Afghan syndrome

The war in Afghanistan from 1979 to 1989 is considered one of the most brutal and longest in human history. 10 years of pain and horror, which was the confrontation between Soviet troops and the partisan movement of local residents. Echoes of military actions of that time sound in the hearts of their participants to this day. The ghost of the Afghan war does not let go of former soldiers for a minute, breaking many lives, and its name is "Afghan syndrome".

Let's not discuss how justified our country's participation in this extremely cruel war was, what goal the government of the Soviet Union pursued, sacrificing the lives of its people, who benefited from it. Let's talk about those people who went through this whole nightmare. About very young and mature soldiers, whose peaceful life was forever crossed out by a war that was largely incomprehensible in terms of its goals and excessive cruelty.

Causes of the Afghan syndrome

When it comes to war, it is hard to imagine a person who would go through all its hardships and remain the same. Memories of past events and military actions keep you in constant tension for many years, forcing you to wake up at night in a cold sweat from nightmares, and to react sensitively to any sharp sounds and movements during the day.

The war in Afghanistan is a special conversation. We fought on foreign territory supposedly for the security of our country for 10 years. The cruelty and atrocities of local residents who fought for their principles on the one hand and the lack of understanding of the true goals of their participation in this war on the other - this is the reality that Soviet soldiers faced, who with all their courage rushed to defend the ideals of the government of the Soviet Union.

Most of them were unable to accept this reality, especially considering the fact that most of the combatants were very young guys with fragile psyches, which was the main risk factor for the development of mental disorders on this basis. Constant psycho-emotional stress, contemplation of terrible atrocities and the death of fellow soldiers had a negative impact on the future life of young soldiers, not allowing them to join the once familiar rhythm of life even in peacetime, depriving them of sleep and the ability to enjoy life, undermining their trust in people and communication skills.

This is the "Afghan" syndrome, which has not abated over time and which has taken the lives of many soldiers already in peacetime. They simply could not accept this cruel reality and injustice, could not find themselves in peaceful life and decided to simply leave it, feeling unnecessary and lonely despite the false concern for their future on the part of the country's government.

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Pathogenesis

In essence, the "Afghan" syndrome is a post-traumatic stress disorder that has affected the psyche and socialization of the individual, changing personal qualities and attitudes toward what is happening. Having understood the essence of the far from humane double standards of the ruling forces, the internationalist warriors could not come to terms with this, continuing their war without weapons in peaceful days, uniting in communities in opposition to the government, restoring justice, even through violence, based on the experience of wartime. And all this is manifested against the background of good cohesion and amazing endurance of former fighters, who have united in groups in opposition to the government and society as a whole.

Negative changes in the personal qualities of the "Afghan" soldiers did not allow them to establish relationships in society. The distrust of people, excessive wariness, and emotional instability that shone through in their entire appearance and behavior prevented them from entering a society that continued to live a peaceful life, which the soldiers had become unaccustomed to.

Some people have a heightened sense of justice, because while they were "cooking" in the cauldron of war, others continued to live a calm, measured, happy life. And even after the end of the war, they cannot "return" home in the full sense of the word, because some important part of their soul remained there, in the Afghan trenches.

Others, weaker in spirit, simply withdrew into themselves, locked themselves in their long-lived feelings, as if reliving the events of the war years. Isolating themselves from society, they only made the situation worse. In the end, many of the "loners" committed suicide or died in a "garbage dump" among the homeless from illness or in a drunken brawl, drowning their mental pain in alcohol.

This state of affairs had a negative impact not only on the "Afghans" themselves, but also on their families and friends. The "Afghan" syndrome spared no one. Tens and hundreds of thousands of unfortunate children, broken families, grief-stricken wives and mothers, crippled lives - these are the real results of our participation in "someone else's" war.

In general, there is nothing surprising in the development of the "Afghan" syndrome against the backdrop of a long-term brutal war. Any stressful situation, be it domestic violence, rape, severe physical trauma, a threat to life and health, or the death of a loved one, can lead to the development of a mental disorder officially called post-traumatic stress disorder (PTSD). And what can we say about the case of repeated stressful situations, which is inherent in wartime. It is impossible to go through a war and remain the same.

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Symptoms of the Afghan syndrome

“Afghan” syndrome, like any other type of post-traumatic mental disorder, has symptoms that can be figuratively divided into 3 groups:

• recurring memories of stressful situations related to war and death,
• rejection of reality,
• symptoms associated with increased emotional excitability, mistrust, aggression.

Symptoms of group 1 consist of memories, dreams and hallucinations that haunt the former warrior constantly. The person is unable to control them, visions appear suddenly, pushing real events and experiences occurring in the present time into the background.

Various factors can trigger memories and hallucinations: a familiar smell, a sharp sound, the surrounding environment, and even the posture or voice of the person the former "Afghan" is communicating with. At the same time, the sensitivity of people who have been through Afghanistan is especially heightened.

Against the background of nightmares, where soldiers in peaceful days again experience all the horrors they had to go through, a fear of falling asleep and insomnia develops. Returning to reality after waking up is also very difficult.

Addiction to alcohol and drugs to reduce nervous tension can have the opposite effect in the form of particularly "real" hallucinations, which a person is unable to control. However, as well as to distinguish ghostly events from those actually occurring. In particularly sensitive individuals, such hallucinations can appear even without the influence of drugs and alcohol.

This state of affairs often leads to a person starting to live in this "parallel" reality that has become habitual for him, in fact completely rejecting reality. The symptoms of the "Afghan" syndrome of the second group come to the fore.

A person becomes indifferent to everything that happens around him. Being constantly in a depressive state, he loses the ability to have positive emotions. Joy, feelings of love and empathy, affection and pity become alien to a person under the influence of stress.

A former "Afghan", intuitively trying to protect himself from unpleasant memories, can cut off communication with people from his "past" life. And this concerns not so much former colleagues, but relatives, friends and comrades with whom the person communicated in peacetime. There is a categorical reluctance to create new acquaintances and relationships, complete alienation from the surrounding life.

The third group of symptoms of the "Afghan" syndrome is characterized by increased excitability and alertness due to a constant feeling of insecurity and fear of a repetition of those terrible events, and a readiness to fight back against offenders at any time.

Any reminder of the terrible events experienced causes a violent, not always adequate reaction. If an "Afghan" perceives a threat to life or health in some sound or action, he tries with all his might to protect himself by bending down, falling to the floor, or taking aggressive actions in response, bringing his body to combat readiness. Former internationalist soldiers tend to solve most problems using their fists.

Sometimes, patients with post-traumatic stress disorder develop paranoid states, persecution mania, and impaired attention and memory due to the horrors of war, which negatively affects their quality of life.

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Stages

The symptoms of the "Afghan" syndrome do not appear immediately. In the literature on the war in Afghanistan and its consequences, there is often a mention of the "Afghan" syndrome as a time bomb. Sometimes it takes six months or even more before the first obvious signs of post-traumatic disorder appear.

A loud sound, screaming or crying, a picture or music, words or text can serve as a trigger to start the process. It is difficult to say what can cause a surge of memories in the brain of an emotionally damaged person, which subsequently results in an inadequate perception of reality and psychosocial deviations in behavior.

The development of the "Afghan" syndrome, like any other post-traumatic disorder, occurs in 3 stages. The main stages of the syndrome can be characterized as acute, chronic and delayed stage of development of the pathological condition.

Post-traumatic stress disorder begins at the moment of the event. The first stage of the pathological process lasts from the beginning of the event until its completion. In other words, for soldiers who have been through the war, the first stage of the syndrome covers the entire period of military actions until their end.

It is this stage that is characterized by increased traumatization of the psyche. Fear for one's life, the death of fellow soldiers and friends, horror from what one sees in war are the main emotions during this period. Nevertheless, it is fear that activates the sense of self-preservation and gives strength to fight.

At the end of the war, in the first days of victory and/or returning home, the soldiers feel some relief, bordering on euphoria. During this period, there is a general revival against the background of a good mood, which subsequently (after several hours or days) is replaced by severe apathy and lethargy. Disorientation in space and time, isolation, fixation on one's feelings and emotions, or, conversely, fussiness and anxiety that are unusual for this person are manifestations of the "Afghan" syndrome at the final stage of the 1st stage.

About a month and a half after returning home to his former life, the second stage of post-traumatic stress disorder begins. Consciousness, based on memories of the experience, again mobilizes all the body's forces to protect against a non-existent threat. A person begins to get lost in what is happening, confuses reality with hallucinations, and reacts violently to any word, movement, or event that supposedly poses a threat.

Events of those terrible days come up in his memory more and more often, and the former soldier begins to live by them, isolating himself from people, limiting communication with his relatives. "Afghans" for the most part do not like to talk about what they had to go through, and this only worsens the situation. An incomprehensible anxiety appears, a desire to take revenge on the world for his suffering. Now any careless word or action from other people is perceived with increased aggression.

Depression combined with eternal fatigue is a common condition for internationalist soldiers during this period. They are so fixated on their experiences that they lose interest in life and its joys, they have poor orientation in life situations, their reaction slows down, which makes them quite vulnerable. It is not without reason that many "Afghans" received injuries and mutilations as a result of accidents or misfortunes within six months after the end of military operations, and many, having gone through the horrors of war, stupidly died in peacetime.

In an attempt to escape reality, many warriors resorted to extremes. Alcohol, drugs, indiscriminate sex – these were all attempts to cope with the overwhelming depression.

At the third stage of the "Afghan" syndrome, an exacerbation of symptoms is observed. Sleep and behavioral disorders, nightmares and visions, tremors of the limbs, increased vulnerability, a feeling of worthlessness and uselessness, physical discomfort without an objective reason - symptoms of the 3rd stage of PTSD. In addition, a person is constantly accompanied by an incomprehensible feeling that something bad, some kind of misfortune is about to happen.

Gradually, a person loses control over his life. Some go to extremes: hooliganism, drunkenness, drug addiction become the meaning of their lives, pathological dependencies are formed. Others, on the contrary, stop various contacts with the outside world, remaining alone with their pain. At this stage, suicide is not uncommon.

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Forms

The most common types of accentuations in this case are:

• Demonstrative personality. Such a person is inclined to achieve the goal at any cost, justifying his actions by any means. People prone to hysteria have some "gaps" in memory, when they commit inadequate actions and completely forget about it, they can lie, completely not seeing the difference between truth and lies.
• Stuck personality. This condition is in many ways similar to paranoia. Obsession with one's thoughts and experiences, a violent reaction to difficult memories that does not subside over time (as happens in most cases), aggression, increased conflict and a tendency to long disputes are the striking features of such people.
• Emotional personality. This type includes overly sensitive people who react badly to criticism and various troubles, who are immersed in their grievances and who are constantly in a bad mood.
• Excitable personality. For such people, reason and logic recede into the background. They act under the influence of instincts and momentary impulses, have poor control over their actions, and are prone to rudeness and violence.
• Dysthymic personality. These people tend to notice only the negative aspects of events and life in general, are almost always in a depressed state, avoid crowds of people. They are very withdrawn, prone to hermitism.
• An anxious personality. People of this type are characterized by constant anxiety about their lives and the lives of others. They are overly impressionable and even fearful, although they hide it behind insolence and self-confidence, they react sharply to failures, feel humiliated and unnecessary.
• Schizoid personality. Very closed, immersed in themselves and their experiences, people who show little emotion. In communication with others, they are cold, taciturn and quite reserved.

All these types of behavioral disorders lead to the fact that “Afghans” cannot find their place in peaceful life, do not get along in a group, and bring pain and trouble to their relatives and friends.

Unpleasant consequences of the “Afghan” syndrome can also include the emergence of various phobias (fear of the dark, closed or open spaces, etc.), the occurrence of panic states without apparent reason, escape from reality through alcohol, nicotine, drug or gambling addictions, and involvement in criminal structures.

The symptoms and consequences of the "Afghan" syndrome are such that they cannot but affect the future life of the fighters already in peacetime. Moreover, over time, the guys' condition worsens, and the lack of appropriate therapy can lead to disastrous consequences.

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Complications and consequences

Post-traumatic stress disorder, which is also the "Afghan" syndrome, has another name - delayed stress. The reason for this is that the main consequences of the stress experienced do not appear immediately after the event, but after some time, gradually worsening the situation.

As usual, one problem leads to another. During the day, the guys who went through the war are haunted by memories bordering on hallucinations, so that they cannot distinguish the evil game of the psyche from reality. The horrors of war, experienced again and again, are always accompanied by an emotional outburst, increased excitement, which subsequently causes terrible fatigue and loss of strength. It would be time to rest at night, but unbearably “real” dreams, in which the soldiers again and again go into battle, risking their lives, do not allow them to relax for a minute.

Nightmarish memories in reality and no less terrible dreams that do not let go of the "Afghans" even at night lead to psychosis and problems with falling asleep. From the fear of reliving all the horrors of war in a dream, former soldiers are simply afraid to fall asleep. Insomnia and restless sleep do not allow the body, already tormented by the day, to fully rest.

Waking up at night in a cold sweat, increased heart rate and mental stress cannot but affect the quality of life of the "Afghans". Fatigue accumulates over time, resulting in depression, attention disorders, and, as a consequence, increased trauma, escape from reality through drugs and alcohol, and suicidal tendencies.

But there is another problem that haunts those who survived and returned home after the terrible events. It is the feeling of guilt towards their dead friends and relatives. Afghan soldiers experience this loss again and again and believe that they have no right to live if their friends and comrades are dead. This difficult condition most often ends in a suicide attempt.

Against the background of the experience, various types of personality accentuation can also develop, when several character traits of a person prevail over others, as a result of which the person opposes himself to society, provoking conflicts. Moreover, accentuation in internationalist soldiers, as a complication of the "Afghan" syndrome, is of a pronounced nature.

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Diagnostics of the Afghan syndrome

The symptoms of the "Afghan" syndrome are characterized by so many negative manifestations that it is difficult to imagine a pathology "richer" in this regard. Each person is individual, and therefore the reaction to stressful situations inherent in a military environment can differ significantly. Nevertheless, it is possible to diagnose PTSD against the background of participation in military actions in Afghanistan, as it is possible and necessary to help people who have gone through the war to return to peaceful life.

Experienced psychotherapists should diagnose the condition of internationalist soldiers. No laboratory tests will help here. Differential diagnostics of any PTSD, including the "Afghan" syndrome, is carried out through a conversation between a psychotherapist or psychiatrist and the patient, his family and friends.

Help from relatives in making a diagnosis is especially important, since “Afghans” have a hard time making contact with doctors who deal with mental health problems, considering themselves to be quite healthy, avoiding frank conversations and memories from the past, and reacting violently to interference in their lives.

But early diagnosis in this case is as important as in the case of seriously ill people, the effectiveness of treatment and the future of the defender of the fatherland depend on it. You need to seek help a month after the soldier returns from the war zone, when some symptoms of developing stress disorder are visible, not allowing the process to become chronic.

When diagnosing "Afghan" syndrome, doctors first of all pay attention to the following points:

• Presence and participation in a stressful situation, which is participation in military operations, being in occupied territory, witnessing acts of violence and death.
• What role did the victim play: did he participate in military operations or did he see the events from the outside?
• The presence and frequency of memories of the experience, the ability to control them, the appearance of hallucinations and nightmares, the time of appearance of daytime and nighttime visions.
• The severity of the reaction to memories, the presence of reactions from the autonomic system (changes in pulse strength and frequency, the appearance of cold sweat, etc.).
• A subconscious desire to get rid of the past, to forget all the horrors of war, which manifests itself in an unwillingness to discuss stressful situations associated with the war, attempts to avoid meeting people or situations that remind one of the nightmarish events, gaps in memories (erasing from memory particularly traumatic events).
• The presence of specific symptoms as a reaction to stress: problems falling asleep, waking up at night, irritability and aggression, memory and attention disorders, constant increased anxiety, alertness and fear of repetition of the event, violent reaction to any frightening events (loud sound, sudden movement, etc.).
• The appearance of pain syndrome against the background of a satisfactory state of health.
• For how long are the symptoms of "Afghan" syndrome present? If the symptoms do not subside within a month, this indicates the development of a pathological process.
• Are there any disturbances in the social sphere and how do they manifest themselves? Is there a loss of interest in areas of life and activity that previously attracted the soldier before leaving for war, limited contact with people, increased conflict, lack of plans, a clear vision of his future?

To make an accurate diagnosis, symptoms of at least 3 of the above-mentioned points must be present. At the same time, some symptoms may indicate other mental disorders or be a consequence of a traumatic brain injury. It is very important to separate one pathological process from another, establishing the relationship between the traumatic event and the condition of the "Afghan" soldier. In some cases, psychological testing greatly facilitates this.

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Treatment of the Afghan syndrome

It should be mentioned right away that there is no general treatment plan for this pathology, because the “Afghan” syndrome is not a disease, but a temporary correctable mental disorder that manifests itself differently in each soldier.

To select appropriate methods and means of treating the "Afghan" syndrome, it is necessary to determine the type and stage of stress disorder, based on the existing symptoms and the strength of the manifestation of the corresponding symptoms.

The main method of treating any post-traumatic disorder is psychotherapy. A large role is given here to cognitive-behavioral therapy, based on changing the patient's behavior in order to identify and correct those thoughts that lead to behavioral disorders. In other words, the direction of thinking of internationalist soldiers is changed, obsessive thoughts and ideas, far-fetched fears are combated.

One of the stages of behavioral therapy is the "neutralization" of triggers that initiate the pathological process of mental disorder by gradually accustoming patients to them. To begin with, various "trigger elements" are arranged according to the degree of their influence on the psyche. Then, with their help, attacks of the "Afghan" syndrome are provoked in a medical office, starting with triggers that have a minimal impact. Gradually, the fighter gets used to the triggers, and they no longer cause such a violent reaction.

Many psychologists agree that the basis of the "Afghan" syndrome is the inability to correctly assess the experience of an extreme situation, as a result of which the patient again and again experiences dramatic events, unable to leave them only in the competence of memory. Thus, a person continues to live, but in two realities: the real one and the one invented by the sick consciousness. Such a life does not so much please as oppress a person, not allowing him to be happy and develop.

In order to accept and process dramatic experience, special psychotherapeutic sessions are held, in which the patient is forced to relive the frightening events, discuss them in detail with a psychologist and evaluate them in a new way. Thus, using various methods, it is possible to achieve reconciliation with the past and the transition of fictional reality purely into memories.

It is advisable to combat obsessive memories using promising modern methods, among which one can single out the rapid eye movement technique.

If the patient has a guilt complex or uncontrollable attacks of aggression, individual sessions with a psychologist are recommended to correct these disorders. Group sessions can also be useful, letting the patient understand that he is not alone in his experiences and helping warriors relearn the technique of communication and psychological mutual assistance.

Additional methods of treating mental disorders due to participation in military operations include: auto-training, relaxation (breathing exercises, listening to music that calms the psyche, yoga), drawing (reproducing your fears on paper and accepting them),

If PTSD is acute and the patient is difficult to communicate with, hour-long hypnosis sessions may be needed to help the doctor see the origins of the disorder, reconstruct the full picture of the tragedy that led to the development of unwanted symptoms, and select effective methods and means of treating the “Afghan” syndrome.

The final stage of psychotherapeutic treatment is considered to be the correction of the patient's goals and plans for the future. With the help of a psychologist, the former warrior mentally draws his own new picture of the future, thoroughly outlining the goals and methods of achieving them, life values and main guidelines.

Complex treatment of "Afghan" syndrome

Unfortunately, it is almost impossible to achieve lasting positive results in people with mental disorders using only psychotherapy methods. In this case, a comprehensive approach to treatment is becoming increasingly relevant, especially considering that in many patients, after so many years, the “disease” has become chronic.

Symptoms such as constant nervous tension, increased anxiety, depressive or panic states, vegetative disorders against the background of nightmares and hallucinations can be relieved with the help of medications. And a combination of traditional treatment with effective psychotherapy will help to achieve a fairly quick and lasting effect.

Among the medications used to relieve the symptoms of "Afghan" syndrome, the following groups of drugs should be highlighted:

• Sedatives, such as tincture or tablets of valerian, drugs with sedative, antispasmodic and vasodilatory effects: Corvalol, Validol, etc. Their use is justified in mild cases of PTSD, if the symptoms are limited to manifestations of nervous tension.
• Antidepressants, mainly from the SSRI group, intended for the treatment of anxiety disorders and depressive states, which are well tolerated by the majority of patients (Fluoxetine, Sertraline, Fluvoxamine, Dapoxetine, Cericlamin, etc.). They are used for pronounced symptoms of the "Afghan" syndrome. They effectively help combat manifestations of anxiety, irritability, stop attacks of aggression, improve mood, prevent the emergence of suicidal thoughts, normalize the work of the autonomic nervous system, and combat pathological addictions.
• Tranquilizers (Seduxen, Phenazepam, Diazepam, etc.). They are prescribed as additional means in treatment with antidepressants. This is due to the fact that taking the latter may initially be accompanied by an increase in the symptoms of nervous tension and the first 2-3 weeks require auxiliary therapy with psychotropic drugs.
• Adrenaline receptor blocking drugs, or beta blockers (Anaprilin, Bisoprolol, Nebilet, etc.) are also the number one drugs in the treatment of "Afghan" syndrome. They are used if there are noticeable vegetative disorders accompanying attacks of memories and nightmares.
• Neuroleptics (Aminazin, Propazine, Tizercin, Triftazin, Risperidone, etc.). Their choice is justified when increased excitability of the psyche manifests itself in the form of hallucinations and displaced reality.

Symptomatic therapy is also carried out with anticonvulsants (attacks of aggression against the background of drug addiction - "Magnesium sulfate", "Carbamazepine"), tranquilizers from the benzodiazepine group (vegetative disorders against the background of increased anxiety - "Tranxen", "Xanax"; nightmares and sleep disorders - "Dormicum", "Sonex"). Sometimes, adjuvant therapy with drugs from the nootropic group can be prescribed (stimulation of the central nervous system, if the "Afghan" syndrome is accompanied by increased fatigue, irritability and frequent mood swings).

Prevention

The best preventive measure is to prevent an event from happening. However, it is not applicable in this situation. Participation in military operations always leaves its mark on a soldier's life, affecting his mental health. Understanding this, you should not wait for the symptoms of post-traumatic syndrome to appear. To prevent serious consequences, it makes sense to seek psychological advice within the first month after returning from the war or at least when the first signs of the development of "Afghan" syndrome appear.

If post-traumatic disorder is characterized by a mild course, which is extremely rare in the case of participation in combat operations, the psyche of a person surrounded by the love and care of relatives can return to normal on its own. Psychological assistance will only help speed up this process.

With pronounced PTSD symptoms, you can’t do without the help of specialists. If the situation is left as is, more than 30% of internationalist soldiers will commit suicide due to a severe mental disorder. The success of treating such patients will depend on the timeliness of seeking medical help, the participation and support of family and friends, and the “Afghan”’s attitude to a favorable outcome. It is also very important during rehabilitation activities and after the former soldier’s return to normal life to exclude factors of psychological and physical trauma that can cause relapses.

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Forecast

The sooner a person seeks help, the more favorable the prognosis for recovery will be, the faster and easier the process of socialization and the warrior’s return to peaceful life in society will be.

"Afghan" syndrome is in some way a figurative concept applicable to all soldiers who had to defend the interests of their native country at the cost of their lives and health. Everything that is said about "Afghan" soldiers and the consequences of "combat" stress also applies to other participants in military actions, no matter on whose territory and at what time they were carried out.

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