Psychologists in War-Torn Ukraine Are Fighting a Battle Against PTSD on Two Fronts

There is a saying in Ukraine: "Real men don't dance."

For military psychologist Andriy Kozinchuk, this is much more than an expression of clichéd machismo — it is the mentality that makes his life, and his job, on the front lines of Ukraine's war a constant balancing act.

"The truth is that men from Ukraine do not talk or cry either — and that is a real problem," Kozinchuk told VICE News, sitting in a busy café in one of the more industrial areas of Kiev. "The problem is the fear that they carry. It poisons them, it needs to be released from inside out."

Kozinchuk is back from the front for a few weeks to work on his plans to develop a rehabilitation center for veterans returning from the country's east.

"Part of my job is to speak to men before they fight, to find out who they are, what they are like, and why they are at the front," he said. "Often the younger men do not know why they have gone — they were told to go so they went, and now they are killing people."

It has been more than a year since war began in Eastern Ukraine, and the country now has about 160,000 active frontline personnel, as well as reservists and trainers.

Psychologists are fighting their own battle on two fronts: Working to prepare for the long-term psychological effect on this generation of men, and struggling to get their profession recognized as useful.

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Up until recently, Ukraine was a very peaceful country. But the rapid onset of war means many of the men have been plucked from their everyday lives and thrown into battle, often without adequate training. Those who do have experience got it while the country was unified with Russia and have pulled Soviet-era weapons out of attics and cellars to take to war.

Kozinchuk, who studied at the Taras Shevchenko National University in Kiev, told VICE News that the soldiers ranged from 18-year-olds to men in their early and mid-fifties.

Before volunteering to go to the ATO — anti-terrorism operation zone; or in Ukraine, the war zone — Kozinchuk was working at the Psychological Crisis Service in Dnipropetrovsk, Ukraine's fourth largest city. It was Kozinchuk's desire to see Ukraine prosper when peace came that pushed him to go to the front, where he could better help the country's soldiers prepare for life after the war.

"As a military psychologist, first of all, I am a soldier. I have weapons and I go and kill people. So in that way I am the same as they are, and that is the only reason they even look at me as a person who can help them," Kozinchuk said, clasping his hands in front of him on the table.

"But still they don't come to me for help. The men say they do not need a psychologist, because they are not psychotic. They do not understand what we do."

This lack of willingness to talk was reflected when VICE News tried to contact soldiers to speak on the record for the story and found that none were willing to be interviewed.

Kozinchuk volunteered to go to the front to fight and to offer psychological help to the soldiers. But the need to counsel soldiers without being seen to be doing so, and the lack of support from commanding officers means he must tread carefully.

"It is really hard [to speak to officers] because officers say or think they know everything," he said. "In our country the culture of psychological help is not that well developed. If somebody is having a problem, they don't go to a psychologist as a rule, they normally go to visit a friend and they get drunk.

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"It is very rare that soldiers come to me for help at all, but when they do, they don't voice it like that. They say, 'Let's go for a cup of coffee, let's have a cigarette,' and I know there is a problem.

"I don't feel like I have a right to say I helped you as a psychologist. He needs to know that he helped himself. But I think that the best military psychologists do it that way. Because if we show them the psychologist helped them, they will feel like they depend on psychological help and his feeling of self worth will lower."

The need for trauma counseling became apparent back in 2013, when the EuroMaidan protests turned violent and families started facing the loss of relatives.

At that time, a small group of psychologists came together to offer counseling services directly on the square. This later grew into the Ukrainian Association of Specialists for Overcoming of Psychological Traumatic Events (UASOPTE).

"We didn't know how long the protests would last, but we suspected it would run for a long time — not so long as it has though," Dr. Natalia Nalyvaiko told VICE News. In contrast to Andriy Kozinchuk's snapshot meeting in a café, Dr. Nalyvaiko has exactly the kind of office one would expect — complete with leather sofa and framed prints.

"We were supporting families who lost people in Maidan, and then later those who lost people in the war.

"We go directly to soldiers who are coming back and do programs to prepare them for coming back, and we work with the families waiting for their soldiers to come back," she added. "They may come back with some changed psychological state, and they should expect different behavior."

And just outside Kiev, Dr. Vsevolod Stebliuk established a clinic at Irpin Hospital to help soldiers suffering from PTSD.

"We created the hospital's first clinic for rehabilitation of the wounded — both physical and mental rehabilitation, although it is not the first in the country," he told VICE News, speaking by telephone.

Stebliuk received some local fame of his own during the war after piling wounded Ukrainians onto his car during the shelling of Ilovaisk and driving them to safety.

Every month, the clinic helps about 27 soldiers dealing with trauma, as well as helping wounded men returning from the front.

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It can often take many months for the symptoms of PTSD to present themselves, and so it is difficult to pin-point exactly how wide-ranging the problem will be in Ukraine, but Stebluik's clinic has seen a number of cases pass through its doors so far. About 30 to 40 percent of injured men are dealing with psychological trauma, and according to the doctor, about 10 percent of those cases are considered to be acute.

"PTSD, according to our observations, manifests in anxiety, sleep disturbances, poor concentration, aggression or depression, and conflict behavior. The problems in the organization of PTSD treatment are the lack of staff professionals, the absence of uniform standards of treatment of PTSD, and the absence of a common practice to refer Ukrainian soldiers to psychologists.

"The lack of a culture of appealing to a psychologist is a very important problem, however, in our center all the wounded are screened for psychological treatment," he continued. "It is very important that an experienced psychologist can make contact with the victims, the wounded."

Stebliuk relies on volunteers to staff his clinic and treat his patients.

"Unfortunately the main problem is the lack of funding for the work of psychologists, and thus the official employment contracts. It does not allow psychologists to work on a permanent basis."

The UASOPTE works with refugees and families as well as soldiers themselves, but again, the lack of willingness to seek out help means the group has to be active in making sure soldiers get the help they need.

"The psychological effect of this war will be very strong and long," said Stebliuk.

But he does see reason for hope. "The trauma we go through now is not necessarily always about bad stuff. It is the rebirth of something."

"There has been destruction, yes, but we are building something new," he continued. "We need to rebuild an identity for Ukraine. It will take years but I can see it happening."

For Andriy Kozinchuk, heading back to the front after spending weeks in Kiev trying to set up his psychological rehabilitation, the key to Ukraine's generation of soldiers surviving the psychological fallout of war lies in society itself.

He cites Israel as a society whose soldiers have low rates of PTSD, between 3 and 7 percent, because of the unwavering support for its soldiers by the citizens of Israel.

Israel has already offered its services to Ukraine, providing free seminars for psychologists and psychiatrists across the region.

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"We will make every effort to help Ukraine in this turbulent time. Such seminars for Ukrainian experts will be held on a regular basis as long as they are needed," Itzhak Carmel Kagan, Deputy Ambassador of the State of Israel, said in a statement.

The hoped-for center will work not only with soldiers, but also with families and their communities to explain the differences in the men. "If a person is at war all his life he wouldn't have PTSD. It manifests only when he is reintegrating into society," Kozinchuk said.

"Imagine someone is at war, and from being a husband and a worker he has become this animal. He'll learn how to kill and survive. So he's coming back home and society is telling him it is not important, what is important is having an iPhone and a cool car.

"And so they try to pigeon hole him into a life where he will be invisible. Some people want the veterans to throw the war out of themselves and discard it - that is impossible. We want them to learn how to live with it," he added.

"Right now we can win war, but our aim is to win peace and that is much harder."