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War Scars. Ukraine Must Now Deal with Soldiers' PTSD

As the fragile Minsk 2 ceasefire continues to hold, Ukraine's hospitals and psychiatric wards are facing a large influx of soldiers returning from the front lines with post-traumatic stress disorder (PTSD)

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This article originally appeared in The Daily Beast

BOYARKA, Ukraine — The men who come back smoke differently. They cover the lit end of their cigarettes with their spare hands, conscious of the fact that a glowing red light might alert the enemy to their presence. They walk around with a different demeanor. They quarrel at home. Sometimes, they have nightmares. Divorce rates spike.

<figcaption>The real challenge will come when the war ends</figcaption>
The real challenge will come when the war ends

But the young men who come back from the war in Ukraine’s southeast—the Anti-Terrorist Operation, or ATO, as it’s known in the country—don’t want to seek psychological help.

“Everyone knows that there are these ‘psychologists,’ but no one really knows what they do, and we’re often confused with psychiatrists,” says Yuliya Apostolova, a Boyarka-based psychologist. “And so often we hear, ‘I’m not crazy. I don’t need that.’”

“But now, because we finally have chaplains, they’ve started going out to the war zone and military psychologists with the troops, and it’s becoming more accepted,” she adds. “Guys who come back now, they’re much more open. Of course, they’ll never admit it, but we psychologists have our own ethics. We don’t release secrets.”

Apostolova tells me this in a dimly-lit pizza shop on a dusty, small-town road, a five-minute walk from her job at the city’s socio-psychological rehabilitation center. Like many Ukrainians in and around Kiev, the 37-year-old with a broad, open face has been infected by nationalist fervor, and now spends many of her non-working hours volunteering. Inevitably, she says, it all runs together with her work as a psychologist. Her two cellphones ring incessantly, interrupting our conversation at least three times, but she doesn’t mind: Apostolova has found purpose in this war.

That’s a good thing, too. Both professionally and personally, dealing with violence is new for Apostolova and the rest of the center’s staff, who are predominantly well-meaning women with the demeanor of patient grade-school teachers. Until recently, they had primarily been tasked with aiding populations affected by the Chernobyl Nuclear Power Plant disaster.

The CSPR centers—in Boyarka, but also in nearby Borodyanka, Korosten, Ivankiv, and Slavutych—opened in 2000 under the Ministry of Emergency Situations, part of a 14-years-too-late effort to help those affected by the 1986 catastrophe. Their work was primarily with families and children; the Boyarka center, for instance, cooperates with a 400-bed children’s hospital. One of the staff social workers ran a support group for expecting mothers; another had a sandbox full of plastic animals for Jungian psychotherapy.

Then last year, amid the conflicts in the east, the CSPR centers were reshuffled into the guardianship of the Ministry of Social Policy, and then placed under the watch of the governmental service in charge of veterans’ affairs—and those of participants of anti-terrorism operations, as the government has chosen to dub the ongoing violence in Donbass.

And that’s how psychologists in a small town an hour west of Kiev came to learn about PTSD.

In the states of the former Soviet Union, Post-Traumatic Stress Disorder has another, familiar name: Afghan Syndrome, for the thousands of untreated veterans of the Afghan War still dealing with the consequences of battlefield trauma. They’re the reference point used by Apostolova and her boss, center director Angelina Lakhtadir, when thinking about their patients. “We’re still dealing with the consequences of that,” Lakhtadir says.

But they had no practical experience in dealing with PTSD. So they began by cobbling together low-cost trainings for treating the condition. Online blogposts for families and friends offered translations of English-language materials. Soon, they put together a plan: Treat the men before they leave. Provide maintenance on breaks. Start preparing for a mass demobilization.

The real strength, though, was in approaching soldiers through their wives and children, the access points they knew best.

“The girls expect their husbands to be the same as they last saw them,” Apostolova explains. “But the men change a lot, and the person who comes home is practically a different person. He still loves her, but he may have some unintentional bursts of aggression. Other times they start to drink, even though before they never tried alcohol.”

Now, those women have a weekly support group where they learn techniques for approaching spouses who come home for short breaks. Apostolova says they warn women that a return to normal may take a long time—and that they must be ready. At the top of their list of no-gos are no surprises, and no crowds. They social workers recommend talking out a day full of activities ahead of time.

“It helps, it helps,” Apostolova says reassuringly, adding that the women are “very scared of this return, because they don’t know what to expect.” Center employees are on call whenever the women may need them—even though, because of the bureaucratic shuffle, the psychologists haven’t been paid in months.

They also deputize children, who may be alarmed by sudden personality changes in their dads, to be caretakers in charge of the recommended three liters of water men on leave are prescribed daily. “We tell children, they take this responsibility upon themselves: Bring dad half a glass of water every half-hour.”

These networks also help bring returning soldiers closer to the psychological care they need, especially those who were drafted and didn’t volunteer. “They know why, and for what, they’re going,” Apostolova says of the volunteer battalions. “But especially the fourth wave of mobilization, it’s young boys who are afraid.”

Ahead of deployment, Apostolova and other volunteers accompany the soldiers to training sessions. They explain fear reflexes amid sounds of grenades exploding. The idea, which Apostolova explains using the metaphor of a snake phobia, is that telling them why their bodies react the way they do makes the experience less frightening. If you preoccupy yourself with learning about different kinds of threats and then—“god forbid”—encounter one, your first instinct will be to identify the type of snake, not to fear it. “You won’t be lost.”

“It’s hard for those guys, because what we’re seeing is that everyone wants to go back. They come back for their break rotations and sleep for two days, see their family, relax with their friends, and then start going back and forth to the recruitment office, war friends... they’re constantly in camo gear,” she says. “They’re yearning to go back. It’s not just patriotism and that they’re defending their country. Now there’s an added, very strong incentive of brotherhood. The people they’re there with, they want to go back to not leave the guys who have become their family.”

Right now, the psychologists are taking it one day at a time. Resources that were initially diverted to helping internally displaced people have now largely been put back for service members and families. On a recent weekend, the Boyarka CSPR hosted a crafts fair to raise money for the military families. Two dozen locals came out with homemade trinkets.

At the auction, many items started at about a dollar, but no one bid. Money is tight, and ongoing devaluation doesn’t help. Lakhtadir, the center’s director, bought a paint-by-numbers picture for a few dollars. Most of the rest was sponsored by one Russian-speaking man in an expensive suit.

The government has said funding—for salaries, and the center itself—will resolve soon, but it’s not clear whether the staff believes that. Much of the war effort is run on the shoulders of volunteers, and they’re used to it by now. (Ukraine’s Ministry of Social Policy did not return a request for comment on the center's funding and reports of unpaid salaries.) The real challenge will come when the war ends, whatever the resolution will be.

For those who come back permanently, the CSPR is creating a comprehensive service: A soldier will report to the center, tell them what he needs—child care, benefits, the like—and a coordinator will take his documents and arrange it for him, jumping through bureaucratic hoops and going to appointments in his stead.

At the same time, a psychologist will be nearby to determine whether the man needs help. “And if he does, they’ll gently broach the subject even if the boy says, ‘No, not me,’” Apostolova says softly. “You can start a conversation with anything, and then he won’t even realize how he starts to feel better.”

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