What prejudices prevent a person from seeking help from a psychiatrist? What is the special experience of Ukraine in terms of the spread of PTSD among the population?
by Dmytro Manhubi, Ph.D. of Psychological Sciences, psychotherapist, psychiatrist, head of the department of primary psychotic episode of the Kharkiv Regional Psychiatric Hospital
October 18, 2024, the VII Kharkiv Security Forum “Civilian Ukrainians: Challenges and Resilience in the Conditions of Terrorist War” was held in Kharkiv. The forum was organized by the Maidan Monitoring Information Center and the Konrad Adenauer Foundation with the support of the Humanitarian Coordination Center.
The forum expert speeches are published here.
Why don’t people go to a psychiatrist? How do people routinely swear on the streets? Like this: “you’re crazy”, “you’re an imbecile”, “you’re an idiot”. And these are psychiatric diagnoses. No one swears like “you have gastroenteritis”. Or, as they used previously, “you’re a syphilitic”. And “you are concussed” is a stigma. This all comes from the post-Soviet space, when psychiatrists were in the service of the State Security Committee and fought dissidents.
Why don’t people go to a psychiatrist? Because we don’t have that mentality. People aren’t raised in a way that if they have mental, psychological, psychiatric problems, they should go to a psychiatrist.
If you knew what people ask in the department when relatives come in: “Do you really have three people in a bed?”, “Do you really beat them?”, “Do you really tie them up?”, “Do you really have no food?”, “Do you really have electric shocks?”, “Do you really do lobotomies?”. Well, anything that is in movies and TV shows.
PTSD (post-traumatic stress disorder) is a very important story. Because no country has ever had so many victims among the civilian population. Among children who have been victims and suffer from PTSD.
And no one could teach us. And when we went to Israel to study, it was a very interesting situation. We arrived, and they said: “We don’t know how to teach you. We can only be moderators. Because your experience is the greatest in the world right now regarding PTSD, such a very global trauma.” They did not yet have this October 7th disaster, they did not yet know what was coming.
And we talked to the Swiss, we talked to the Americans. The Americans tell us very simply: “We have never fought on our territory, we have never had a civilian population suffer. We do not know how to treat childhood PTSD.” We, of course, understand that PTSD, post-traumatic stress disorder, is inherent in war. But it exists in civilian life. That is, someone attacked someone, or a terrible traffic accident, or a catastrophe, or some violent acts, and so on. But these were very minor cases.
After our victory, there will be a very large wave of people with post-traumatic anxiety disorders. It is very difficult to treat them now. Because there is such a term – retraumatization. That is, we treat, we pour, and it pours out.
Because, first of all, there must be rehabilitation. We cannot drive all Kharkiv residents to the west of Ukraine, where it is a little quieter, where there are lakes and forests and there are rehabilitation specialists. We cannot. In our conditions, we cannot do that now. Kharkiv is a city on the frontier. We cannot treat them on the front line. Therefore, we are left with only the medicines that we treat. That is why people are afraid: “you treat us with medicines, we will be on antidepressants, we will be on drugs there.” This is the first.
Secondly, a very big problem is the story with children. Most adopted or foster children are left in hospitals, they are left in psychiatric wards, if there is even the slightest hint of a mental disorder. And they refuse to take them in these conditions. And yes, we have a law on psychiatric care, which says that a child who does not suffer from a mental disorder should not be in a psychiatric hospital. We do not have boarding schools, there are no shelters for children, and children must be under supervision somewhere until they are 18 years old. And most somatic hospitals are filled with children who were abandoned by these families who previously received money for them. And this is the second problem.
The third problem is childhood anxiety disorders and childhood PTSD. And we must learn to treat them. Because children do not respond well to psychotherapy. After all, we are smart adults, we can build some cognitive structures, imagine something there. And children, they are emotional. And we work with such children.
I have military patients with whom I work both online and in person. One soldier told the story about his PTSD. He is walking along Khreshchatyk in Kyiv with his girlfriend, turns his head to the left and sees Russian tanks leaving Bessarabka market. And they turn into battle formation, ready to shoot at him. And this is his trauma, which he received a month and a half ago. Mental trauma. His comrades died, he has severe PTSD, he remembers everything: “I turn my head to the right and see the colorful Khreshchatyk, the girl is smiling. I turn to the left and I see these tanks. I understand that this is what I am seeing.” This is not a hallucination, these are flashbacks.
And the same flashbacks, they come with sounds, they come with smells. For example, prolonged exposure therapy is conducted in a way that a person is gradually taught not to react. It is not very difficult to understand how it will go with a soldier. I hope that it will be virtual therapy. For example, if a person has received a mental trauma from a dog attack, then every day they are shown a toy dog, then a small live puppy. Then a larger puppy. And so on. Well, we can’t do that live, so somehow it will have to be done virtually.
The acoustic problem is one of the underlying problems that leads to anxiety disorders, to generalized anxiety disorders, to all the disorders that are associated with war.
Military personnel can understand something about the sounds of war. And civilians don’t understand the sounds of war at all. Some are afraid, some are scared, some are hiding. We in our hospital have tried to go to the bomb shelter twice since the beginning of the war. Well, understand, 60 mentally ill people, 20 staff members, children. People under medication. We are on the third floor, we are trying to get to the bomb shelter with all this crowd with medication, food, everything. And we also had foreign citizens stuck there, we had two pregnant women at the beginning of the war. Well, it was terrible. And now we have the two-wall rule, we stay there when there is some risk and anxiety. And if you are aware, in April 2024 two missiles flew into the hospital territory. Thank God, there were only two victims there. And they were cut by glass. So somehow they hit a place where the old buildings stood without windows. Although people were very scared.
