Inside a psychiatric hospital in Kyiv, the mental trauma of the war is written on every soldier’s face.
Voices From Pavlivka
It’s been a month since “the tragedy,” as he calls it. When the subject arises, he freezes and looks at the floor. He gulps for air. He cannot say it.
His doctor, a motherly woman, speaks for him: There were four of them. They were stationed near the front line, in eastern Ukraine, and on that night they shot a Russian drone from the sky. A small victory. Then its wreckage hurtled down, hunks of ragged metal slicing into the men below. He was the only one left standing.
In the numb hours that followed, someone came to collect the others — one dead, two wounded — and he was left to hold the position alone through that freezing night and into the next day.
By the time they came for him, he could not find words. “That’s it,” the psychiatrist said. “He withdrew into himself and doesn’t want anything.”
The soldier has been sent for treatment at a Kyiv psychiatric hospital named for Ivan Pavlov — Pavlivka, as it is known. In peacetime, Pavlivka treated people with severe mental illnesses, mostly schizophrenia, but the war has forced a pivot. Hospitals in Ukraine cannot manage the volume of psychiatric casualties coming in, and commanders need their troops back. Last June, Pavlivka opened an overflow unit with 40 beds, but six weeks later, it grew to 100.
The soldier’s ward is a quiet place, high-ceilinged, with chess boards and a Ping-Pong table; you could mistake it for a rest home, except that the door handles have been removed.
Nurses make the rounds to distribute pills or to take the patients for injections. The soldiers wear uniforms, but their packs and boots are lined up on the floor beside their beds. In the ward, they wear slippers.
A junior lieutenant named Ruslan has the same dream, over and over: He dives for a trench, but it is not a trench; it is a grave. He keeps his visits with his wife and children short. “I would like to lie in a hole somewhere and hide,” he says.
One soldier says when he returned from the combat zone he no longer had the ability to sleep. Another says he can no longer tolerate crowds, that his thoughts are “like when you go fishing, and you tangle the line.” The ward is full of stories like this.
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Each war teaches us something new about trauma. In World War I, hospitals overflowed with soldiers who screamed or froze or wept, described in medical texts as “moral invalids.” By the end of World War II, a more sympathetic view had emerged, that even the hardiest soldier would suffer a psychological collapse after sufficient time in combat — somewhere, two experts from the surgeon general’s office concluded, between 200 and 240 days on average.
Russia’s war in Ukraine stands out among modern wars for its extreme violence. Its front lines are close together and barraged with heavy artillery, and rotations from the front line are infrequent. Ukraine’s forces are largely made up of men and women who, until a year ago, had no experience of combat.
“We are looking at a war that is basically a repetition of the First World War,” says Robert van Voren, who heads the Federation Global Initiative on Psychiatry, which provides mental-health support in Ukraine. “People just cannot fight anymore for psychological reasons. People are at the front line too long, and at a certain point, they crack. That’s the reality we have to deal with.”
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With each conflict, our view of trauma has become more expansive. In the aftermath of Vietnam, it became clear that wartime experiences could imprint a generation of men, making it difficult for them to work or take part in family life.
Now researchers believe that the effects of trauma may stretch even further, beyond the end of a human life, encoding traits that shape children not yet born.
These possibilities haunt Dr. Oleh Chaban, a psychiatrist who has advised Ukraine’s Defense Ministry. He has observed Ukraine’s soldiers since 2014, when Russia seized Crimea. Chaban finds them intensely focused in combat, sharpened by adrenaline. It’s when they leave the war zone that symptoms begin to surface, nightmares and flashbacks and insomnia.
Chaban, a professor of psychology at the Bogomolets National Medical University in Kyiv, worries about what this will mean in years to come. Epidemiologists studying children born after famine have found, decades later, traces of what their parents experienced. Higher rates of obesity, schizophrenia, diabetes. Their lives are shorter. “It worries me,” he says. “I want my grandchildren and great-grandchildren to live in a country called Ukraine.”
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For the doctors at Pavlivka, it is all they can do to keep up. Dr. Antonina Andrienko, who oversees one of the soldiers’ wards, realized, early on, that her workload would not allow her to go home. On weeknights she sleeps on a cot in her office.
In her ward, the soldiers rest and take smoke breaks. There is no gym — just two exercise bikes in a room off her office — and no psychotherapist. Standard treatment at the hospital, says its director, Dr. Vyacheslav Mishyev, “is as it was: mostly medication.”
After three or four weeks, soldiers return to their units to be assessed by a medical commission. Mishyev estimates that some 70 percent of them will return to duty.
“This is the reality in which we work,” he says. “Either we return them to the armed forces or we recommend to declare them unfit for military service due to pronounced changes in personality and psychological trauma.”
In her office, Dr. Andrienko listens to them, sometimes for hours. She starts by asking about simple things, the pain in a soldier’s back or stomach, circling around the subject of the terrible things they have seen. This is what they need, she says: someone to listen to their stories. Their wives and children cannot do it.
Once they start talking, it can be hard to get them to stop. There was a soldier whose parents lived in the gray zone, and they were sitting in the kitchen when someone threw a grenade in their window. He went home to collect their remains and took two bags. One for his father, one for his mother.
“What tablet will help?” the psychiatrist said. She groped for something to say to the soldier, and finally told him, “to compensate for this somehow, you have to find a girl and marry, and give birth to five children, and give them all the love which you could not receive from your parents.” Her voice wavered. She swallowed.
“In the current situation, no pill will help,” she said.
The soldiers describe symptoms coming on mysteriously, as a failing of the body. Oleksandr, a fisherman before the war, began to feel it during a rotation from the combat zone. He stuttered, his hands shook, his blood pressure rose. He was no longer in danger, but his body was permanently on alert.
Ruslan, the junior lieutenant, was an art teacher before the Russian invasion. Now he cannot shake the feeling that something terrible is about to happen. In Bakhmut, he commanded a sapper unit and was assigned to plant mines in front of Ukrainian lines, steering a vehicle loaded with ammunition and men, back and forth, back and forth, under fire. He made it through, incredibly, but this is the paradox: Now the experience is with him all the time.
“All the horrors in Bakhmut are now starting to haunt me,” he says. “It was hell; I live in hell.”
Many describe a feeling of remoteness, even among family. Valeriy, who was a construction worker before the war, says: “Sometimes my wife talks to me, and then she will notice. She says, ‘Did you hear what I said?’” It’s true; sometimes he can’t hear her. His thoughts rotate on an axis, something that happened at the front: a whole crew, his friends, who burned to death inside a tank. He remembers their names, their hometowns, their positions, the names of their wives.
Valeriy recalls promising one of them, in a conversation just before sleep, to help fix his roof. “Our beds were next to each other, and then he was gone,” he says. The bodies had not been retrieved from the site of the fire, and this fact eats at him. Another thing eats at him, too: One wife asked how her husband died, and he could not tell her.
“Sometimes I wake up at night and can’t breathe,” he says. “It takes time to calm down. I have a pill ready on my bedside table to take right away.”
He has been in the ward since the summer, but other men arrive and depart. The soldier stunned into silence by the drone attack was off again last week, scheduled to appear before a medical commission that would determine whether he was fit to return to war.
“He was grasping at straws to avoid going back,” Dr. Andrienko says. This is a familiar refrain, she says: “Mama Tonia, write something so I can stay another two days.” She tries to approach these questions practically; the country is fighting a full-scale war.
Before the soldiers leave, she takes their photographs. She hangs them on the wall so she won’t forget them — the living ones in a gallery in her office, and the dead ones in the hallway outside.
