Ukraine: Traumatised by war and PTSD

On the front line of Ukraine’s battle against PTSD, with war veterans, psychologists, priests and volunteers.

Jenea, a 30 year-old Ukrainian soldier, recovering from his injuries at the Kiev Central Military Hospital [Ioana Moldovan/Al Jazeera]

Donetsk, Ukraine – Thin curves of cigarette smoke float through the dimly lit underground corridor. This Ukrainian army bunker sits on the front line of the battle with separatist fighters in the east of the country. Muffled blasts can be heard outside.

Grom puts out another cigarette. His anguish is etched upon his face.

Just moments before, soldiers were sitting on a sofa watching television. Then, all of a sudden, there was blood, medics and a comrade with a head injury from a mortar round that had hit his underground shelter.

It is August 2015 and the first time I have met Grom. His real name is Aleksandr, but now everyone calls him by his nom de guerre, which means thunder.

The 33-year-old is from Vasylkiv, Kiev Oblast, and is one of the Zenit unit’s two sappers or combat engineers. He is also a military psychologist and understands well the psychological toll of this war.

One occasion stays with him. It was November 2014, in Mariinka, Donetsk Oblast, and his unit of 50 men was under attack from more numerous separatist forces. Feeling sure that death was certain, he called his family to say goodbye.

When he and his comrades staged a counterattack, he killed his first human being. “I did not feel anything,” he says. “I could not think of anything.

Afterwards, he called his family to tell them: “I‘m alive and fine.” They cried. He laughs when asked if he did too.

There are many reasons why Ukranian soldiers are reluctant to see psychologists. Some don’t acknowledge that they have a problem, while others fear the stigma associated with mental illness or believe that a person who hasn’t experienced war could never understand what they have been through.

Young Ukrainian soldiers on the front line in Zenit, a Ukrainian army position 2km from Donetsk airport [Ioana Moldovan/Al Jazeera]
Young Ukrainian soldiers on the front line in Zenit, a Ukrainian army position 2km from Donetsk airport [Ioana Moldovan/Al Jazeera]

“These men are hard guys, they don’t have fears,” Grom says of his comrades.

Pavel, the Russian: ‘Something changed inside me’ 

Some 20km northwest of Kiev, a Russian man sits in a Post-Traumatic Stress Disorder (PTSD) seminar for veterans of the war in the east.

Pavel is from Moscow and a member of the Russian Rebel Army that came to fight alongside Ukrainian forces.

At the Ukrainian Evangelical Theological Seminary in Pushcha-Voditsa, Pavel sits in a circle of more than a dozen people. His elbows are on his knees, but his fingers don’t stop moving. He leans back in his chair. The tips of his black leather army boots pat the floor in a swift rhythm. He doesn’t talk much, but when he does, it is to joke.

He is at the Wounded Warrior Ukraine’s seminar for those with shock trauma because a friend persuaded him to come. But it has taken a long time to get him here.

“The biggest problem is that guys who have PTSD don’t want to realise it,” Pavel says.

“I am one of these guys. But I know something changed inside me,” he confesses.

In a corner of the room, a large green cake made out of Roshen chocolate bars sits on a table. Local children have prepared it for the soldiers. Two small windows let in cold air.

A loud roar suddenly fills the room – 15 voices in unison. One of the physical exercises in which the soldiers stand with their feet apart, shaking their hands, snapping their fingers, patting their shoulders, then their knees, over and over, harder and faster each time, has just concluded with yelling and an exchange of hugs. 

Combat Shock Trainers: ‘The link between civilians and soldiers’

This is the first in a series of four seminars spanning five months. The aim is to train Ukrainian servicemen to become Combat Shock Trainers. They learn how to combat military-induced psychological shock and PTSD as well as how to train their colleagues to do the same.

“Many soldiers cannot open [up] to strangers, to psychologists or shrinks, but they can open [up] to their comrades,” explains Oleh Hukovskyy, a psychiatrist, psychotherapist and lead trainer with Wounded Warrior Ukraine. 

“We start to create a hidden link in the system … veterans who can meet soldiers when they come back from the war, [becoming] the first link between civilians and soldiers.”

Teaching soldiers how to become psychological instructors is an idea that appeals to participants in the seminar.

Maxim, the wounded soldier: ‘I was haunted by my fears’ 

Maxim, 25, a veteran who lost his right leg below the knee and is now a co-trainer at Wounded Warrior Ukraine [Ioana Moldovan/Al Jazeera]
Maxim, 25, a veteran who lost his right leg below the knee and is now a co-trainer at Wounded Warrior Ukraine [Ioana Moldovan/Al Jazeera]

“People from ATO [those who have participated in the Ukrainian military operation against separatist forces in the Donbass, referred to as the ‘Anti-Terrorist Operation’] should come together and communicate, share experiences, thoughts and fears,” says Maxim, a 25-year-old soldier who went through the Wounded Warrior training and is now a seminar co-trainer.

“This is the best cure, it leads to self-healing. They don’t need psychologists,” he adds.

As a volunteer soldier, Maxim says he was never afraid of dying, but he did fear being wounded.

On August 19, 2014, the thing he dreaded most happened. A mine exploded and Maxim lost his right leg from below the knee – and with it, he says, his independence. 

But when he got his prosthetic in November of that year, it was as though he had been given a new lease on life. He felt joy at the prospect of regaining his independence, of no longer having to use crutches to get around.

That feeling lasted for a month and then the depression started to set in. He grew aggressive and started being rude to his mother. He couldn’t sleep without painkillers. 

In March 2015, he went to a PTSD seminar crying.

“During the training, I understood why I react like this,” he says. “I understood that my fear was causing the aggression, fear that I will not be able to stand up, to walk, to have a family and children. I was haunted by many fears and they all turned into aggression.”

Vsevolod Stebliuk, the war hero: ‘The best medication is knowing I am needed to help others’ 

Irpin Military Hospital is just outside Kiev, in the middle of a forest [Ioana Moldovan/Al Jazeera]
Irpin Military Hospital is just outside Kiev, in the middle of a forest [Ioana Moldovan/Al Jazeera]

“Before this war, we had no experience in the psychological support of veterans. The last experience was with the Soviet Union Afghan Company, but that was 30 years ago,” says Colonel Dr Vsevolod Stebliuk, an adviser to the Ukrainian Ministry of Defence on military medicine and rehabilitation.

“Now, the system of preparing specialists starts from zero. We have more than 24,000 psychologists with a diploma, but I think only 1,000 of them can work with veterans.”

Just outside Kiev, at Irpin military hospital, Stebliuk established Ukraine’s first complex for the physical and psychological rehabilitation of war veterans. It was opened on April 25, 2015. More than 500 soldiers have undergone rehabilitation there since.

The centre is the first in the country to provide an ergotherapy unit, which employs work and physical exertion as a form of treatment, and an IREX – interactive rehabilitation and exercise system – unit, using virtual reality.

“Every soldier who has been under fire on the front line has some stress reactions,” Stebliuk says.

“From my experience, near 50 percent of the soldiers who took part in ATO need psychological help. It is not only PTSD. [The percentage with] PTSD, in our opinion and that of the Ukrainian Research Institute of Social Psychiatry, is near 20 percent.”

The methods for dealing with it are agreed, says the colonel. “But half of them are only on paper.” 

“The reality is we don’t have a lot of staff for the social rehabilitation centres, we don’t have financial support and we have a low level of social … [understanding about] our veterans [and their problems].”

Irpin sits in the middle of a forest; its various buildings connected by small walkways that weave through the trees.

Soldiers in dark blue hospital robes stand as the colonel passes. Stebliuk is a war hero. 

During the shelling of Ilovaisk, he saved the lives of many of his comrades – piling wounded soldiers into a car and driving them to safety. But the usually smiling colonel finds that episode difficult to remember.

“I can tell you that PTSD is a real problem,” he says calmly. “I had my own period of psychological trauma after the Ilovaisk catastrophe. For one month I could not sleep. I had a high level of anxiety and aggression. Now, I sometimes have a problem with depression episodes.”

But, still, he must deal with the trauma of others.

“Every day I take bad energy,” he says. “This year, mothers of unknown soldiers were calling me asking for help to find their dead sons. It is a big psychological trauma every time. But I think that, for me, the best medication is that I am needed to help.”

Taras, the trainer: ‘My girlfriend told me: you are like an animal’

During training, participants are taught methods to combat military-induced psychological shock and PTSD [Ioana Moldovan/Al Jazeera]
During training, participants are taught methods to combat military-induced psychological shock and PTSD [Ioana Moldovan/Al Jazeera]

Stebliuk’s work here has led him to the conclusion that different types of soldiers experience different symptoms. The soldiers can be divided into three groups: mobilised soldiers, military personnel and volunteers.

While all experience anxiety and aggression, it is by and large only the mobilised soldiers – those who previously had no military experience and were not ready to fight – who suffer from depression. That group also has high levels of psychiatric medication and alcohol abuse, he found. 

“The level of aggression can be a big problem in the future, because it is possible to have unexpected responses in different situations,” Stebliuk says.

“When I came back from the war, I had a high level of aggression towards people,” says Taras, a 25-year-old soldier who was injured fighting with the Aidar battalion and is now a co-trainer with Wounded Warrior Ukraine.

“There were a few times when it was really dangerous for different people around me. It could have been for some drunk guy on the trolley bus or for my girlfriend when we were having an argument,” he says, recalling how she once looked into his eyes and told him: “Man, you are like an animal.”

Natalia Nalyvaiko, the psychologist: ‘War ruins everybody’

“Our society is not ready to embrace these soldiers with all their problems,” says Stebliuk. That is why he believes that the volunteer group of crisis psychologists who work with him have an important role to play, even if they lack financial support from the state.

Dr Natalia Nalyvaiko is part of this group, which recently formed the Ukrainian Association of Specialists for Overcoming of Psychological Traumatic Events.

It started as a handful of psychologists who came together to offer counselling services on the barricades of the Maidan revolution, back in December 2013.

She takes a seat in the brown leather armchair in her office, where her diplomas hang on the wall. She is still deeply saddened by the memories of killed protesters, she says. This is her pain.

“When we started, we were fresh and did not know a lot of stuff. Many foreign colleagues, from Georgia, USA, Canada, Latvia, Israel, came to Ukraine as volunteers, providing training, supervision and psychological support,” she explains.

“They were helping us to develop programmes and later we started developing our own.”

The association now has schemes in place not only for those who have been fighting in the conflict but for those displaced by it and for the families of dead soldiers. They have also developed a programme for the families of returning soldiers, which aims to teach them what to expect from loved ones who have been fighting on the front lines.

Wounded Warrior Ukraine teaches soldiers to become psychological instructors [Ioana Moldovan/Al Jazeera]
Wounded Warrior Ukraine teaches soldiers to become psychological instructors [Ioana Moldovan/Al Jazeera]

Taras believes that is especially important. “These people who are around me, my family, my friends, people who love me, are also fighting, just not on the front line,” he says. 

“Every day, they worried for my life.

“When I came back, my family wanted to communicate with me, but I did not want to share anything or answer their questions. I wanted to stay alone. I needed this time to be alone. And people around you don’t understand that.

“You must know how to explain that you need some distance and it was hard for me.”

But Taras didn’t consider going to see a psychologist because he feels uncomfortable talking to people he doesn’t know.

Nalyvaiko agrees that Ukraine’s psychologists weren’t prepared. The country had few military psychologists and, because it hadn’t recently been involved in a conflict, they had never experienced war.

But all that has changed. “For the last two years, we haven’t had a minute without trauma. Everybody is affected in one way or the other. The war wins, it ruins everybody,” Nalyvaiko adds.

And it takes its toll on Nalyvaiko and the other psychologists, too. In fact, psychological support is a must for those working with wounded soldiers or returning from the front line, so the psychologists hold reflection groups, where they come together to share their feelings and vent their frustrations.

Marina and Darina, the volunteers: ‘Some of the soldiers just need to talk’

Marina and Darina hang their blue and yellow protective coats in the stand in the hallway before walking out of the Kiev Central Military Hospital. Another day of volunteering with wounded soldiers has come to an end.

For Marina it started when her older sister took her to a picnic for war veterans. As she was about to leave, some soldiers asked her if she would come again. She did, almost every day. That is how she became a volunteer. 

“Some of the soldiers just need to talk, some need to have fun, others just need to feel like a normal person – to have a normal conversation, about anything else but the war,” she says.

But there are others who will talk for hours about the war. She listens as they describe what they endured. They say most of the soldiers tell them that they don’t see the point in talking to a psychologist.

“Show me that psychologist who will help me erase the year that I’ve spent on the front and I will talk to him,” a soldier Darina visited that day said.

Darina, 25, spends most of her free time volunteering with the wounded soldiers.

“I have talked to soldiers that went to a psychologist,” she says. “They told me they did not feel like they could open up because the specialists asked them strange questions and made them do weird exercises.” 

Darina says she herself experienced post traumatic syndrome after her home town of Lugansk was shelled. 

She believes the soldiers feel closer to the volunteers because they spend more time with them and can talk about anything.

But, says Marina, “we, as volunteers, cannot help them overcome some problems”.

“They can open up to us and we can listen, but if they cannot sleep at night or have some addictions, we cannot help them,” she adds.

That’s when the volunteers must advise the soldiers to seek professional help.

Volunteers Marina and Darina participate in a PTSD seminar organised by Wounded Warrior Ukraine [Ioana Moldovan/Al Jazeera]
Volunteers Marina and Darina participate in a PTSD seminar organised by Wounded Warrior Ukraine [Ioana Moldovan/Al Jazeera]

As for them, they find their own ways of coping with the trauma they encounter – sharing stories over tea in a small restaurant near the hospital.

“You know,” Darina laughs, “it is the same logic soldiers have. We, volunteers, would rather talk to other volunteers, because they can really understand us.”

When she can’t talk to Darina, Marina says she goes home, takes a hot bath and cries.

There’s a joke among volunteers, they say: “Volunteers don’t have burnout, they are already ash.”

Father Sergey Dmitriev, the priest: ‘You relive their pain, their grief’

The psychologists have another source of help.

“The role of the church is to reduce the stigma associated with psychological help and to create awareness that [soldiers with PTSD] have to turn to professional care,” explains Father Sergey Dmitriev, a priest in the Ukrainian Orthodox Church under the Kiev Patriarchate and the head of the Eleos Ukraine NGO, which, among other things, provides psychological and physical rehabilitation for returning servicemen. 

“The priest cannot and must not be a substitute for the psychologist,” Dmitriev continues. “The priest remains a priest. When a soldier comes to him, the priest should offer his help and after, guide him to seek the help of a good psychologist. If that will happen everywhere, we’ll all make a huge step in solving this problem.”

He sometimes receives soldiers in his office, a small room in one of the buildings adjacent to Saint Michael’s Cathedral in Kiev.

Beside his computer monitor is a photo of the priest with a group of soldiers. His desktop wallpaper shows soldiers sitting at a table in an image reminiscent of The Last Supper. Dmitriev laughs and explains that they took the photo at Easter.

The father studied PTSD at Yale University in the United States and believes psychotherapy was never studied in depth in Ukraine. He traces this back to Soviet times when, he says, those with psychological or psychiatric disorders faced state repression, while those who opposed Soviet rule were declared mentally ill. The resulting stigma remains to this day.

“When you tell a soldier to go see a psychologist, not even a psychiatrist, he will tell you, ‘No, I am not crazy!” says Dmitriev. “Our society does not fully comprehend the magnitude of the psychological stress that it, itself, bears. It does not fully understand post traumatic stress as a disorder.”

“People can come to the church because there’s no stigma here,” explains Father Sergey Dmitriev [Ioana Moldovan/Al Jazeera]

Dmitriev spent time with soldiers in Crimea and Donbass. After returning home he experienced difficulty sleeping, suffering nightmares, irritation and aggression.

“When you live with people for four months in a tent, when someone close dies and you bury him or when soldiers are left without hands or legs and you communicate with those wounded soldiers, you relive their pain, their grief,” he reflects.

He sought professional help, spending two hours a day with a psychologist for a month. He believes prayer also helped him and says that, from his experience, those soldiers with religious faith tend to recover quicker than those without.

Dmitriev believes that the church can become a neutral ground where psychologists and those who need their help can meet.

“We have the trust, the space, the light, water and tea. People can come to the church because there’s no stigma here,” he says.

And he believes it’s something that will be needed for a long time to come as the psychological consequences of war affect generation after generation.

“It’s like an infection that will be transmitted genetically,” he says. “Psychologists and priests, working together, can stop this infection.” 

Grom, the soldier military psychologist: ‘War is my job’

Grom is now back from the front.

At a self-service restaurant in Kiev he steps outside to smoke. As he holds the cigarette, lit end covered with his palm, he listens to the street musicians who are scattered along the city centre boulevard. 

“This is not our concert,” he says, a grim smile on his face. Back on the front lines, he would greet the staccato of mortar fire with the phrase: “Ladies and gentleman, welcome to our concert.”

“I cannot adapt here in peace, with friends that don’t understand war,” he confesses. “They call me a crazy man because I want to go back. But war is my job.”

“I need to talk to a psychologist, but I don’t have the time,” he reflects.

He finds the thought of switching roles – from therapist to patient – amusing.

“Psychologists are not prepared for this, they must go to war to understand soldiers’ problems, to feel the same way,” he says.

So, for now, whenever he struggles, he talks himself through it. “I don’t want to talk about my problems, because they are mine – not even to my wife, she does not need to know what I went through.”

After all, according to one of his Facebook posts: “With the exception of severe forms of social anxiety, manic irritability, up to the desire to hurt myself, depression as a permanent status and unwillingness to be born into this world, I am quite a normal person.”

Pavlov, 45, during an exercise at Wounded Warrior Ukraine's PTSD seminar [Ioana Moldovan/Al Jazeera]
Pavlov, 45, during an exercise at Wounded Warrior Ukraine’s PTSD seminar [Ioana Moldovan/Al Jazeera]
Source: Al Jazeera