Observer PTSD. Russian therapists on how war, mobilization, and drone attacks shifted public mood from shocked to apathetic

Moscow-based psychotherapist Ksenia (name changed) was holding therapy sessions on Saturday, June 24th. A column of Wagner PMC troops was advancing towards the capital, Putin was addressing the nation, and utility workers were urgently breaking the asphalt on the “Don” highway to halt the rebellious mercenaries. However, at the therapy sessions the Muscovites were hardly paying any attention to these events, as Ksenia recounts:

“The clients we've been working with for a while, those who understand what it's safe to discuss with me – yes, they did mention the rebellion. But it was more of a discussion, without any sense of panic. Moreover, this topic did not dominate the entire counseling session. As for new clients, the subject of Wagner PMC was not brought up at all. It appears that people are becoming less easily surprised by things.”

At the beginning of the war, both Ksenia herself and her clients reacted to the unfolding events with much more heightened emotions. In the initial days, she confided in her personal psychotherapist, saying, “I'm going to cry for a while here with you and then I'm going back to work.”

It appears that after the onset of the major war, every psychotherapist and psychiatrist in Russia has found their own specialist to help cope with the unfolding events. Another Moscow-based psychotherapist, Pyotr (name also changed), confesses:

“At certain moments, I realized that my reserves were depleted. I would cancel all work, appointments, and take sick leave. I would just lie there like a stone, take antidepressants, and talk to friends. To help others, it's important to somehow distract oneself from one's own state.”

Psychotherapists find themselves in the same situation as their clients today, explains Tatiana (name changed), a staff member of a Russian urgent psychological support project:

“In ordinary life, the client is always in a more vulnerable position. But the war has changed everything. Psychologists and psychotherapists are trying to somehow comprehend the new reality. We even conducted several seminars with colleagues. However, a specific action plan has not been developed yet.”

Over the course of a year and a half of war, both she and her colleagues have seen a noticeable increase in their workload. In 2022, the number of Russians seeking psychological support from the VSK Insurance House service increased sevenfold compared to 2021, as reported by Vedomosti. The peak of requests for psychological help in 2022 occurred during September-November. 82% of the requests came from women, with the primary complaints ranging from emotional issues like chronic fatigue to aggression. Interestingly, the majority of those seeking help were young individuals, with 70% of patients falling within the 18-35 age range.

According to the statistics from the service where Tatiana works, the peak of requests for assistance was reached in September of the previous year following the announcement of mobilization. Complaints subsided in October and November, only to experience a new peak during the winter months. From December to March, Tatiana and her colleagues received around 250 requests per month. By summer, the number of complaints had decreased by approximately 30%.

Another indirect way to gauge the impact on Russians is through the sales of antidepressants, which increased by one and a half times during the first six months of the war. By October 2022, TASS reported a 70% growth, which was particularly pronounced during the announcement of mobilization.

“Mom and dad are defending killers”

Psychotherapist Maria Potudina observes that with the start of Russia's invasion of Ukraine, the primary complaints from her clients have changed:

“After the war began, the requests from my clients who remained in Russia shifted. It's no longer just family problems stemming from misunderstandings or generational conflicts. The main cause of quarrels now is differing attitudes toward the war. The problem is no longer that 'Mom doesn't accept me' or 'Dad doesn't like my husband'. Now it's a horrifying tragedy: 'Mom and Dad are defending killers'. And it's not just a mere quarrel anymore; it's a loss. People realize they are losing their parents, and there's no going back.”

According to Potudina, the war has led many of her colleagues to reconsider the ethical standards of their profession. This has sparked debates within the psychological community since February 2022:

“Some specialists believed that we should remain neutral and not openly express our position on the war. Others, including myself, decided that we should call a spade a spade instead. It was important for me to define my stance and signal it to my clients and the people around me. The question isn't about who is right and who is wrong. It's about the right to call violence violence and evil evil. This is what I convey to my clients: you also have the right to call black black.”

Certainly, not all professionals have adopted an anti-war standpoint. Frequently, endorsing the war and repression has severely harmed those who seek their guidance. Potudina has encountered several instances of this among her clients, but she deems it inappropriate to share them. However, she does offer an example involving her friend:

“He identifies as LGBTQ and had been regularly attending therapy. When the anti-war protests commenced, he arrived for a session directly from a rally that had been dispersed, and he felt deeply disheartened. The therapist voiced support for dispersing these protests, asserting that it was justified. As a result, all the trust-building efforts that had been undertaken crumbled. My friend is now grappling with a state of profound distress. He struggles to fathom how he can continue with a therapist who believes that individuals like them should be subjected to physical violence and incarceration.”

Maria Potudina elucidates that the majority of Russians with anti-war sentiments have undergone what is referred to as “witness trauma.” This parallels the experience of a child who witnesses an adult physically mistreating another child. Or, in other words, when he is in a situation where violence is present, yet he is not under any direct threat:

“This was an experience shared by all of us when we opened our news feeds, read about the events in Bucha, and were struck by shock. During that period, we all underwent a form of witness trauma. Individual reactions may vary. There's a fear of potential harm befalling oneself or loved ones. Coupled with that is a sense of helplessness - a realization that I'm powerless to aid. There's even a mixture of relief and joy in the fact that I'm unharmed. And naturally, there's also a sense of guilt in being alive while these others are not.”

These impacts can give rise to enduring consequences, including panic attacks, disruptions in sleep patterns, depression, and headaches. Potudina explains that these effects might manifest much later, even after the war is over.

PTSD away from war

Psychiatrists employ different terminology and diagnoses. One such diagnosis is Observer Post-Traumatic Stress Disorder (PTSD). However, fundamentally, it arises from the same source - witnessing violence directed towards others, according to Olga (name changed), a psychiatrist and a member of staff at a significant psychiatric institution in Moscow:

“The peak of visits to psychiatrists was after Bucha and Mariupol. During that time, I diagnosed one of my clients with 'Observer PTSD.' She was experiencing flashbacks and nightmares with images from Ukraine. The content of her nightmares was closely linked to the news. All those interviews with people, stories from Ukrainian grandmothers, the tears, the disfigured bodies. People in sessions were essentially recounting these interviews.”

At the beginning of the war, news from the frontlines and occupied territories pushed some Russians to suicide. One well-known example reported in the media was the story of a 40-year-old Russian who took his own life in a Georgian hotel and left a note: “I hate everything related to aggression, including the wars my country first waged with Georgia and now in Ukraine.” Olga believes that many people felt something similar at that time:

“Some found solace in their families, children, and the obligations they held for their pets. I personally feel very fortunate that I was on antidepressants when the war began. Without them, I don't know how I would have gotten through all of this. If someone came to us with suicidal thoughts, my task was to diagnose and refer them to colleagues who are guaranteed not to be Z-fascists. My interactions in professional forums show that the greater a doctor's capacity for critical thinking, extensive reading, and alignment with evidence-based psychiatry instead of punitive approaches, the greater the likelihood that they are not Z-fascists.”

Olga herself left Russia, but she continued to remotely prescribe medications for people: “Technically, it's not very legal to do this from abroad, but there's a war going on and I believe you can ignore Russian laws in this situation.”

Chronic stress and the new shock of mobilization

“The initial reaction to the war was agitation, a fight-flight-freeze response,” explains psychotherapist Tatiana. “It lasted for about a month. Then, the stress transitioned into a chronic stage.”

Mobilization has left a deep impact on the psyche of many Russians. For instance, Olga had a patient who had waited in line for three days at the Upper Lars border crossing and began experiencing hypnagogic hallucinations. These are hallucinations that can occur even in a healthy person at the moment of falling asleep. The man felt as if hands were reaching out to him and someone was chasing him.

Since November 1, 2022, former opposition journalist Natalia Zubkova from the Kemerovo region opened a hostel called “Tihoe Mesto” (Quiet Place) in Batumi for those fleeing from the war and mobilization. According to her, Russian arrivals were in a state of complete despondency:

“Some were grappling with suicidal thoughts. In the case of one of our lodgers, these thoughts were so intense that I had to seek out a psychiatrist for him. Fortunately, a foundation stepped in, and now the young man is receiving specialized support and antidepressant medication. He found himself emotionally detached from his family and closest relations. However, what seemed to be the heaviest burden on his psyche was the prevailing support for the war among his circle of friends, acquaintances, and classmates. Many who come to seek refuge here share a similar sentiment: they once had friends, but now it feels as if those connections have been severed, as if those friends have metaphorically passed away.”

During times of war, many individuals experience exacerbations of psychiatric conditions. Delusions and psychoses are structured in such a way that they manifest what a person perceives in their surroundings, explains Sasha Starost, the head of psychological assistance at the Feminist Anti-War Resistance (FAR) group:

“For instance, an individual who was formerly an opposition activist came to us. He developed a psychosis rooted in persecution. The content of his delusion was that he was being hunted and targeted for imprisonment due to his anti-war stance. When we attempted to help him, he began suspecting that we were colluding with his enemies. Unfortunately, we lost contact with him.”

As a last resort to avoid conscription, psychologists provide consultations on how to simulate mental illnesses at the military draft office. According to Olga, it's more reliable to begin this process beforehand, prior to the next mobilization wave:

“If you also decide to pursue this, I recommend studying the course of lectures on general psychopathology by Andrey Snezhevsky. He's a psychiatrist with a controversial reputation, but the course demonstrates various illnesses, and each symptom is described quite thoroughly. So, choose your 'Pokemon' and venture into the realm of psychoneurological diagnosis. Chances are you'll be able to deceive an average psychiatrist.”

What is to be done?

According to specialists, face-to-face communication is incredibly helpful. This is why informal gatherings are making a comeback. It's not only clients of psychologists who benefit from this, but the specialists themselves find solace in it, as Ksenia admits:

“The opportunity to connect with like-minded individuals in an intimate setting is truly therapeutic. Those who remain in Moscow are particularly burdened by loneliness. They simply lack someone to talk to; their loved ones have left. Yet, the fear prevents them from opening up to strangers. Recently, a potential client reached out, stating that they were seeking a psychologist who opposes the ongoing events. I pondered for a while on how to respond, conveying that I can work with them without violating any laws.”

Ksenia shares that she has been focusing more on “self-sustaining” activities. Eating well, sleeping, and taking walks. “I understand this might sound silly, but these are crucial things. Additionally, what has been immensely helpful for me is that I continue to do what I've been doing prior to February 24 – helping people. This is also a way of resisting what's happening.”

Indeed, this is one of the most effective means of adapting to the current situation. Psychotherapist Tatiana explains that people generally adapt in two main ways:

“The first group chooses to move forward and take action despite the circumstances. The second group, however, enters a state of 'internal emigration.' Psychologically, this is known as 'dissociation.' Essentially, they carry on with their lives, deliberately neglecting a certain portion of reality. They avoid consuming news, refrain from engaging in conversations about the war, and continue with their daily routines. However, at some point, reality inevitably catches up with them. This is particularly evident when they have children returning from school, where the so-called 'discussions of important things' have been held by the administration.”

Pyotr works as a school psychologist in Moscow. According to him, the abovementioned “important discussions,” unlike the war, don't significantly affect children's mental well-being:

“If these discussions are carried out strictly according to guidelines, as is done in many cases, they often result in mere jokes and debates. That's because the content is actually quite peculiar and extremely abstract. Nevertheless, war doesn't spare children either. Among the younger ones, its effects are increasingly seen in how they play. There's a standard psychological technique where you ask a child to draw a fictional creature, and they end up drawing an actual T-90 tank heading to fight in Ukraine. In that moment, you realize the child probably watches television. Among older children, there's more shock and comprehension of the grave consequences. Those who support the war are in the minority among them.”

“First they supported everything but then got overwhelmed”

Psychotherapist Pyotr also shares stories about clients from the other side of the barricades:

“Some of them initially supported everything, but now they're overwhelmed. When Russia was advancing, they experienced an emotional upsurge. The last time they felt it was after Surovikin's appointment. About two months later, they started realizing that things were going off course, resources were being depleted, people were dying, and this was compounded by worries about relatives at the frontlines.”

In Belgorod, where the war became much closer after the raids of the Russian Volunteer Corps, the psychological atmosphere changed, albeit not in the most predictable manner. Local psychologist Elena (name changed) explains that during the initial shelling, which happened last year, her fellow residents did indeed fear the explosions and the operation of air defense systems, but they adapted quite quickly:

“People got used to loud bangs and gunfire. They quickly returned to their everyday problems. Many simply stopped realizing they were in a constant state of threat. They're even surprised: 'Everything's fine, what am I worrying about?' I hear this and immediately recall the explosions. I remember the banners that used to encourage us to pursue careers as builders, now proclaiming, 'Military service is the choice of heroes.' I remember the smoke rising over Shebekino, visible from my window. Nonetheless, the bombings themselves don't greatly concern people.”

On the other hand, according to Elena, the overall atmosphere of anxiety is on the rise:

“Not long ago, there were many cases of conflicts between relatives and friends over the war. It had a profoundly destructive impact on everyone. Now, even the presence of Z symbols in the city has greatly diminished, and people have become less supportive of the war. Even my mother, for example. Everyone has shifted their focus to the fact that there's a real physical threat, and disagreements have taken a back seat. People are busy. They're pondering whether to leave or not. How to safeguard themselves from the next wave of mobilization. How to protect their savings. Once again, like at the beginning of the war, people are preparing emergency kits.”

Adaptation

Many psychologists point out that after the intense autumn stress associated with mobilization, a sense of calm or even apathy has settled in. Here's how psychotherapist Timur perceives it:

“People experienced strong anxiety last autumn and during the first months of winter. Now there's an emotional plateau. Perhaps the recent Wagner group incident briefly triggered new anxiety, but it faded within two days. Interestingly, women and teenagers hardly discuss these topics at all. War, drones – as if none of it exists. It's a form of adaptation, a pushing aside of these events from consciousness (except perhaps for the Wagner group's Moscow raid). Men are more engaged with the news cycle. Especially since rumors of a possible new mobilization have emerged. But what's intriguing is that both men and women struggle with long-term planning.”

Many have begun to adapt in some way or another to what's happening. According to Maria Potudina, there are entirely physiological explanations for this: “The body can't constantly function on adrenaline and cortisol. After a while, even under the most nightmarish circumstances, adaptation occurs.” However, even if the anxiety subsides, loneliness, fear, and helplessness remain. These sentiments, according to insights shared by all the interviewed experts, have emerged as the foremost concerns among Russians as of late. Those who remain in Russia are compelled to acclimate themselves to these realities, Potudina explains:

“They find themselves navigating a world where everything appears normal as they step outside the walls of their home – lilacs are in bloom, the sun shines – yet concurrently, they exist within a totalitarian state. They receive periodic propagandistic missives from government agencies, surveillance cameras are omnipresent, and avenues for protest are restricted. An important aspect to consider is that people lack the means to escape their enforced solitude, to encounter like-minded individuals. This sensation of helplessness is profoundly distressing, prompting individuals to seek out culprits, occasionally placing blame on themselves. This reflects a mechanism of psychological defense, one that can be inwardly or outwardly directed: 'I'm not doing enough, they're not protesting effectively, they fled, they stayed.' Within the realm of social media, people segregate themselves, opting to close off accounts. They establish microchannels exclusively for close acquaintances. This serves partly to circumvent allegations along the lines of 'all Russians are at fault,' and partly to sustain connections with others.”

According to the observations of psychotherapist Pyotr, neither the battles in the Belgorod region nor even the drones in the sky above Moscow elicited a strong reaction from his clients. As per Pyotr's viewpoint, only clients with initially heightened levels of anxiety are experiencing distress. Another psychologist, Iosif (name changed), also shares an account of the absence of any significant emotional response to the drones over Moscow. Last autumn, he left the country and recently returned to Moscow for personal reasons:

“Since the end of winter, clients haven't been expressing fear of mobilization. Everything seems to have stabilized somehow. Some have chosen to simply ignore what's happening. Others have left. Still, others have devised a plan on how to leave and are adhering to it diligently.”

Sasha Starost, the head of the Psychological Assistance Department at FAR, reveals that the number of Russians seeking support services has significantly declined. It went from 200 per month to 60. Both Sasha and psychiatrist Olga note that people have become calmer. However, there's one exception — the destruction of the Kakhovka Hydroelectric Power Station by Russia managed to shock people:

“These videos of rescuing people and animals are all over everyone's stories right now. But I think it's temporary. Even if Russia were to explode the Zaporizhzhia Nuclear Power Plant, the reaction wouldn't be similar to the first few months. Back then, our generation encountered war for the first time. Now, the war is ongoing, and everything else is just its various individual manifestations.”

The upheaval caused by Evgeny Prigozhin also triggered a lively but short-lived response. Patients of psychiatrist Olga complained of poor sleep, while clients of psychotherapists reported heightened anxiety. On the day of the rebellion, the number of requests for help received by Tatiana's emergency psychological service nearly doubled. She and her colleagues even created a guide for clients on how to stay calm and watch the news correctly.

According to Pyotr, within just a couple of days, his clients from Moscow hardly remembered the rebellion:

“By Saturday afternoon, people became tense, yet by evening, their unease subsided. Some experienced relief, others disappointment, but by the start of the next week, the recent events didn't appear significant or deserving of their attention.”