Foundation’s case-managers talked to the chief doctor of the Center for Psychological Health and Rehabilitation of Veterans “Lisova Polyana” of the Ministry of Health of Ukraine

Anna Glushkova and Oleksandr Vitsan, case-managers of the “Pislya Sluzhby” veterans’ Foundation talked with Ksenia Voznitsyna, chief doctor of the state institution - Center for Psychological Health and Rehabilitation of Veterans “Lisova Polyana” of the Ministry of Health of Ukraine. Got acquainted with the institution and the principles of work.

Discussed the most frequently asked question, such as:

• First signs of PTSD, how can a case-manager detect them and redirect to the specialist. 
• The consequences of not treating the contusion and what the kind of diagnosis it is. 
• Art therapy for veterans. 

– Considering PTSD, what can be advised for the case-manager, how to recognize the signs for an untrained person?

– Post Traumatic Stress Disorder is a fairly serious diagnosis, which can be diagnosed by a psychotherapist or a psychiatrist. And It has particular diagnosis criterias which are detected by the specialist. Obviously, every psychologist or a case-manager can recognize some of the signs of the disorder due to the direct communication with the patient, which should be redirected to the expert. Even a psychologist without a medical degree can detect some of the symptoms, which are alarming and threatening, and then refer a person to a specialist. This is incredibly important. There are lots of myths about PTSD nowadays. But there is a statistics, that only 20%, 30% maximum of people that experienced catastrophic events develop PTSD. Big part of those, around 70% can get rid of that fairly quickly, due to the treatment it can be overcome. 

But there is a percentage that will be constant, chronic, resistant to the treatment. This is what we are talking about. But this is a small percentage of the whole amount. And another important aspect about PTSD: fist criteria of its detection - experience of living an event of an extremely catastrophic nature, with a threat to a life or health. Therefore, PTSD cannot develop as a result of a breakup, health loss or house loss - this is not a criteria for such a diagnosis. Obviously - the war is that type of event which can trigger the development of PTSD.

– What about the consequences of the contusion, if not treating it.

– First of all, contusion is not the right term, and society has to acknowledge this. The breakthrough happened in 2021-2022. A contusion is a blow to the brain, and we say concussion is a concussion. And now in everyone's diagnoses you can see "explosive mine injury, closed craniocerebral injury, concussion" - this is the correct name for "contusions". Actually, this is a concussion, which can be accompanied by an acoustic injury in the form of damage to the vestibular or auditory apparatus. That is, there is a shock and an acoustic injury, which can be both separately and together. More often - together, because the entire explosive wave passes through natural openings. And of course, the insidiousness of this trauma is its invisibility, which also has psychological consequences. Outwardly, it is practically not manifested and it is often believed that it is reversible, that 3-5 days will pass and everything will be restored is also a myth. Under the influence of many factors, this recovery does not occur. And how was treated in the acute period, and maybe the person had an injury earlier (whether an accident or a traumatic sport, or whether the person is over 50 years old - there are many factors). And of course, after several episodes, they are layered, accumulated and can have long-term consequences in the form of post-concussion syndrome. Actually, the effects of blast waves, if they have already taken hold, are always recognized through 3 groups of symptoms:

• Somatic group - bodily: decreased hearing, vision, noise or ringing in the ears, pressure instability, weather dependence, sympathoadrenal crises and much more.
• The second group is cognitive: a decrease in memory, concentration of attention, deterioration of mental processes that you used to do very easily,
• The third group is emotional and behavioral: anger, aggressiveness, tendency to depression, suicidal acts, heightened sense of justice. That is, the psycho-emotional group is also very characteristic of post-coma syndrome.

And every patient with such signs must have all three groups. And this greatly affects the quality of life. Allegedly, this is not some serious pathology, and not a heart attack, not a stroke, you live with it every day. But these symptoms do not allow you to live, work, and communicate with your family. For example, let's take an IT specialist: he needs visual, emotional, and cognitive concentration, and people often lose this ability. And it is necessary either to be properly treated, or to reformat the profession.

– What’s your opinion on art therapy?

– We have been using it for a long time now, since 2014, but this is absolutely an additional helping method to a main treatment. And I would not call it an art therapy, rather an art rehabilitation, because this is a psychotherapeutic method, as a CBT or gestalt therapy. There is a psychotherapist trained in a special treatment method - art therapeutic. Artist or a master who comes to lead a workshop with soldiers - he is not an art-therapist, he doesn't have required education, this is just a help to relax, to think, to have fun and to get emotional support - this is very important in a general rehabilitation. 

– But those kinds of workshops have to be led by professional psychologists?

– Not necessarily! It could be an artist, who knows art well, it would be great if it was an art-therapist, but there aren’t many of them and art-therapy requires talking and working through traumatic experiences, and it could be more of an individual work. This is more of a general, emotionally supporting activity, which allows a person to relax a little bit and to accept professional help. 

– Please tell us from your own experience, are there a lot of people who want to attend such art - therapies?

– Not really, we always have to discuss this, consider, but when they come to it, all of them say that it fascinates. Because we often use those art-rehabilitative sessions with the use of our partner group ARTREHUB, they use Ukrainian ornament, symbols, and tell about the history of Ukraine. It really draws into it and it is very interesting. All of them love clay, attend sessions much better, because it is a classical grounding element of rehabilitation. 

Strong partners - is an essential part of each team which works with veterans and soldiers. Due to the joint efforts and professional experience our defenders can feel that the support is always near.