The Afghan Syndrome

The war in Afghanistan, 1979-1989. Is considered one of the most cruel and longest in the history of mankind. 10 years of pain and horror, which was the confrontation of Soviet troops and partisan movement of local residents. The echoes of military operations of that time sound in the hearts of their participants to this day. The specter of the Afghan war does not let the former soldiers for a single minute, breaking many lives, and the name "Afghan Syndrome".

We will not argue how justified was the participation of our country in this extremely brutal war, what purpose the government of the Soviet Union pursued, sacrificing the lives of its people, who benefited. Let's talk about those people who went through this whole nightmare. About very young and mature warriors, whose peaceful life was forever crossed out in many ways incomprehensible with respect to their goals and exorbitant cruelty by the war.

Causes of the afghan syndrome

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

The war in Afghanistan is a special one. We fought in a foreign territory allegedly for the safety of our country for 10 years. The brutality and brutality of local residents who fought for their principles on the one hand and the failure to understand the true aims of their participation in this war on the other - this is the reality that Soviet soldiers encountered with courage, who rushed to uphold the ideals of the government of the Soviet Union.

Most people could not accept this reality, especially if we take into account the fact that most of the participants in the fighting turned out to be very young children with a weak psyche, which was the main risk factor for the development of mental disorders on this basis. The constant psycho-emotional tension, the contemplation of terrible atrocities and the death of brother-soldiers adversely affected the future life of young soldiers, not allowing them even in peacetime to join the habitual once-rhythm of life, depriving them of sleep and the ability to enjoy life, undermining their trust in people and communication skills.

Such is it, the "Afghan" syndrome that has been unsettling over time, which took the lives of many warriors already in peacetime. They simply could not accept this cruel reality and injustice, could not find themselves in a peaceful life and decided to just leave it, feeling themselves unnecessary and lonely despite the false care for their future by the government of the country.

[1], [2], [3]

Pathogenesis

In its essence, the "Afghan" syndrome is a post-traumatic stress disorder that affects the psyche and the socialization of the personality, which has changed personal qualities and attitude towards what is happening. Realizing the essence of the far from humane double morality of the ruling forces, the internationalist soldiers could not reconcile themselves to this, continuing their war without weapons on peaceful days, uniting in opposition to the government of the community, restoring justice, even by violence, based on the experience of war times. And all this is manifested against the background of good cohesion and amazing endurance of former fighters, united unanimously in oppositions to the government and the society as a whole of the group.

Negative changes in the personal qualities of the "Afghan" soldiers did not allow them to establish relations in society. The distrust of people, their excessive suspicion, emotional instability, which prevented them from entering a society that continues to live a peaceful life, from which the soldiers have become unaccustomed, manifested in their entire appearance and behavior.

Some people felt a sense of justice, because while they were "brewing" in the cauldron of war, someone continued to live peacefully with a measured happy life. And they, even after the war, can not "return" home in the full sense of the word, because some important part of their souls remained there, in the Afghan trenches.

Others, weaker in spirit, simply withdrew into themselves, locked in their long-lived feelings, as if re-living the events of the war years. Isolating themselves from society, they only aggravated the state of affairs. In the end, many of the "singles" ended their lives by suicide or died in a "garbage" among homeless people from illnesses or in a drunken brawl, pouring out spiritual pain with alcohol.

This state of affairs negatively affected not only the "Afghans" themselves, but also their relatives and friends. The "Afghan" syndrome spared no one. Tens and hundreds of thousands of unhappy children, ruined families, grief-stricken wives and mothers, crippled fates - these are the real results of our participation in the "alien" war.

In general, there is nothing surprising in the development of the "Afghan" syndrome against the backdrop of years of brutal war. Any stressful situation, whether 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 repetition of stressful situations, which is inherent in the war time. It is impossible to go through the war and stay the same.

[4], [5], [6], [7]

Symptoms of the afghan syndrome

"Afghan" syndrome, like any other kind of post-traumatic mental disorder, has symptoms that can be divided into three groups:

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

The symptomatology of group 1 consists of memories, dreams and hallucinations, which persecute the former warrior permanently. Man can not control them, visions arise suddenly, pushing away real events and experiences occurring in the present tense, to the background.

Recall memories and hallucinations can various factors: a familiar smell, a sharp sound, the surrounding situation and even the pose or voice of a person with whom the former "Afghan" communicates. At the same time, the sensitivity of people who have gone through Afghanistan is especially high.

Against the backdrop of nightmarish dreams, where soldiers in peace days are once again experiencing all the horrors through which they had to go through, a fear of falling asleep and insomnia develops. Return to reality after awakening is also very difficult.

The addiction to alcohol and drugs to reduce nervous tension can have the opposite effect in the form of especially "real" hallucinations, which a person can not control. However, as well as to distinguish ghostly events from occurring actually. In particularly sensitive individuals such hallucinations can appear even without the influence of drugs and alcohol.

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

A person becomes indifferent to everything that happens around. Being constantly in a depressed state, he loses the ability to positive emotions. Joy, feelings of love and empathy, caress and pity become alien to the person who is under the influence of the experienced stress.

The former "Afghan", intuitively trying to protect himself from unpleasant memories, can prevent communication with people from the "past" life. And this applies not so much to former colleagues, how many close, friends and associates with whom a 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 sense of insecurity and fear of recurrence of those terrible events, a willingness at any time to rebuff the offenders.

Any reminder of the terrible events that have been experienced causes a stormy, not always adequate reaction. If in some sound or action "Afghan" sees a threat to life or health, he tries to defend himself with all his strength, crouching, falling to the floor, or taking counter aggressive actions, bringing his body into combat readiness. Former internationalist warriors tend to solve most of the problems with the use of kulaks.

Sometimes in patients with post-traumatic syndrome against the background of the horrors of war, paranoid states, persecution mania develop, attention and memory are disturbed, which negatively affects the quality of their life.

[8], [9], [10],

Stages

The symptomatology of the "Afghan" syndrome does 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 delayed-action mine. Sometimes it should take six months or more before the first obvious signs of post-traumatic disorder appear.

Trigger, or trigger, to start the process can serve as a loud sound, screaming or crying, picture or music, words or text. It is difficult to say that in the brain of an emotionally injured person, it can cause a surge of memories that later develops into 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 syndrome originates at the time of the event. The first stage of the pathological process lasts from the beginning of the event to its completion. In other words, for warriors who have passed through the war, the first stage of the syndrome covers the entire period of hostilities until their end.

It is this stage characterized by increased traumatization of the psyche. Fear for their lives, the death of fellow soldiers and friends, the horror of what they saw in the war - the main emotions in this period. Nevertheless, it is fear that activates a 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, fighters feel some relief bordering on euphoria. During this period there is a general revival amid a good mood, which later (after a few hours or days) is replaced by a strong apathy and lethargy. Violation of orientation in space and time, isolation, looping on their feelings and emotions, or, on the contrary, unaccustomed to this person fussiness and anxiety - 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 the memories of the experience, once again mobilizes all the forces of the body to protect against a non-existent threat. The person begins to get lost in what is happening, confuses reality with hallucinations, reacts violently to any word, movement or event that is supposedly a threat.

In memory, the events of terrible days are increasingly emerging, and the former warrior begins to live by them, fencing off people, limiting communication with relatives. "Afghans" for the most part do not like to talk about what they went through, and this only aggravates the situation. There is an incomprehensible anxiety, a desire to take revenge on the world for their suffering. Now any careless word or act from other people is perceived with increased aggression.

Depression combined with eternal fatigue - the usual state of soldiers-internationalists in this period. They are so fixated on their experiences that they lose interest in life and its joys, they are poorly oriented in life situations, their reaction slows down, which makes them quite vulnerable. Not without reason, many "Afghans" were injured and maimed in the course of six months after the end of hostilities as a result of accidents or accidents, and many in a stupid way, passing through the horrors of war, perished in peacetime.

Trying to get away from reality, many warriors struck at extremes. Alcohol, drugs, sex indiscriminately are all attempts to cope with the surging depression.

At the third stage of the "Afghan" syndrome there is an exacerbation of symptoms. Sleep and behavior disorders, nightmares and visions, tremor of extremities, increased vulnerability, sensation of worthlessness and uselessness, physical malaise without objective reason - symptomatology of the 3rd stage of PTSD. Plus, the whole person is accompanied all the time with incomprehensible on what based the feeling that something bad is going to happen, some misfortune.

Gradually, a person loses control of his life. Some are struck in all serious: hooliganism, drunkenness, drug addiction become the meaning of their life, pathological dependencies are formed. Others, on the contrary, stop various contacts with the outside world, remaining one on one with their pain. At this stage, cases of suicide are not uncommon.

[11], [12],

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, by any means justifying his actions. People who are prone to hysteria, there are some "dips" in memory, when they commit inappropriate actions and completely forget about it, they can lie, completely not seeing the difference between truth and lies.
• A stuck personality. This state is similar in many respects to paranoia. The obsession with one's thoughts and feelings, the violent reaction to heavy memories that do not cease with time (as it happens in most cases), aggression, increased conflict and a tendency to protracted disputes are the bright features of such people.
• Emotional personality. This type includes overly vulnerable people, who react heavily to criticism and various disorders, immersed in their grievances, constantly in a bad mood.
• Excitable personality. In such people, reason and logic go to the background. They act under the influence of instincts and momentary motives, they do not control their actions well, are prone to rudeness and violence.
• Dysthymic personality. These people tend to notice only the negative aspects of events and life in general, almost all the time are in a depressed state, avoiding the accumulation of people. They are very closed, inclined to recluse.
• Anxious person. People of this type are characterized by constant concern for their lives and for the lives of others. They are too impressionable and even timid, although they hide it behind insolence and self-confidence, they react sharply to failures, feel humiliated and unnecessary.
• The schizoid personality. Very closed, immersed in themselves and their experiences, people who show little emotion. In communicating with others, they are cold, laconic and sufficiently restrained.

All these kinds of behavioral disturbances lead to the fact that "Afghans" can not find their place in a peaceful life, do not get along in a team, bring pain and trouble to relatives and friends.

Unpleasant consequences of the "Afghan" syndrome can be considered the appearance of various phobias (fear of darkness, closed or open spaces, etc.), the emergence of panic conditions for no apparent reason, escape from reality through alcohol, nicotine, drug or game addiction, involvement in criminal structures.

Symptoms and consequences of the "Afghan" syndrome are such that they can not but affect the future lives of fighters already in peacetime. And over time, the condition of children is getting worse, and the lack of appropriate therapy can lead to disastrous consequences.

[13],

Complications and consequences

Post-traumatic stress disorder, which is also the "Afghan" syndrome, has one more name - deferred stress. The reason for this is that the main consequences of the experienced stress are not manifested after the end of the event, but after a while, gradually exacerbating the situation.

As usual, one problem pulls the other. The children of the past war are haunted by memories bordering on hallucinations, so that they can not distinguish the evil play of the psyche from reality. Again and again experienced horrors of war are always accompanied by an emotional outburst, increased excitement, causing subsequently terrible fatigue, a breakdown. It would be time to rest at night, and unbearably "real" dreams, in which the soldiers again and again go into battle, risking their lives, do not allow you to relax for a minute.

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

Night awakenings in a cold sweat, increased heart rate and mental stress can not but affect the quality of life of "Afghans". Fatigue accumulates over time, pouring out into depression, disturbing attention, and, as a result, increased traumatism, avoiding reality through drugs and alcohol, suicidal tendencies.

But there is another problem, which deprives people, survivors and returned home after terrible events. This is a sense of guilt for dead friends and loved ones. Soldiers-"Afghans" again and again experience this loss and believe that they do not have the right to live if friends and fellow soldiers are not alive. This serious condition most often ends with an attempted suicide.

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

[14], [15],

Diagnostics of the afghan syndrome

The symptomatology of the "Afghan" syndrome is characterized by so many negative manifestations that it is difficult to imagine a more "pathological" pathology in this respect. Each person is individual, and therefore the reaction to stressful situations, typical of the military situation, can significantly differ. Nevertheless, to diagnose PTSD on the background of participation in military operations in Afghanistan, it is possible, as possible and necessary, to help people who have gone through the war to return to peaceful life.

Experienced psychotherapists should conduct diagnostics of the condition of internationalist soldiers. No laboratory tests here will help. Differential diagnosis of any PTRS, including the "Afghan" syndrome is conducted with the help of a psychotherapist or psychiatrist's conversation with the patient, his relatives and friends.

The help of relatives in the diagnosis is especially important, since the "Afghans" are hard pressed to contact physicians dealing with mental problems, considering themselves to be completely healthy, avoiding frank conversations and memories from the past, vigorously reacting to interference in their lives.

But the early diagnosis in this case is also important, as in the case of seriously ill people, the effectiveness of treatment and the future of the defender of the fatherland depend on this. Seeking help should be a month after the soldier returns from the war zone, when some symptoms of a developing stress disorder are seen, preventing the process from going into a chronic form.

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

• The presence and participation in a stressful situation, which is participation in military operations, being in the occupied territory, contemplation of acts of violence and death.
• In what role was the victim speaking: whether he participated in military operations or saw events from outside.
• The presence and frequency of memories of the experience, the ability to control them, the emergence of hallucinations and nightmares, the time of day and night vision.
• The severity of the reaction to memories, the presence of reactions from the vegetative system (changes in strength and pulse frequency, the appearance of cold sweat, etc.).
• The desire at the subconscious level to get rid of the past, to forget all the horrors of the war, which manifests itself in the unwillingness to discuss stressful situations related to the war, attempts to avoid meeting people or situations reminiscent of nightmarish events, gaps in memories (the erasure of memory of especially injurious incidents) .
• The presence of specific symptoms as a reaction to stress: problems with falling asleep, night waking up, irritability and aggression, memory and attention disturbances, constant increased anxiety, alertness and fear of recurrence of the event, violent reaction to any frightening events (loud sound, sharp movement, etc.) .
• The appearance of pain syndrome on the background of a satisfactory state of health.
• How long has the symptom of the "Afghan" syndrome been observed? If the symptoms do not die out within a month, this indicates the development of the pathological process.
• Are there any violations in the social sphere and how are they manifested? Is there a loss of interest in the spheres of life and activity that used to attract a fighter before his departure for war, limit contact with people, increased conflict, lack of plans, a clear vision of his future.

To establish an accurate diagnosis, the presence of symptoms of at least 3 of the above points is necessary. However, some symptoms may indicate other disorders of the psyche or be a consequence of a traumatic brain injury. It is very important to separate one pathological process from the other, establishing the relationship between the traumatic event and the condition of the "Afghan" warrior. In some cases, this is greatly facilitated by psychological testing.

[16], [17], [18]

Treatment of the afghan syndrome

It should be mentioned at once that there is no general treatment for this pathology, because the "Afghan" syndrome is not a disease, but a temporary correctable mental disorder that every fighter has his own way.

To select the appropriate methods and means for treating the "Afghan" syndrome, you need to determine the type and stage of the stress disorder, based on the symptomatology and the strength of the corresponding symptoms.

The main method of treating any post-traumatic disorder is psychotherapy. A large role is played here by 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 being changed, the struggle with obsessive thoughts and ideas, far-fetched fears.

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

Many psychologists agree that the "Afghan" syndrome is based on 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 already in two realities: the real and imagined by the sick mind. Such a life is not so much pleasing as it oppresses a person, not allowing him to be happy and develop.

With the purpose of acceptance and processing of dramatic experience, special psychotherapeutic classes are conducted, on which the patient is forced to relive frightening events, discuss them in detail with a psychologist and evaluate in a new way. Thus, applying various techniques, it is possible to reconcile with the past and the transition of fictional reality purely to memories.

Combating obsessive memories is advisable to conduct promising modern methods, among which one can single out the technique of rapid eye movements.

If a patient has a complex of guilt or uncontrollable attacks of aggression are observed, individual sessions with a psychologist for correcting these violations are shown. Group exercises can also prove useful, making it clear to the patient that he is not alone in his experiences, and helping warriors re-learn the techniques of communication and psychological mutual help.

Additional methods of treating psychiatric disorders against the background of participation in hostilities include: self-training, relaxation (breathing exercises, listening to music that soothes the psyche, yoga), drawing (reproducing your fears on paper and accepting them),

If PTSD occurs in an acute form and the patient does not make good contact, hours of hypnosis sessions may be needed that help the doctor to see the origins of the disorder, restore the full picture of the tragedy that led to the development of unwanted symptoms, and select effective ways and means of treating the "Afghan" syndrome.

The final stage of psychotherapeutic treatment is the correction of the patient's goals and plans for the future. With the help of a psychologist the former warrior mentally paints his own, new picture of the future, thoroughly drawing out the goals and methods of their achievement, life values and basic guidelines.

Complex treatment of the "Afghan" syndrome

Unfortunately, it is almost impossible to achieve persistent positive results in people with mental disorders alone using the methods of psychotherapy. In this case, a comprehensive approach to treatment is becoming more relevant, especially if we consider that in many patients, after many years, the "illness" has acquired a chronic form.

To stop such symptoms as constant nervous tension, increased anxiety, depressive or panic state, vegetative disorders against the background of nightmares and hallucinations can be achieved with the help of medications. A combination of traditional treatment with effective psychotherapy will help to get a fairly fast and lasting effect.

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

• Soothing (sedative) remedies, such as tincture or valerian tablets, preparations with sedative, spasmolytic and vasodilating action: Corvalol, Validol, etc. Their appointment is justified for easy PTSD if the symptoms are limited to manifestations of nervous overexertion.
• Antidepressants, mainly from the SSRI group, are designed to treat anxiety disorders and depressive conditions that are well tolerated by the majority of patients (Fluoxetine, Sertraline, Fluvoxamine, Dapoxetine, Zericlamine, etc.). They are used for severe symptomatology of the "Afghan" syndrome. Effectively help to combat the manifestations of anxiety, irritability, stop attacks of aggression, improve mood, prevent the appearance of suicidal thoughts, normalize the work of the vegetative system, struggle with pathological dependencies.
• Tranquilizers (Seduxen, Fenazepam, Diazepam, etc.). They are prescribed as additional agents in the treatment of antidepressants. This is due to the fact that the reception of the latter can initially be accompanied by an increase in the symptoms of nerve strain and the first 2-3 weeks require auxiliary therapy with psychotropic drugs.
• Drugs that block adrenaline receptors, or beta-blockers (Anaprilin, Bisoprolol, Nebilet, etc.) are also the number one drugs in the treatment of the "Afghan" syndrome. They are used if there are noticeable vegetative disorders accompanying bouts of memories and nightmares.
• Neuroleptics (Aminazine, Proparazin, Tyzercin, Triftazin, Risperidone, etc.). Their choice is justified, when the increased excitability of the psyche is manifested in the form of hallucinations and a substituted reality.

Symptomatic therapy with anticonvulsant drugs (attacks of aggression against the background of drug dependence - "Magnesium sulfate", "Carbamazepine"), tranquilizers from the benzodiazepine group (vegetative disorders against the background of increased anxiety - "Tranxen", "Xanax", nightmares and sleep disturbances - "Dormikum", "Sonex.") Sometimes, ancillary 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 changes of mood).

Prevention

The best measure of prevention is the prevention of an event. That's only in this situation it is not applicable. Participation in hostilities always leaves its mark on the life of a warrior, reflecting on his mental health. Realizing this, you do not need to wait for the symptoms of post-traumatic syndrome. To prevent serious consequences, it makes sense to seek psychological counseling within the first month after returning from the war, or at least with the appearance of the first signs of the development of the "Afghan" syndrome.

If the posttraumatic 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 love and care of relatives can return to normal on their own. Psychological help will only help accelerate this process.

With a pronounced symptomatology of PTSD without the help of specialists can not do. If the situation is left as it is, more than 30% of internationalist soldiers will end their lives by suicide amid a strong mental disorder. The success of the treatment of such patients will depend on the timeliness of seeking medical help, the participation and support of relatives and friends, the attitude of the "Afghan" himself to a favorable outcome. It is also very important during the rehabilitation activities and after the return of the former soldier to normal life, to exclude the factors of psychological and physical trauma, which can cause relapses.

[19], [20], [21], [22], [23]

Forecast

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

The "Afghan" syndrome is in some ways a figurative concept applicable to all soldiers who, at the cost of their lives and health, had to protect the interests of their native country. All that is said about "Afghan" soldiers and the consequences of "combat" stress concerns other participants in the hostilities, no matter on whose territory and at what time they were conducted.

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