Posted 11 августа 2023,, 08:24

Published 11 августа 2023,, 08:24

Modified 11 августа 2023,, 09:40

Updated 11 августа 2023,, 09:40

Dr. Denis Rassokha: «All participants of the SMO and their relatives need to see a psychiatrist»

Dr. Denis Rassokha: «All participants of the SMO and their relatives need to see a psychiatrist»

11 августа 2023, 08:24
Post-trauma stress disorder, adjustment disorder, withdrawal into alcohol and drug addiction, cruelty and a lot of pain. These are invariable companions of any armed conflict. And the participants of the SMO will return. What will necessarily happen behind closed doors in families, what should society as a whole prepare for?

Yekaterina Maximova

Denis Rassokha, a psychiatrist at the Empathy Center, told Novye Izvestia about this.

— Increasingly, crimes committed either by members of the SMO or against them are being recorded in the country. Cases of pseudo-debauchery have also become more frequent. For example, two recidivists, shouting that they were at war, tried to drown a girl in a fountain. Is this already PTSD? Post-traumatic disorder of both society and individuals?

— The surge of hooligan incidents is a mass psychosis. When one person can infect others with his anxiety or his cruelty. There are a lot of violent videos, «bloody» news. And against the background of this flow of negativity, cruelty increases.

It's like living with constantly anxious people: sooner or later, your anxiety also increases. It's just that these are questions about general anxiety, and the story with the girl is already a question of cruelty. And if a person had such a borderline condition, he was so cruel, then this can somehow strengthen his worst qualities even more.

A PTSD (post-traumatic stress disorder) — these are mostly some kind of obsessive thoughts, a feeling of helplessness. And most often they bring pain to the person himself, and not to others. After all, cruelty is not characteristic of PTSD.

— Openly recruited convicts. Now, having received a pardon, they are returning home. Many of these people have committed violent crimes in the past, then they have been in even more stressful conditions and have now returned to society. Is this the most dangerous category?

— Not always bright psychopaths commit some crimes right here in the moment. They can wait, live quite peacefully on the outskirts of the same Moscow with their mothers in a one-room apartment, and then they get into some such moments that they can become even more violent than recidivist criminals.

And we do not know whether those who have committed particularly serious crimes have now received amnesty. Whether they were released.

— Released. In Karelia, two repeat offenders returned and killed six people.

-It is more likely that such people will commit a crime again. Of course, it is not always the one who killed, next time he will go to kill again. It's just that the probability increases.

There are quite a lot of people with an emotionally unstable personality type (psychopaths in the old way). And just imagine: they first sat in a colony, then got into a war zone. And when you are in such a bunch of people, when everyone can do anything there and all this with impunity, then often, roughly speaking, such an animal instinct wakes up, which can manifest itself in peaceful life.

— Is there any advice: what to do when you become a victim of an aggressor?

— There is no universal advice. Just don't engage in any conversations with them. Not to engage in any kind of interaction with them at all.

— You said that a person with PTSD — not a psychopath, he just feels bad. Is there a developed system of providing assistance to people with PTSD in Russia? And how expensive is it to «pull out» such a patient?

— First of all, yes, this is psychotherapy. These are special methods of treatment that are aimed at post-traumatic stressful things, at working out some disturbing moments.

There is a special method of psychotherapy. This is DPDG — desensitization and processing of the movement of the eyeballs.

Is it expensive… It seems to me that it is much more expensive to conduct your own than to provide assistance in the future.

Theoretically, there are a lot of trained psychologists in the country. Sometimes even they can quite cope if they have special methods. And it is long and expensive to teach doctors, and it is much easier to teach a psychologist.

— Have the participants of the current Ukrainian conflict already addressed you?

— Yes, periodically.

— Do they come themselves or do relatives sound the alarm?

— As a rule, by yourself. At least, everyone came to me by themselves. They did not like their condition, that is, it was so, it became so, obsessive thoughts, and now they come.

-Suppose a person does not even think that he needs the help of a psychologist or a psychiatrist. She hopes that he will cope on his own. When should relatives start sounding the alarm? What exactly in the behavior of their relative should alert them so that they have already connected medicine?

— The main thing is some outbursts of tearfulness or aggressiveness, that is, some such bright emotional moments. When there is a feeling that a person is instantly turned on. For example, he used to be calm or could get started, but here some external factor is small and as a result — an inadequate reaction.

Roughly speaking, a fork has fallen, and he starts shouting: «What is this happening?!». Or, conversely, tearfulness. I'm exaggerating, of course, but something like that.

That is, when some small factors cause a response that is inadequate to the stimulus.

It didn't happen before, but now it's happening — that's the main thing, probably. Or some kind of periodic fading, too. Or a person begins to tell a lot about some vivid memories that arise after three months of staying at home. In the first two or three months, such changes in the psyche are normal, and then, after all, our psyche must adapt.

If during the first two months she does not adapt, then she needs the help of specialists.

I would recommend that after all these events, after returning, at least a few sessions with psychologists should be held for everyone. For example, in the United States, all participants in combat operations are required to undergo several DPDG sessions. There may be more, but they should go through several sessions with a psychologist in any case, if they have been to a hot spot.

— We don't have such a requirement?

— We do not have such a requirement at the moment. But I would recommend in any case, after returning, to go through at least a few sessions with a therapist, at least to say some things that worry.

— Does this also apply to civilians? Maybe it's time to send the whole Belgorod region to specialists, too?

— It's not PTSD, it's an adjustment disorder. And these are slightly different things. PTSD is when you see some things, and then they are constantly in your head. That is, someone's psyche can cope, and for some it does not cope.

If she does not cope, just some disturbing aspects arise, then this is more of an adaptation disorder. And PTSD is when …

Here, for example, you are walking down the street, you see that some person with a tattoo is walking, and you remember that you had an obsessive thought (or a so-called flashback) that your friend once had the same tattoo there, and his arm was torn off in the war. And you saw how his arm was torn off in this trench. And that's it: you stand rooted to the spot and think about it.

— And what is more difficult to treat: is this PTSD when you stand rooted to the spot or when adaptation is disrupted?

— Everything is also quite individual here. And everything depends on the psyche, on the susceptibility of the psyche. Some even have very severe post-traumatic stressful things in just a few sessions with psychotherapists, with the addition of medications. And some have to be treated for years.

Sometimes it doesn't even depend on the severity of some injury. It was even, perhaps, a few traumatic experiences, a few bright things, but at the same time several sessions with a psychologist help, and it happens that one bright flashback is ingrained in the memory. That is, there is definitely no way to say. A lot depends on the personality, too.

— All the same, veterans will get drunk, fall into some harmful addictions, and someone will go to religion?

— In fact, there is a very high risk. These people received high adrenaline, these are very high such outbursts of emotions. And then in some cases these emotions are no longer enough. And a person is already used to these emotions.

And there is a transition to other addictions. The easiest way is to go into alcohol, into drugs. This is the simplest, it gives an emotional background.

Therefore, I will repeat my recommendation once again: seek help. At least at the level of a psychologist. So that the specialist can see what and how is happening in the patient's life in general, and whether there are any problems, whether there are any bright emotions, whether the person wants to continue receiving these emotions. Well, or in some cases, not emotions, but simply the need to somehow drown out your general condition with alcohol or drugs, because this is the easiest.

As for religion, it is to a lesser extent, because it does not give such vivid emotions. Most often, those who have experienced losses, namely family ones, go to religion. If, for example, a brother died. Or the patient saw the death of his brother.

When a friend and a comrade-in-arms dies, then most often the participants in the war, on the contrary, want to take revenge, and not go into religion. And, by the way, often after these hostilities, many people want to return to hot spots only to take revenge on someone there, even if they don't need to. I had a story when a soldier received a concussion, he was already mobilized and was not taken to the front. Then he enlisted in the PMCs.

— If a person can no longer live in a peaceful life, will medicine help?

— Such a person needs to work with a psychotherapist. These are questions of psychotherapy, these are questions of obsessive thoughts, memories. That is, first of all, it is work with a psychotherapist, it is the study of the trauma that was.

— How much does one session of such therapy cost?

— In different ways. About 2-2.5 thousand rubles.

-Is there a shortage of imported drugs that are needed now by people who have passed through the SVO?

— Everything has already returned to normal. There were problems: from March to the autumn of last year, indeed, some drugs simply disappeared and there were none at all. Now I would say that everything has returned. At this point in time, there is only one antidepressant left, which is still missing, and I understand that its supplies are not going to be returned. And everything else, in principle, is there, including the most modern drugs.

— Is it exclusively imported? If suddenly the sanctions are strengthened and the drugs disappear again, then there is nothing to replace them with?

-There are imported medicines that are simply better. In Russia, there are some drugs that for some reason do not meet the quality. There was such a thing that there was not one antidepressant for a while, they switched to Russian analogues, and now they are much worse.

— There have been a lot of initiatives from politicians related to the SVO lately, the State Duma has adopted a lot of laws. Would you advise them to better take up the modernization or improvement of psychological assistance to people who return to peaceful life after their own?

— I would recommend them, probably, to modernize everything that is now. And be sure to introduce a psychotherapist's consultation. In some cases, on the recommendation of a psychotherapist or psychologist, I would introduce mandatory consultations with psychiatrists. To have full-time psychiatrists who would do this.

For example, in Moscow there are free consultations for all residents of Moscow, there are several free dispensaries. I don't remember exactly, but it's five or 10 free consultations a year.

In fact, this requirement is mandatory consultations, which would save a large amount of life in the future. This applies to alcoholism and suicide. Because there is still a very high risk of suicide, and the wave of suicides after the Afghan and Chechen wars was high. Mandatory visits to specialists would actually save more than one life already in civilian life.

Reference: Post-traumatic stress Disorder (PTSD) — a severe mental condition that occurs as a result of single or recurring events that have a super-powerful negative impact on the human psyche.