Nicole Tung visited several mental health treatment centers in Ukraine, and spent time with several soldiers suffering from the psychological harm of battle earlier this year.
Night brings little sleep and terrifying dreams. Day brings panic attacks and flashbacks. All are exhausted and some think of suicide. They fear their own thoughts, and what those thoughts might drive them to do.
Vladyslav Ruziev, a 28-year-old Ukrainian sergeant, has recurring nightmares about his experience being pinned down with his unit last winter, powerless to do anything about the constant Russian artillery, the bitter freeze, the comrades he saw lose arms and legs. “Sometimes the ground was so thick with the wounded that the evacuation vehicles drove over their bodies by mistake in the chaos,” he said, recalling scenes he witnessed on the front earlier this year.
In a year and a half of war, many of Ukraine’s troops have had breaks totaling only about two weeks. And when they do get short respites away from the front, what many of them need most is treatment for psychological trauma.
That need is growing and far outstrips Ukraine’s ability to address it, as a New York Times journalist found in visits to institutions providing that care, and in interviews with soldiers, therapists and doctors.
Andriy Remezov knows that suffering all too well — after going in 2014 to fight the Russian proxy forces in the East, he returned home and went into a tailspin.
“I got addicted to drugs and alcohol, and even thought about suicide, but my comrades rescued me,” said Mr. Remezov, 34. He got treatment, became a psychologist and got married.
He rejoined the army last year. On a two-day trip to Kyiv, sipping coffee in his kitchen his wife, Marharyta Klyshkan, he explained that each time he leaves the front, he spends some quiet time mentally reviewing what he has endured “so I can put it on a shelf in my mind.” Otherwise, he said, “all this information can just destabilize me.”
Ukraine’s mental health system can handle only a fraction of the need, he said, and most soldiers make the mistake of trying to tough it out on their own, as he once did.
A handful of centers in Ukraine treat mental trauma with traditional psychotherapy and alternative treatments: electrical stimulation, time with animals, yoga, aquatic therapy and more.
At Lisova Polyana, a hospital near Kyiv, therapists use “biosuggestive therapy,” a mix of talk, music and touches to the head, chest, shoulders and arms. Even having barbers give haircuts can be therapeutic — a safe encounter with a stranger, giving a sense of routine and care.
The hospital treats soldiers with both psychological harm and physical wounds, including brain injuries like concussions. “This has become an epidemic now because Russian artillery is like rain,” said Ksenia Voznitsyna, the director. She added, “We also work with those who were tortured while in Russian captivity.”
The hardened men can have trouble lowering their guard. For some, touch is threatening. In one group session, hypervigilant warriors struggled to comply with instructions to keep their eyes closed. One shook uncontrollably.
The goal for now is just to get them well enough to return to the front. Long-term recovery must wait.
On a previous rotation away from the front line, Maksym, 35, attacked his roommate during the night, thinking the other soldier was a Russian enemy. After that he insisted on having a room to himself.
The buzzing of bees overhead put him on alert, expecting drones. A shooting range gave him a flashback of battle.
“We lost most of the men in my unit,” he said. “I cry sometimes. When I’m falling asleep, I can visualize it all over again.” He added, “I remember the faces of all our dead comrades.”
Maksym saw little point to the therapies in this stint, his second, at a rehabilitation center outside Kharkiv, in the northeast. But like many soldiers, he was caught between the horrors of the front line and the feeling that it was the only place where he belonged.
“At the front, I know my task and I know my duties,” he said. “But here, I don’t know.” He added: “Maybe one day when the war here is finished, I’ll go to another combat zone somewhere else.”
Between therapy sessions, he sat outside, apart from the others, smoking and staring into the distance, one hand clasped on the back of his neck. He could not help mentally revisiting his every combat move, wracked with guilt.
Yet he said he would return to the front because he could not let his fellow soldiers down. Days later, rejoined them.
On a sunny afternoon in Kyiv, dozens of troops in fatigues gathered at Spirit Rehabilitation Center, to do something most had never done before: Ride a horse.
An instructor led men on horseback around a barn, had them do arm exercises, and told them to lean forward and hug their horses. One soldier, his arms wrapped around his mount’s neck, broke into a wide smile.
“They are learning to ride horses, but it also gives them focus, to be in the here and now, to be present,” said Ganna Burago, founder of the equine therapy program.
Afterward, she gathered the soldiers in a circle and asked how the experience made them feel. One soldier said it made him happy, an emotion he never expected to feel again.
It was the last session of its kind. The program ended for lack of funds.
Among traumatized veterans, there is a common theme with enormous implications: that others cannot possibly comprehend their suffering, that they don’t know how to return to a civilian world that now feels utterly alien.
“You can’t understand because you haven’t smelled it, heard the sounds, the feeling of what it’s like to kill someone,” said Maksym.
Oleksiy Kotlyarov, 36, a military surgeon, sees years’ worth of grisly wounds every day at an understaffed medical station near the front, under incessant shelling, with minimal rest. Suffering depression, panic attacks and bouts of crying, he has been diagnosed with P.T.S.D.
In the field, with a vital job to do, he adapted to fear, he said, but in the capital, where there are crowds and signs of ordinary life, he felt out of control.
At the front, “everything is gray and destroyed,” he said. “Here, people are smiling, having coffee. There, everyone suffers.”
Much of the treatment soldiers get, like sculpting clay and physical therapy, reacquaints them with a world that is not threatening, easing them into ordinary contact with others, including civilians, while occupying their bodies and minds.
“At first, soldiers are apprehensive about art therapy,” said Iaroslav Chabaniuk, a pottery instructor at the internal affairs ministry’s medical center in Kyiv. But, he added, it “gives them a break from their own thoughts.”
The soldiers and those who treat them say Ukraine is just beginning to deal with a mental health crisis that runs deep and will last for years.
Ms. Klyshkan, the wife of Mr. Remezov, said being cheerful, patient and supportive with him required a lot of energy, a need that would not go away soon. She considered getting a paying job, but decided she could not do both.
“The most important thing is that I not expect him to be the same person as he was the last time we saw each other,” she said.
Anton Kosianchuk, 22, one of the soldiers being treated at Lisova Polyana in Kyiv, pointed to a tattoo on his bicep of a screaming, demonic face.
“This is the reflection of my inner condition,” he said.
Dr. Kotlyarov spoke for many soldiers when he said: “I’m not the same person as I was before this war. I have low empathy, I’ve become tolerant to violence.”
Evelina Riabenko and Anna Barsalo contributed reporting.