Fragments from a War Diary, Part #172
I want to share with you an issue very important and personal to me, and that is the issue of post-traumatic stress disorder. Talking about mental health, and in particular one’s own mental health, is often a taboo issue in many countries and in particular in Ukraine but it should not be because mental health is just like physical health. An external event or events has interfered with your body and this causes you to become sick. In mental health cases the injury your body suffers is typically related to the balance of complicated chemicals that cause the brain to interact with the body via the body’s complex neurological network. These chemicals are designed to create appropriate emotional and psychological reactions to situations of danger, shock and the like. However when people have extreme experiences, as is commonplace in war, such as daily danger of death or experiences of being separated from their friends and loved ones, or constant concerns about the welfare of their family, or concerns that they might be driven from their homes or their homes destroyed - then these experiences become too much for the brain’s complex chemical networks to manage.
The delicate balance of neurological chemicals in the brain becomes distorted, particularly if one is exposed to shocks or dangers or events repeatedly or that are wholly outside the realm of normal experience. It is possible for the chemicals in your brain to become imbalanced for an indefinite period. You may experience symptoms of high anxiety, insomnia, extreme thinking or even psychosis: believing that things are happening that are not actually true. The effect of mental trauma upon each person’s mind is different and in large part it depends upon the personality of the individual involved. Contemporary psychiatry suggests that we are all a little bit crazy, in one direction or the other on various “disorder spectra” as they are sometimes known. Extreme external events may drive us further away from the centre - an imagined “normality” that does not in fact exist for anyone - and may make our moods and behaviour increasingly erratic or difficult for others to cope with. This almost invariably causes intense mental anguish in the patient.
I know about this because I suffer from post-traumatic stress disorder and I do not mind sharing this fact with you because I want to break down the stigmas involved in discussions of mental health so that society may become more open about these things and so that people may feel less shame. It is no different to say that you have post-traumatic stress disorder than it is to say that you have a broken leg. I have been through a lot of stresses in my life and here is not the place to tell you my story which I will probably have to take with me to the grave. Nevertheless suffice it to say that it began with a series of events about five years ago, and yes it involved malicious actions by the Russians against me and my family, and that explains in large part why I am here in Ukraine doing everything I can to help Ukrainians defend their country and to promote the international legal polity that keeps modern Europe stable.
In my case there were various misdiagnoses along the way but even saying that is probably unfair because there are no clear lines in psychiatry between one condition and another. There are just a series of labels that are used to describe certain sorts of collections of symptoms and those labels all overlap with one-another. Therefore so-called misdiagnosis may just be a matter of style: a patient answering one psychiatrist’s questions in a slightly different way or eliciting slightly different symptoms on a different day. Most psychiatric conditions stretch over an extended period of years and it is a matter of trial and error in treating them. Psychiatrists themselves will admit this: they have no concrete and cast-iron answers as to what is wrong with a person and depending upon the symptoms and the clinical history of the patient, they will try different medications. Then they wait a while and they see what happens. And then maybe the change the medications and see whether there is a different result. This aspect of psychiatry makes it the most demanding and challenging of all branches of medicine because there are no clear answers and no clear treatments.
Post-traumatic stress disorder is a long-term condition that can come and go in waves. Some days you may feel perfectly fine and the next day you may have insomnia or nightmares or relentless anxiety about things that may never come to pass. In extreme cases you may have paranoia or hallucinations. The only real treatment for post-traumatic stress disorder is to relieve the patient of the anxieties (s)he is suffering from. Therefore if the patient has lost a spouse or partner, for example, that person needs to be replaced in their lives. Or if they have suffered financial collapse then that needs to be rebuilt. The only way of addressing trauma is really to treat the cause head-on.
Humans are funny things. Because of my truly extraordinary and fascinating life and career I have no fear of death or injury. I suppose that is why I can go and work on the front line of war zones and talk to people and organise things in circumstances in which other people would be afraid. If I am injured then I just get on with whatever curse life has inflicted upon me and I carry on. By contrast I have a series of phobias derived from devastating experiences earlier in my life and career and I have irrational anxieties in response to those phobias. And my symptoms of post-traumatic stress disorder consist of insomnia, nightmares and panic attacks relating to these very specific things that would not affect others in the same way because they have not had the dramatic life experiences that I have had.
My post-traumatic stress disorder is now mostly in remission, with the benefit of specific medications, known as anxiolytics, that are designed to reduce anxiety so that a person can sleep and not have nightmares and similar such things. Other people need anti-depressants. Others need anti-psychotics. Each of us is different. These medications are mostly extremely tried and tested and they are safe and they are just like taking any other sort of medication. You should not be afraid of them. If you feel extremely mentally distressed then it is incumbent upon yourself to seek psychiatric help and assistance so that you can talk about the experiences in your past that so plague you and so that a qualified psychiatrist can prescribe you treatment that will make you feel better. I am someone who has been through all of these experiences with the pains and agonies involved and that is why I wanted to share some of my experiences with you. There is no shame and no stigma attached to mental health issues, and properly treated you can lead a full, valuable and useful life, with wonderful friends, a fantastic family and a beautiful career. I have all of these things.
Everywhere I look in Ukraine, I see symptoms of mental ill health. People walking in the street, on the tram, getting drunk and unreasonable in a bar, I see the symptoms of anxiety, mental distress and post-traumatic stress disorder. Ukraine at war has a lamentable lack of decent psychiatrists and those that there are are grossly over-worked. Substantial healthcare sector investment is required in mental health if Ukraine’s soul is not to be ruined with untreated mental health issues related to wartime experiences. Alas this is a common and often uncounted cost of war but we can face this challenge all the more if we cast aside our stigmas and our shame and we acknowledge that mental health is just like any other sort of healthcare: it is caused by external events; it is not your fault; and the goal is simply to get better.