"I didn't know that there was anything left in me. But after the fourth session, I saw the real me.And I realized that all is not lost." -Andriy, war veteran, former Ukrainian prisoner of war.
In my practice, I have seen many difficult stories. I myself have participated in many tactical and psychological debriefings with our captives, conducted more than 300 combat debriefings in the units of the Armed Forces of Ukraine, participated in reintegration programs after exchanges, and underwent specialized training at the National Defense University in the program of reintegration and post-isolation support. But this case is special because it is critically difficult. Severe depression always has a high risk of suicide.
A veteran who survived more than two months of captivity by the Wagnerites came to our clinic. He was captured near Bakhmut in late 2023. He was captured by the orcs wounded after a heavy battle in which almost all his comrades were killed, and he himself received concussion and grenade wounds.
Attempts to execute him on the spot of capture, brutal beatings, physical and mental torture throughout his captivity, intimidation by shooting, forced starvation and insomnia.
He came to us after a long period of treatment and work with a psychologist, but still in a severe depressive state. He hardly spoke, only short phrases, unwilling to live, exhausted, broken, deeply withdrawn. His body was traumatized. His psyche was in a constant state of defense. Deep sleep, human trust, memory, the joy of living-everything was erased, or everything was protected by a defensive mask (pattern) that had managed to replace his pre-war behavioral patterns. And this was exactly the kind of case that we are taught about in psychiatry departments-the destruction of a personality, when a person seems to be "frozen" inside-emotionally, physically, spiritually-and it is almost impossible to reach him or her.
Such stories of severe depression often end in tragedy. In general, captivity by orcs causes severe deep personality changes that are difficult to recover from.
Our team was facing a difficult case. Everyone realized this. And we chose the following approach: a combination of psychiatry, psychedelic medicine and modern psychotherapeutic interventions.
Our treatment plan was individualized, taking into account the severe consequences of torture and mental exhaustion. It included:
🔹 Short-term sedation with propofol
🔹EMDR
🔹 Drug therapy with antidepressants
🔹 Preparatory psychotherapy for Ketamine-assisted therapy (KAT) *.
🔹 Several sessions of CAT.
🔹 Integrative metaphorical psychotherapy using Pure Language and Symbolic Modeling.
*Ketamine in subanesthetic doses was used under controlled conditions. It opened access to deep, blocked experiences and images.
At the preparatory stage, using EMDR, we managed to "reconstruct and go through" the day of captivity with all the details that came up during the memories: capture, transportation, first interrogation, torture in a "glass," other traumatic details and circumstances that were important to remember in a safe therapy room.
Next was "Pure Language," which opened up a world of metaphors, symbols, and internal images with which the patient interacted without re-injuring himself. Through symbolic representation of the body (color and shape of pain), his feelings, grounding and focusing on breathing (mindfulness exercises), existential search for meaning, discussing problems, desired results and ways to achieve them, he gradually regained the ability to feel, live and speak.
The therapeutic teamwork allowed us to shift the internal "armor" that the veteran wore after the torture of captivity. Memories, emotions, and images emerged, and together we went through this path to integrating the trauma.
The result: he's back!
Two and a half months later, we saw a man who not only survived, but started living.
He started talking, returned to his girlfriend, started meeting people, writing his memoirs and just wanted to live. Now he participates in veteran programs and dreams of helping others who have lost themselves in the darkness of captivity.
"It was not just a treatment, it was a rebirth. I don't know how you did it, but I am here again. And I am," He told me during our last meeting.
Why am I writing this?
There will be many more such stories. And we must be ready for them - not only as a state, but as a medical community, as a society. Treatment of PTSD, severe depression after captivity, and complex trauma is a challenge for which we already have the tools. They exist in Ukraine. And they work. And military psychologists and psychiatrists from all over the civilized world are learning from us. Yesterday, I had a conversation with the authors of the Montreal model of ketamine-assisted therapy, which we have already supplemented with our approach.
And yet, this is not just a medical case. This is a story about the way home of one of the thousands of our Heroes who served in captivity in special conditions, preserving their dignity and love for the Motherland. We should be grateful to them for their service.
The government and big business should help finance such assistance.
Vladyslav Syniagovsky
Psychiatrist, psychotherapist, military psychologist at the Experio Center
Photo by Cherkasy Regional State Administration
