to war anymore. Now the commander has sent a request to return Sasha to the front. Alas, he will either die there or return after the war as a completely unhealthy person. All treatment will go down the drain.
Zeroing as a defensive reaction
Kostya began to forget his colleagues. The fighters complained that he was not looking at them, but through them. Mechanically, he remembers what to do, but he does not recognize people. His brain is constantly trying to return him to a period when everything was still normal, calm – when the war had already begun, but Kostya had not yet reached the front line. Once he said to the commander: “Dude, who are you anyway?” He was angry at first, and then turned to us.
Sometimes, during our conversation, Kostya suddenly looks around the ward and asks: “Firstly, who are you, and secondly, where am I?” At some point, the pills did their job. And we explained to Kostya that he was in a psychiatric clinic, before that they said that he was in a sanatorium, so as not to make him nervous. He already roughly understands what month it is. The brain rested a little and returned to the normal course of events. It is important now that Kostya does not reset to zero again.
By the way, he has all his relatives in Russia. He and his wife came to Ukraine in the 2000s. It was a good job, then he opened his own business. When the invasion began, Kostya gave the car to help the Armed Forces of Ukraine, and he went to the front. I asked if he communicates with relatives in Russia. He replies that he tried at first to open their eyes to what was happening, but it was useless.
Now many in our country hate Russians. But the most interesting thing is that those who lie in my department do not have this hatred at all. They understand that what the enemy is doing is bad. But they have no time to hate, they need to protect their home. The fighter understands that there is an enemy who is also fighting, that he must be outwitted and defeated.
They have no time to hate, they need to protect their home
There is no such hatred for all Russians even in our other patient, Petya, who experienced cruelty on himself. This guy is a veteran of the ATO, at the beginning of the war he was occupied. Opponents specifically searched for former military or those associated with the military, tortured them. Petya got into such a torture chamber. There he was terribly beaten, all his ribs were broken. But he managed to get out of captivity and immediately went to the draft board. There he said that he would not go anywhere until he was sent to war. Already from the front, from the front line, Petya had a week off. He takes care of himself, so he went to the doctor for an examination and there, among other things, he admitted that he sees some changes in the psyche. For example, he recently fell out with his wife. The doctor contacted us, we examined Petya and saw absolutely clear PTSD. They called the commander and said: he will not return now, he needs to be treated. He's been with us for a month now. He toils that he has nothing to do, and rushes back to the war. Petya has no direct evidence not to go there. And he is still an effective fighting unit. And he also has a completely peaceful motivation: after the victory, he wants to revive the business he did before the war.
Alternative
There was one military man who fought in Afghanistan, then in Chechnya on the side of Ichkeria. And even in peacetime, he constantly sat with people like him at military forums. He is always on alert, literally lives in war. He came to us because there was a mess in the dugout, the fighters were jostling as little brothers sometimes shove. And his bar fell, he decided that it was strangers who attacked, and began to knead everyone in a row. With us, he filonil, took pills every other time. We don't have a department where we can treat forcibly. He himself said that there was no need to treat him, that he should return to the front as soon as possible, help, protect. So he was taken to the unit. There, at least, he can be useful. But after the war, he will most likely sit in our psychiatric ward, because in reality he is dangerous to society.
After the war, he will most likely sit in our psychiatric ward, because he is dangerous to society
About half of the fighters want to return to the front. They are experienced military men and believe that they are needed there. In the army now, mostly accomplished people, they have wives and children. And everyone wants to see how my daughter goes to school. But at the same time I want my daughter to call you a hero. Hence the dissonance. For many of those who want to return, we advise against doing so. Their psyche simply cannot stand it, and then we will get sick members of society. It is very important to be honest about all this. Therefore, we say: if you want to return, if you are not ready to part with military affairs, then volunteer. And then, just like little boys, their eyes light up! One of our patients, Slavik, now brings his colleagues what they need. Some socks, thermal underwear. He communicates with them, they remember him, joyfully meet him. He is pleased. We know this, because after discharge we have to observe a person for another two years. Only then does he set off for free swimming. Any PTSD sufferer needs to be explained that our treatment will end, and then he will have to work on his own. Here, of course, the role of the family is great.
Our treatment will end, and then he will have to work on his own.
Wives, sisters, mothers often visit us. They ask how to communicate with the fighters so that their unpleasant memories do not return. We advise: remember how you started dating, first dates, interest in each other. Wives come to our fighters and to the hospital. Due to the shelling in the city, there are power outages, and there is often no light in all sorts of not very important rooms. And you must see these romantic gatherings of couples in our dining room by candlelight.
If we observe the positive dynamics of the patient, we can let him go home, where, as they say, even the walls are treated. Wives then tell us that they now begin a completely different family life. People have a renewed interest in each other. I will not raise the sexual topic, although the treatment also has a positive effect on it.
I can advise the wives and girls of the fighters one thing: do not ask them about anything. It is difficult for the military to tell, and for the civilian it is difficult to listen. He came to rest, to get enough of emotions, impressions. Just live the life you tried to live before. If you are a married couple, then at some point it is better to give the children to their grandmother and go to a cafe. Then play with the child. Just make it your goal to learn to rest.
positive motivation
It is very important that a person has something to live for. We examined Dima, who, after the Russian retreat, returned to his city and saw that he was not at home. All relatives, fortunately, managed to leave, but only a piece of the fence remained from the house. Dima carved wood as a child. And when I saw fragments of my crafts on the ruins, I just burst into tears. With his mind, he understood that this was a war, that many houses were destroyed, but then he could not stand it. But it motivated him. Now Dima wants to finish everything as soon as possible and rebuild his house. I, he says, love this place to the point of impossibility. The man himself knows how to heal himself.
Actually, no one sent Dima to us. He came to visit a friend whom I also treated. My friend and I went outside to meet him. A large car drove along the road, made a noise, and this military time – and grouped up. I realized: here's another one. We contacted his commander and said that we were taking a fighter for examination. Fortunately, we did not find any pathologies in him. In general, such a reaction to noise, like Dima's, is a common thing. The main manifestation of PTSD is anxiety, all sorts of anxiety states. The explosions they hear on the battlefield respond later in that the usual urban noise makes people group up, even lie down on the ground. In Kyiv, there are now a lot of military men on vacation, and they are often immediately visible precisely by this reaction.
Ordinary urban noise makes people group up, even lie down on the ground.
However, this happens to civilians as well. In all of Ukraine now, probably, there is no such person who would not know what explosions and bombings are. Therefore, in all the time I worked at the clinic, I never encountered the reaction that we know from veterans of previous wars, I did not see contempt for civilians “who were not there.” After all, our whole country is at war.
From the very beginning, the entire Ukrainian state began to move like a big anthill, and to collect something for the military. There are boxes for the APU in stores. People buy sausage, canned food, chocolate. Everyone is trying to help the army in some way. The military understands this and responds with gratitude. Yes, it happens that the guys are upset that there is a war, but here people calmly go to the cafe. I usually answer this like this: yes, of course, but let's go to a cafe. And we really go, and I explain that people need to somehow relax, that everyone has a moral and information overload, you need to take positive emotions somewhere.
Psychiatrists see a psychiatrist
My close friend was under occupation in the area of Bucha and Irpen, he has a house there. There was no water in the house, nothing to cook on, nothing to drink. He went for water, but the Russian military did not let him in over and over again. Now he lives in Kyiv, goes to work, but at home he keeps a large supply of water in eggplants, because he is afraid that he will not have water. This is how his PTSD manifests itself.
Many doctors are also crippled, and after the war it will be very difficult for them. People have to work in such an environment that they never dreamed of in peacetime. For example, my friend, an anesthesiologist-resuscitator, says that now it’s just a pipe. You are swimming in a pool of blood, pus and gore. Everything is needed, all at once.
Many doctors are also crippled, and after the war it will be very difficult for them
My first medical specialty was a medical examiner. And at the beginning of the war, I was still working on it. It would seem that when you constantly see a violent death, it hardens, makes you rougher. We have our own cynical humor. For example, when you need to assemble a human body from parts, this is called “playing Tetris”. But even this experience does not protect against what we have just seen. Before my eyes, adult uncles, experienced forensic experts, cried when they had to open the bodies of children after Bucha and Irpin.
The de-occupied territory is reminiscent of Murmansk in 1945 – at one time I was very interested in the history of the Second World War and read just about Murmansk, which Hitler wanted to completely destroy. You walk down the street and see a small handle sticking out of the ruins. You go into the house and find a child there and a mother who tried to close it with herself. Both are dead.
We seemed to be ready for it. Although no, I'm lying, we were not ready for this. No one believed that there could be such atrocity in the 21st century! You see a pregnant woman on your desk, who was about to give birth. Or an old man who was shot in the street. And you think: well, he just went for bread or water. Well, well, well, why was he killed?
We were not ready for this. Such an atrocity in the 21st century! You see a pregnant woman on your desk, who was about to give birth. Or an old man who got shot in the street
After that, I also sought help from a psychiatrist, my colleague. There were no medicines, but we all worked through it. It is breaking us all now, because ordinary life has been broken by the war, and irrevocably broken.
Therefore, it is very good that I went to study as a psychiatrist. Now it will be a very necessary profession. We can cure people and help build a healthy society after the war.