PSYCHOSOCIAL SUPPORT FOR PEOPLE WHO PASS AN ARMED CONFLICT

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Content
Introduction
1. Psychology of War
1.1. Modern local conflicts and their impact on society
1.2. Members of armed conflict as an object of the impact of a traumatic situation
2. Psychology participants in armed conflict
2.1. Features of mental reactions in soldiers affected by armed conflict
2.2. Post-traumatic stress syndrome: causes and mechanism of development of the participants of armed conflicts
2.3. Symptoms and consequences of post-traumatic syndrome in the former military
3. Adaptation and rehabilitation of members of armed conflicts
3.1. The legislative framework for the rehabilitation and adaptation of members of armed conflicts in Russia
3.2. Psychological and medical rehabilitation of military personnel - members of military conflicts
3.3. Technology social work with the participants of military conflicts on their psychosocial adjustment to civilian life
Conclusion
References
Application
? Introduction
Many of the millennium, humanity, along with the development of culture, science, public awareness to improve the forms, means and methods of armed resolution of various conflicts. On the eve of the XXI century the problem of using military force in dealing with these or other contentious issues does not give grounds to hope that the nightmares and the horrors of war will remain only in the history of mankind. Terrorism as a means of achieving political and economic objectives are not only rooted in the past, but downright blooms in some regions of the world, including in the suffering of the CIS. And while there is a threat of armed violence, there will be a need to counter that threat, as with the use of armed force.
Those who passed the test of war, given the opportunity to discover and know yourself in a situation when you find yourself in front of the main terrestrial value - human life, when its value overshadows everything else in the world. Largely for this reason that people find it difficult to return to "normal" human life. To life, where money, wealth, villas, cars, etc. are the most important human life. Modern society declares the main value of life and human freedom, giving rise once rapists and killers, ready for next to nothing to take away from others this very life.
For the first time the impact of participation in combat operations on the psyche of the soldier experts spoke after U.S. military action in Vietnam - became the so-called "Vietnam syndrome". According to medical examinations of veterans of the Vietnam War, in 1988, with 30,6% of Americans experienced post-traumatic stress disorder, in 22,5% - in part. In 55,8% of persons with post-traumatic stress syndrome, were found borderline neuropsychiatric disorders likely to be unemployed are 5 times more than the other, divorce had been 70%, the isolation of people - from 47,3% expression of hostility - at 40%, were in jail or been arrested - 50% Kolodzin B. "What is post-traumatic stress, or How to live after the mental trauma. Copyright 1999 by American Psychiatric Press, Inc ..
The problem of post-traumatic stress disorder in recent years become increasingly important. This is due to the fact that throughout the world and in Russia, including there are many sources of tension, accompanied by intense fighting. A growing number of soldiers involved in the solution of these conflicts involved in the fighting.
Many authors have described the various states of military psychotrauma the participants of various wars, there were terms such as "Korea's syndrome", "Vietnam syndrome", "Afghan syndrome". Some authors use the term "Chechen syndrome".
In modern armed conflicts, loss of health mental health are 1 - 3%, in the Great Patriotic War - 10 - 12%. At first glance, this facilitates the task of military psychiatrists. However, given the clear dominance in local conflicts among the mental disorders of acute psychological stress reactions (at least 50% of troops engaged in active combat), the number of soldiers requiring mental health, including and medical-psychological assistance is greatly increased (Nechiporenko VV, Litvintsev, Snedkov EV, 1997).
Currently, a central place in the doctrine of mental, upset-stvah caused by factors in the combat situation and emerging as the pre-hospital and at the hospital stage, take up the study of regularities of their formation, dynamics and outcomes patoplasticheskogo design features, as well as finding scientific solutions the organization of psychiatric care in a modern local war.
The situation of hostilities, leading to marked changes in the functional state of mental activity, characterized by the development of extremely strong negative emotions such as fear, anxiety, severe mental and physical exhaustion. Emerging from the military in fighting mental disorders collectively define the term post-traumatic stress disorder (PTSD).
98% of troops who took part in the fighting in Chechnya, suffering from post-traumatic syndrome, approximately 30-35% of soldiers in Chechnya, becoming alcohol and drug dependence.
Post-traumatic stress disorder in people who took part in the hostilities, leading to the fact that a person the feeling of transience of life and the future is narrowed range of interests. This greatly complicates its social adjustment to civilian life. Characteristically, holidays, friends who are going to battle, only to reinforce post-traumatic syndrome.
Thus, local military conflicts kept flaring up in different parts of the globe, put their imprint on the psychology of soldiers returning from the hot spots. Quick access to peaceful reality often does not allow participants to military events to respond adequately to these or other circumstances from the perspective of the surrounding majority. Doctors and psychologists have identified a set of different symptoms of this process, as the Vietnamese, Afghan, and now the Chechen syndrome. So what happens with all these people? Find the answer to this question is the main purpose
1. ? Psychology of War
1.1. Modern local conflicts and their impact on society
All of human history can be divided into two parts - war and peace. These are two polar state, where any company in its development and relations with the external environment. Despite all the hopes of the best minds, the hopes and predictions of humanists, that with the progress of civilization extreme conflict, destructive forms of relationships in human society, including war, is gradually getting off to nothing, were not justified. Moreover, in recent centuries has been a trend not only more frequent wars, but repeated growth in the scale reached their territories and of the masses, the number of engagement of the countries and peoples, the degree of bitterness, the number of victims and the amount of damages. XX century actually a culmination of human evolution of belligerence and war as a particular socio-political phenomenon.
To the trends of war and peace, Russia has developed in line with global patterns. Throughout its history it has survived many wars, and XX century did not in this sense exception. On the contrary, the most difficult and bloody fights were just the latest time - two world wars (1914-1918 and 1939-1945.), Both of which were named by his contemporaries and the Great Fatherland, but then, due to historical circumstances, the First World has lost these patriotic names. But "pre-war, and especially the inter-war" (to 1941) periods that have befallen our country, were filled with lots of big and small armed conflicts.
Characteristic for those years the state of "cocked" inevitably impact on all spheres of public life, but the most severely affected in the popular consciousness that shaped the fate of several generations. Internal readiness for war, the expectation of a new war as an ambulance and brought up the inevitable and in the younger generations born in the interwar period. And the participation of the army in a number of local conflicts fueled even more this general attitude. So the psychology of society is gradually transformed into the psychology of combatants - both the real and potential. The Great Patriotic War of 1941-1945. Really became popular, pass it through their armies and fronts of many millions of people who brought this process to its logical conclusion by extending the psychological personality type, formed in an extreme tactical situation, the civil society, and for many years, making him dominant. This was aided and injected into the postwar world situation of the Cold War.
And although the country as a whole is gradually shifted to the "peaceful uses" for the Soviet Army since the Second World War was not so "peaceful". Some of its units and parts, not to mention military advisers and specialists participated in the Korean War 1950-1953. In a number of local wars and military conflicts in Asia, the Middle East and Africa in the events in Hungary in 1956 and Czechoslovakia in 1968, border conflicts in the Far East and in Kazakhstan in 1969 Finally, on Dec. 25, 1979 The Soviet government decided to invade Afghanistan: we got involved in a protracted nine-year war on foreign soil. This sad page of history ended in February 1989 the complete withdrawal of the Union "limited contingent".
At the end of perestroika, and especially after the collapse of the Soviet Union broke dozens of armed conflicts on the territory of former Soviet republics - conflicts that were involved in a variety of formation and structure of the once united army of the united state. The war in all its manifestations has become a way of life of hundreds of thousands of people, formerly called the Soviet people, a lot of "hot spots still smoldering rage, or the post-Soviet space. We again went to war (and in the most terrible - Civil), and no one knows how to come of it. Because war has become a habit, which became flesh and blood of generations, continues to exist - in psychology, consciousness, the soul - and after it is formally completed.
During the whole XX century in Russia be gradual militarization of the public consciousness when in the course of large and small armed conflicts in the civil environment penetrated features Kolodzin B. "What is post-traumatic stress, or How to live after psychological trauma." Copyright 1999 by American Psychiatric Press, Inc. Psychology combatant. This process was long and diverse that carry both negative and some positive features, which can not be seen and can not be understood in isolation from the historical context of the era. But in order to find out how, under the influence of some factors laid the foundation of this process, you must apply directly to the war, in which it arises and socio-psychological and moral phenomenon - combatant, "a man at war."
1.2. ? Members of armed conflict as an object of the impact of a traumatic situation
Shocked our country in recent years, disasters, natural disasters, ethnic and inter-regional conflicts, increasing violence, etc. has clearly shown how important is helping people - victims of war and ethnic conflicts, as well as participants in hostilities.
In modern life in many countries, including Russia, the military, especially involved in local conflicts within their own countries and in military operations abroad, have a special place in the group of individuals with increased risk of psychogenic disorders. Post-traumatic stress disorder was first described in the United States after the Vietnam War. At all times the military service was accompanied by a set of fairly specific traumatic effects. Army life with its various costs, narrowing "the degree of freedom" because of the need "to live on the orders of" a disturbing tension and fear of death during the war, are often unclear and a number of personal perspectives of many other largely unavoidable stressful factors legitimately influence the state any soldier. In contrast, over the centuries formed a set of social-emotional positive for military factors, actively supported by the society. Warrior - defender of the hearth, family, country. His arms are intended for the liberation mission of safeguarding life, justice, freedom. Awareness of high purpose of military service prevented her heroic soldiers to overcome many difficulties. In this society's attitude to his defense counsel has shaped their sense of pride for the chosen way of life and confidence in their social significance. With all the so-called "unpopular" wars in the society, as demonstrated by scientific evidence, in the armies of various countries increased the number of mental disorders. It should be noted that in the literature of wartime psychogenic disorders are considered separately: the parties to the hostilities and the population.
The positions, a situation that has arisen in recent years in Russia Army, gave rise to many soldiers a large number of mental disorders. During local wars, they are complemented by the most important for modern belligerent officer and soldier personal and at the same socio-public "reasoning" about the purposes and methods of war and its consequences. Military doctors are increasingly used non-traditional, but reflects the clinical reality, terminological designation as a "combat fatigue, psychological stress reactions, affective disorders. And "Vietnamese", "Afghan", "Chechen syndrome and others. In 15-20% of military personnel who participated in the war in Afghanistan, in the hostilities in Karabakh, Abkhazia, Tajikistan, Chechnya, according to the chief psychiatrist of the Ministry of Defense of Russia VV Nechiporenko (1995), there are "chronic post-traumatic condition" caused by stress. Up to 12% of hostilities would like to dedicate his life to any belligerent armies. These people have worked out their own perverted views on the prohibition of murder, robbery, violence. They join the ranks of soldiers, not only in different countries, but also criminal structures. To the greatest extent it relates to the participants of local wars, particularly in Afghanistan and Chechnya. Specialists of these wars called "epidemic of immorality" (MM Reshetnikov), leading to the devaluation of the idea of liberating mission of the army, to the criminalization and psihopatizatsii many soldiers.
Analysis of the behavior of soldiers and officers, including in Afghanistan and Chechnya, can draw attention to the fact that "along with real heroism, solidarity, fraternity and other militant relative positive attributes of the war, looting and murder (as the outcome of" showdown "among their own) , medieval torture and cruelty to prisoners, perverted sexual violence against the population (especially in foreign territory), armed robbery and looting are an integral part of any war and do not refer to the unit, and a typical phenomenon for any of the belligerent armies, as soon as the tread on the land of the enemy. inevitability of retribution for what he did not usually recognized immediately, but over time, unlike the publicly proclaimed heroic memories, constant anxiety and guilt for what he brings to the deformation of the personality, it "tacitly projected on all interpersonal relations, constituting part of the emotional field and sometimes the whole emotional background of "Alexander's YA, Lobastov OS, Spivak, LI, BP Shchukin psychogenic in extreme conditions. - Moscow, 1991 ..
Psychic trauma, psychological distress and its consequences - that is what will determine the days before the end of life spirit of survivors in military conflicts.
2. ? Psychology participants in armed conflict
2.1. Features of mental reactions in soldiers affected by armed conflict
As the veterans were in the exclusive, by modern standards, terms of surviving for them required the skills and behaviors that can not be considered normal and customary in civilian life. Many of these behavioral patterns, suitable only for the combat situation, so deeply taken root, that will be felt for many years.
Traumatic events have occurred with people at all times. But veterans of local wars and armed conflicts occupy a special place because they were lucky too large dose of non-human experiences. The horrors of war have influenced not only by its intensity, but also frequent recurrence: trauma followed one after another, so that the person did not have time to "get over".
To see how this is natural and how important it is for spiritual comfort, turn once more to the definition of mental health: doctors believe that an event that has all the signs of trauma, will have its effect on almost anyone. This means that the loss of mental balance, violent mental manifestations in this case is quite normal.
If the injury was relatively small, the increased anxiety and other symptoms of stress will gradually over several hours, days or weeks. If the injury was severe or traumatic events occur repeatedly, a painful reaction can persist for many years.
For example, a modern combat veterans of the roar of low-flying helicopter or a sound resembling an explosion, can cause acute stress reaction, "as in war." At the same time man strives to think, feel and act so as to avoid painful memories Trebukhov SN, Trifonov BA, Bunkova OA "On the types of psychological response of the wounded from the combat signs of psychological trauma. / / Collection of "Current issues of treatment of mental illness", Chelyabinsk, 2002 ..
Just as we have become immune to certain diseases, our mind generates a special mechanism to protect themselves from painful experiences. For example, a survivor of the tragic loss of loved ones, continue to subconsciously avoid installing with someone close emotional contact. If a man thinks that in a critical situation, he behaved irresponsibly, it would then be difficult to take responsibility for someone or something.
The problem of mental health of troops involved in modern local wars and armed conflicts, is today one of the most pressing domestic military psychiatry, and psychological and psychiatric consequences of combat mental trauma (BPT), especially in the context of medical and rehabilitation tasks - zone of mutual scientific and practical interests of both civilian and military specialists.
Under combat stress is to be understood multilevel process of adaptive activity of the human body in boevoyobstanovki, followed by stress mechanisms of reactive self-regulation and consolidating specific adaptive psychophysiological changes.
Status of combat stress in a theater of military action carries each. Arising before direct contact with the real threat to the vital, combat stress continues until the exit from the war zone. Thanks stressful mechanism establishes a memorable trace new emotional and behavioral skills and attitudes, the primary importance for the preservation of life. Combat stress at the same time is a state of destabilization, prepathological limiting the functional reserve of the organism, increasing the risk of disintegration of mental activity and persistent somatovegetativnyh dysfunctions.
The frequency of acute stress reactions among soldiers in terms of heavy intense fighting usually reaches 10-25%. When poorly trained troops, mismanagement of, the lack of objective information, the abnormal stress responses may be on the mechanisms of induction of lightning to reach almost 100% of personnel, poured in a phenomenon known as collective panic
Clinical manifestations of psychic trauma of combat is closely related to the nature of the fighting and the duration of stay in a combat situation. Substantially modifies the value in its formation and dynamics have a lack of social support from the community, colleagues and commanders, a lack of unit cohesion, deprivation of biological factors (food, sleep, rest). Factors constitutional predisposition (diathesis) show significance in the initial period of stay in a combat situation, with the prevailing response in the form of "escape from reality."
Along with the natural, "normal" psychological reactions of anxiety and fear with no signs of mental dysfunction in conditions of intense fighting, quite often there are transient mental disorders - acute stress reactions, with mixed and changing picture of depressive symptoms, anxiety, anger, despair, agitation, hyperactivity or inhibition (up to dissociative stupor) against the background of events stupefaction, nekotorogosuzheniya field of consciousness, inability to adequately respond to external stimuli, sometimes followed by partial or complete amnesia. The development of acute stress reactions among the personnel of the negative impact on the level of combat capability of troops and often creates an additional threat to the life of the combatant or his comrades. Since none of the symptoms of distress do not prevail for a long time and they expire quickly (from several hours to two or three days), Syndromological assessment of the affected essentially impossible. However, the presence of such symptoms already requires urgent psycho activities due to the risk of more extensive and less reversible nonspecific, and more - and nozospetsificheskih stress disorder.
In a combat situation the main causes of psychological distress, risk to life and responsibility for the execution of tasks, lack of and uncertainty of incoming information, lack of time in deciding and implementing combat operations, the level of mismatch of skills requirements of the terms of the battle for the individual and the psychological unpreparedness to perform a specific task , the uncertainty in the reliability of weapons, lack of confidence in the command, the factors of isolation (during operations in isolation from the main forces, the finding in isolated shelters), etc.
Mental disorder associated with traumatic experience, resulting from a combat situation is individual, but its degree depends largely on the cumulative response to this factor in all divisions. The collective reaction has a strong influence on the discipline and organization units.
Another factor affecting the human psyche, is the mastery of weapons and military equipment, the completeness objective presentation of future conditions of warfare. An important factor contributing to the BPT is a violation of sleep. After a sleepless night fighting ability decreases rapidly decreases the amount of memory, especially short-term, resulting in less absorption of incoming information and difficult decisions in crucial moments. The response to sudden-onset emergencies is reduced.
All mental disorders wartime specialists into three main groups. First isolated mental disorders, the leading symptom of which is the pathological fear. His typical picture are: palpitations, cold sweat, dry mouth, trembling of limbs, covering the whole body under an hour, involuntary separation of urine and feces, functional paralysis of limbs, stuttering, loss of speech.
There are forms of motor and numb with fear. Motor are usually different types of uncontrolled movements, for example: a flight from the source of danger. The soldier, seized numb form of fear, is in a daze, his face gray, fading glance, contact with them difficult. This group includes also "hidden" form of fear, which is called "feverish passivity" and is characterized by a senseless activity, leading to disruption of the job. At the headquarters of this "activity" slows down or even paralyze the work. A concrete manifestation of it may be the formation of new working groups, which do not produce anything meaningful, but the organization of numerous telephone calls and radio messages that contradict each other.
The feeling of fear among the people spread like a chain reaction, because of their lack of personality while in organized team of personal responsibility and the prevailing emotion in her actions that are often primitive. This leads to a collective reaction, one of which - the panic.
The second group of reactions is an attempt to man "to erase the memory of the battle scenes. The consequences of such reactions are most often from various disciplinary infractions, alcohol and drug abuse. Typically, these reactions occur after the fighting, but may also occur in the period.
The third group isolated violations, known as battle fatigue associated with prolonged the fighting. In this group of distinguished "battle shock" - a simple emotional reaction that occurs within a few hours or days of intense fighting. Characterized by anxiety, depression and fear. "Fighting fatigue - occur in a few weeks of fighting high intensity.
BPL also differ in severity. The most common ones in the mild are excessive irritability, anxiety, isolation, loss of appetite, headaches, fatigue. In cases of moderately severe mental disorders are manifested in the form of hysterical reaction, aggressiveness, temporary memory loss, depression, increased sensitivity to noise, a pathological fear of rolling sometimes in panic, loss of sense of reality of what is happening. In severe cases occur in affected hearing, vision, speech, motor coordination.
"Combat reflexes" did not seem unusual, until the man was in the area of hostilities. But back home, found himself in an environment where such reflexes are produced, at least, a strange impression. A thousand times, directly and indirectly, in many ways a man pointed out that it is time to stop behaving like a war. But no one explained how to do it.
According to the stories of many veterans, returning home was equally, if not more severe than the military experience: no one with whom to have a heart, never felt completely safe, and it was easier to suppress emotions than to allow them to break out, with the risk of losing control. In this situation, the mental stress for a long time does not find an outlet.
1.2. ? Post-traumatic stress syndrome: causes and mechanism of development of the participants of armed conflicts
Thus, post-traumatic stress disorder (PTSD) arises as a delay or a prolonged reaction to a stressful event or situation of exceptionally threatening or catastrophic nature, which may cause distress in virtually any person (natural and manmade disasters, battlefield, monitoring the violent death of others, the role of victims of torture , terrorism, etc.) Fontana D. How to cope with stress: Per. from English. - M.: "Education - Press, 1995. Essentially PTSD - this is a response to powerful emotional stimuli, in fact, already supposed onset of a stressful situation.
The main psychological factors of PTSD usually include the fear of being killed, wounded or be captured, the impressions of paintings injuries and deaths of colleagues, feelings of guilt for the deaths of his comrades, the pain, tried and tested by the wounded with injuries and his worries about his future destiny, which usually compounded by the inevitable sense of excessive physical and mental fatigue.
By what signs can detect the presence of post-traumatic stress? If we say that someone is "sick" post-traumatic stress - what exactly do we mean? First of all, this man has experienced a traumatic event, ie experienced something terrible, that does not often happen to people. By definition, psychiatrists, a traumatic event is called, "going beyond the limits of normal human experience."
The war in Southeast Asia, during which it was blown up more ammunition than all the belligerents in World War II, has generated more than enough traumatic experiences. Events taking place there just did not fit in the head, had nothing to do with a normal human life.
But post-traumatic stress - it is not only the presence of a traumatic event in the past. This event - the only part of the picture, the external factor, which played a role in the painful process.
Traumatic events have occurred with people at all times. But Vietnam veterans have a special place, because they were lucky too large dose of non-human experiences. The horrors of that war influenced not only by its intensity, but also frequent recurrence: trauma followed one after another, so that the person did not have time to "get over".
The other side of post-traumatic stress refers to the inner world of the individual and linked to the human response to the events experienced. We all react differently: a tragic accident can cause serious injury to one and almost not affect the psyche of another. It is also important, at what time an event occurs: one and the same person at different times, may react differently Trebukhov SN, Trifonov BA, Bunkova OA "On the types of psychological response of the wounded from the combat signs of psychological trauma. / / Collection of "Current issues of treatment of mental illness", Chelyabinsk, 2002 ..
The most immediate manifestations of PTSD are mentally strong, relatively short-term emotional distress. Some of them may be relatively simple, physiological, which are the reaction of fear and panic. Others show a more complex manifestations, occurring at a psychotic level. Other developing pathological conditions occurring at the neurotic level - neurotic reactions, which often takes the protracted nature (pathological development, etc.).
Post-traumatic stress disorder (PTSD) in Russia is often called the "Chechen" or "Afghan" syndrome. This is absolutely correct, because the origin of the disorder very clearly associated with heavy, prohibitively difficult experience, which goes far beyond normal human experience. War, sudden man-made and natural disasters, harsh and life-threatening violence - that's the situation, having gone through that, people at risk of contracting PTSD.
PTSD is described relatively recently, did the American psychiatrist who has studied veterans of the Vietnam War. Unfortunately, the frequency of this disorder in Russia must be very large - considering all the troubles and the wars that followed one after another for many years.
The impression which produce suffering from PTSD on others, pleasant, not name. They seem hostile, secretive, rude. With them it is difficult to talk because you can not even reach an understanding, as if talking to them in different languages. Often it seems that the patient treats you with contempt, keeps himself deliberately provocative, "a penny will not put." Clearly, in this regard, people suffering from PTSD, with difficulty, and arranged to have great difficulty being held at work, especially when you consider that the usual requirements for labor discipline are unacceptable to them. Unfavorable "image" of these people is compounded by their tendency to drink and drugs. All this contributes to their social exclusion, as a result they are often involved in criminal networks.
But this is only one side of the coin. Subjectively PTSD looks completely different. This deeply affected poor people, torn apart by terrible memories of his experiences, these memories suddenly, against the will arise again and again, awake and asleep - which is especially frightening because the dream they have already been disturbed, and when unable to sleep, he was suspended nightmares. The heavy mood chasing them constantly. It is compounded by the impression that most people who have not experienced what they experienced, not in a position to understand them. Dealing with the same comrades in misfortune is difficult because it revives memories of communion from which he would like to be free.
Identified several variants of post-traumatic stress
disorders in combat conditions Trebukhov SN, Trifonov BA, Bunkova OA "On the types of psychological response of the wounded from the combat signs of psychological trauma. / / Collection of "Current issues of treatment of mental illness", Chelyabinsk, 2002.:
Acute combat trauma. Arose in the fast-paced and rapidly changing circumstances of battle. The sharp, but not psychotic changes in mental activity. Wounded and sick was observed "subjective unexpectedness. Some say that "not even managed to wind up, the pain and fear arose later, when he saw blood." Emotional states in different wounded soldiers were, often, polar. We have observed the one-anxiety, fear, agitation, feeling of hopelessness of the situation, others apathy, "everything happened in a dream," as if not to me, "looked at it all as if from outside."
Prolonged (protracted, chronic) combat trauma Ibid. When her stress factors have been stretched over time (from several hours to several weeks) - there is an accumulation of emotional stress and negative emotions. Patients talked about their feelings about a possible surprise attack by militants, the upcoming battle, the death of colleagues, fears "hit a mine," become a target for a sniper. At the same time against the background of emotional stress experienced some uncertainty, anxiety and fear, others - apathy, depression.
There was variation in occurrence and development of a painful emotional state, but usually the first stage of the accumulation of emotional tension, which, due to the interaction of certain personal characteristics and situational influences did not find otreagirovaniya.).
A running, long-standing post-traumatic stress disorder is difficult to treat. Not only because chronic diseases in general difficult to treat, but also because of the nature of suffering: for doctors, too, seem to be people who are sick, unable to understand them. In the USA, effective assistance to individuals, has long suffered from PTSD, is provided through a network of specialized public institutions. Similar in Russia yet.
2.3. ? Symptoms and consequences of post-traumatic syndrome in the former military
When a person is not possible to defuse internal tensions, his body and mind find a way to adapt to this stress. This, in principle, and is the mechanism of post-traumatic stress. Its symptoms - which in the complex look like a psychological disorder - in fact nothing but a deep-rooted behaviors associated with extreme events in the past.
In post-traumatic stress disorder experience the following clinical symptoms See. For example: Diagnosis and treatment of anxiety disorders (Manual for Physicians). Ed. YA Alexander and others Copyright 1989 by American Psychiatric Press, Inc.:
1. Sverhbditelnost. Man closely monitoring everything that is happening around, as if he is constantly in danger. But that danger is not only external but also internal - it is undesirable that the traumatic experience, possessing a destructive force, break through into consciousness. Often sverhbditelnost manifests itself as constant physical stress. That physical strain, which does not allow to rest and relax, can create many problems. First, the maintenance of such a high level of vigilance requires constant attention and the enormous amount of energy. Secondly, the person begins to feel that this is his main problem and as soon as the voltage will reduce or relax, everything will be fine.
In fact, the physical strain may perform a protective function - protects our consciousness and can not remove the psychological protection, while not reducing the intensity of emotions. When this happens, the physical stress leave itself.
2. Exaggerated response. At the slightest surprise people fling (thrown to the ground at the sound of low flying helicopters, drastically turns around and takes the fighting stance, when someone is approaching him from behind), suddenly starts, rushes to run, shouting, etc.
3. Dullness of emotions. It happens that a person totally or partially lost the ability to emotional expressions. It is difficult to establish close and friendly relations with those around him unavailable joy, love, creativity, growth, playfulness and spontaneity. Many veterans complain that since they hit the grave events they became much more difficult to feel these feelings.
4. Aggressiveness. The desire to solve problems with brute force. Although, as a rule, it concerns the impact of physical force, but also occurs mental, emotional and verbal aggressiveness. Simply put, people tend to apply coercive pressure on others whenever its wants, even if the goal is not vital.
5. Impaired memory and concentration. Man has difficulty when you want to concentrate or remember something, at least, such difficulties arise in certain circumstances. At some points in concentration can be great, but is to appear to any stress factors as a person loses the ability to concentrate.
6. Depression. In a state of depression, post-traumatic stress reaches the darkest and most dreary depths of human despair, when it seems that everything is senseless and useless. This feeling of depression is accompanied by nervous exhaustion, apathy and negative attitude towards life.
7. General anxiety. Manifested at the physiological level (an ache in my back, stomach cramps, headaches), mental health problems (constant anxiety and concern, "paranoid" phenomenon - for example, unjustified fear of persecution), the emotional experience (the constant feeling of fear, self-doubt, complex guilt).
8. Rage. Not tides of moderate anger, namely the explosion of anger. Many veterans reported that such attacks tend to occur under the influence of narcotic substances, particularly alcohol. There are, however, and in the absence of alcohol or drugs, so it would be wrong to assume the main cause of the intoxication of these phenomena.
9. Drug abuse and drug substances. In an attempt to reduce the intensity of post-traumatic symptoms, many veterans, abuse tobacco, alcohol, and (to a lesser extent) other drugs. It is important to note that among the veterans - the victims PTSN there are two large groups: those taking only medications prescribed by a doctor, and those who do not take any drugs or narcotics.
10. Unsolicited memories. Perhaps it is the most important symptom, which gives the right to speak about the presence of PTSN. In memory of emergent awful, ugly scenes associated with the traumatic event. These memories may arise as a dream, and during wakefulness.
In reality, they appear in those cases where the surrounding environment is somewhat similar to what happened in that time ", ie during the traumatic event: the smell, sight, sound, seemed to come from that time. Vivid images of the past came down on the psyche and cause severe stress. The main difference from conventional memory is that post-traumatic, unwanted memories are accompanied by strong feelings of anxiety and fear.
Unsolicited memories that come in dreams, are called nightmares. We veterans of these dreams are often (but not always) associated with the fighting. Dreams of this kind are usually of two types: first, with a precision tape, aired by a traumatic event as it is engraved in the memory of surviving his rights; in the dreams of the second type of situation and characters can be entirely different, but at least some of the elements (person, situation, feeling) like those that occurred in the traumatic event. Man awakens from this dream completely shattered, and his muscles tense, he was sweating.
In the medical literature, night sweats sometimes regarded as a separate symptom, on the grounds that many patients wake up wet with sweat, but do not remember what they dreamed. However, obviously, sweating is seen as a reaction to the dream, regardless of whether or not it is implanted. Many veterans and their families indicate that during sleep a person tossing in bed and wakes up with clenched fists, as if ready to fight.
Such dreams are perhaps the most frightening aspect of PTSN for man, and people rarely agree to speak about it.
11. Hallucinatory experiences. This is a special kind of unwelcome memories of traumatic events with the difference that the hallucinatory experience of the memory of the incident appears so bright that the events of the moment as to fade into the background and seem less real than memories. In this "hallucinatory" detached state of the person behaves as if he were again going through a traumatic past event, it acts, thinks and feels like the moment when he had to save his life.
Hallucinatory experiences are not typical of all: this is just kind of unwanted memories, which have a special brightness and soreness. They tend to occur under the influence of narcotic substances, particularly alcohol, but the hallucinatory experiences may occur in humans and sober, and he who never uses drugs.
12. Sleep problems (difficulty falling asleep and interrupted sleep). When people visit the nightmares, there is reason to believe that he could not help resist falling asleep, and that is the cause of his insomnia: a man is afraid to fall asleep, and again to see this dream. Regular lack of sleep, leading to extreme nervous breakdown, complete the picture of symptoms of post-traumatic stress.
13. Thoughts of suicide. A man often thinks of suicide or is planning any action that would eventually lead to his death. When life seems more frightening and painful than death, thought to end all suffering may seem tempting. When a man comes up to the brink of despair, where do not see any way to improve their situation, he begins to think about suicide.
Many combatants reported that at some point reach this face. All those who found the strength to live, came to the conclusion: you have the desire and tenacity - and eventually appear brighter prospects.
14. "Wine survivor." Feelings of guilt due to the fact that he survived a severe test, which cost the life of another, often characteristic of those who are suffering from "emotional deafness" (inability to experience joy, love, compassion, etc.) since the traumatic events. Many victims PTSN ready for anything, just to avoid reminders of the tragedy, the death of comrades. Strong sense of guilt sometimes provokes attacks of self-deprecating behavior.
These are the main symptoms and course of post-traumatic stress.
Reflex suppression driving unpleasant feelings inside - where their emotional impact is felt with less intensity. This is usually accompanied by a constant muscular tension. And as people get used to suppress the negative feelings (anger, hatred, jealousy, anger, suspicion), he also loses the ability to experience positive emotions (love, kindness, friendliness, trust). And it was a positive feeling - to himself and to others, to life - give people the desire and courage to change something in yourself and in the circumstances of his life.
3. ? Adaptation and rehabilitation of members of armed conflicts
3.1. The legislative framework for the rehabilitation and adaptation of members of armed conflicts in Russia
To begin, consider the basic regulatory and legislative acts concerning the status of a belligerent man, his responsibilities, rights and responsibilities.
Basic legal act defining the issues of military service in our country, is the Law "On Military Duty and Military Service".
Law on the Status of military personnel was adopted by the State Duma on 6 March 1998, the Federation Council approved March 12, 1998.
Law on the Status of troops includes three chapters:
general provisions;
rights and freedoms of servicemen, citizens discharged from military service, and members of their families;
duties and responsibilities of military personnel.
The first section states that the status of military personnel is a collection of their rights, freedoms, duties and responsibilities established by law and guaranteed by the state.
Features status is determined by the duty to protect the State, including - at the risk of life Yarskaya VN Anthropology Social Policy / Human Resources. 1998 ..
Officers, military service by conscription, by their legal status equal to officers serving in the military under the contract.
Soldiers have the right to possession of all of Russia documents on citizenship, to carry and use in accordance with the law of arms.
Limiting troops in a number of general civil rights of offset benefits. In addition, privileges, guarantees and compensation in the private provision and the families of military personnel.
Article 3. p.2.
Legal protection of servicemen, citizens discharged from military service members and their families is a function of the state and is secured by the laws and other normative legal acts of the rights, privileges, guarantees and compensations to the persons and other measures of social protection, as well as the legal mechanism to implement them .
Article 3. p.2.
Social protection of servicemen, citizens discharged from military service, and their families is a function of the state and provides Semenets NY Issues of social protection of servicemen, citizens discharged from military service, and members of their family / social problems of development of human resources. Saratov, 1997. S. 153-160.:
realization of their rights, privileges, guarantees and compensations, public authorities, military authorities and local authorities;
improvement of mechanisms and institutions of social protection of these persons;
protect their lives and health, as well as other measures aimed at creating conditions of life and activities appropriate to the nature of military service and its role in society.
Local authorities may establish military, storerooms and their families additional benefits.
Dates of military service established by the RF Law on Military Duty and Military Service Law of Russia on 11 February 1993. On military duty and military service with the changes and additions from March 6, 1998 .. Over the status of military prisoners of war persists. The rights of soldiers, retired, and their families are protected by law.
Article 4. Legal status of military bases.
p.1. The legal status of military bases are the RF Constitution, federal constitutional laws, this federal law, federal laws and other normative legal acts of the RF, as well as norms of international law and international treaties of Russia.
p.2. The legal and social guarantees for servicemen, including measures for their legal protection, as well as material and other forms of security provided by this Federal law can not be abolished or reduced federal laws and other normative legal acts of the RF except by making amendments and additions to the present Federal Law .
Thus, Russia's law on the status of military provides the legal and social protection of servicemen, their families, as well as citizens discharged from military service members and their families
The soldiers are under state protection. Nobody in the right to interfere with their performance, except for persons authorized to do by law.
The Act also defines the compensation for death or personal injury, military:
In the case of death (death) soldier is paid a lump sum:
family members of military personnel (contract) - 120 salaries salaries, set at the date of payment benefits;
family members of soldiers (recruits) - 120 times the minimum monthly salary for a military post on the first wage group.
In the case of injury to personnel (injury, trauma, contusion) or disease, they have received in the performance of military duties, they shall be paid a lump sum:
personnel (contractors) 60 monetary salary;
soldiers (recruits) 60 minimum monthly salaries for military posts.
Thus, the state law on status of military bears responsibility for the social protection of servicemen, provide them with various kinds of allowances. In addition, the State undertakes to review the facts of military abuse, violence and threats against them, as well as encroachment on their lives, honor, dignity, housing as aggravating circumstances of the crime.
In April 2004 the State Duma will consider a bill on additional social protection to members of armed conflicts, which once again demonstrates the relevance of the topic for today's Russia.
This federal law under the Constitution of Russia sets in Russia additional measures of social protection of citizens, taking (taking) part in armed conflicts and hostilities, their families, which determine their status in society, they compensate for the damage suffered to life and health .
The law will define the status of combatants and armed conflict, Op. on http://gazeta.ru:
members of Armed Conflicts - citizens passing (passage) military (special) service, and performing (Officer) duties, either temporarily (found) in the forces, formations, military units, units, time units, headquarters and institutions of the RF Armed Forces, other troops, military formations and bodies, organizations in areas of armed conflict, as well as during the conduct of peacekeeping operations in armed conflicts;
involved in the fighting - the citizens who take (took) a direct part in hostilities in the forces, formations, units, units, time units, staffs and agencies of the RF Armed Forces, other troops, military formations and bodies and organizations;
disabled armed conflicts (fighting) - the citizens from participating in armed conflicts (fighting), who became disabled due to injury, concussion, injury or illness resulting from the tasks in situations of armed conflict (fighting);
makers (take) part in ensuring the fighting - civilian personnel RF Armed Forces, other troops, military formations and bodies, the various categories of employees of public authorities, local authorities and other citizens who take (take) part in the combat support ;
members of the family members of the armed conflict and hostilities - the spouse (husband), minor children, children above the age of 18 who became disabled before they reach the age of 18, children under the age of 23 who are studying in educational institutions full-time education, persons dependent members of the armed conflict and combatants, the parents or adoptive parents there.
It also assumes that:
1. Undergoing military service under the contract, employees of internal affairs bodies, agencies and bodies of the correctional system, directed to areas of armed conflict, set the salaries of the military post (s) and allowances for military (special) rank in an amount.
2. Undergoing military conscription in armed conflicts, sets the monthly salary of a primary military posts, soldiers and sailors, performing military service under the contract in positions to be filled by soldiers and sailors, sergeants and petty officers, and upon separation from military service, they receive a lump sum allowance of two salaries for the military posts of soldiers and sailors, performing military service under the contract.
3. For a direct part in hostilities shall be paid an additional payment at the rate of one day:
1) servicemen undergoing military service or under contract as to which states have military ranks of soldiers, sailors, sergeants, petty officers, private individuals and junior officers of the internal affairs bodies, agencies and bodies of the correctional system - 1,3 minimum monthly salary at the military post (s) on the primary military posts, soldiers and sailors (salaries of established posts), performing military service (service) under the contract;
2) undergoing military service under the contract in positions for which the states have military ranks ensigns, warrant officers or officers, and persons of middle, senior, senior commanding staff of internal affairs bodies, agencies and bodies of the correctional system - 1.5 minimum monthly salary on military post (s) installed on the primary military posts, soldiers and sailors (the salary established posts), performing military service (service) under the contract.
Lists of direct participation in combat are prepared and approved in accordance with regulations approved by Presidential Decree.
4. Persons involved in combat support:
paid salaries (tariff rates) in polutorokratnom amount;
stipend in the amount of polutorokratnom established norms;
6. Additional payments are made monthly on the personal accounts of members of armed conflict and the combatants that are open to credit institutions Russia at their request and with their written notice.
The bill specifically stipulates the principles of rehabilitation of participants in armed conflict
"Chapter 3. Article 8. Comprehensive rehabilitation participants in armed conflicts and combatants constitutes a system of medical, psychological, socio - economic measures aimed at eliminating or possibly more than full compensation for Disability caused by the disruption of health with persistent disorder of body functions in connection with participation in armed conflict and hostilities. Purpose of rehabilitation are to restore the social status of members of the armed conflict and the combatants and their social adaptation.
2. Comprehensive rehabilitation participants in armed conflict and the combatants include:
1) medical rehabilitation, consisting of rehabilitation therapy, reconstructive surgery, prosthetics and ortezirovaniya;
2) psychological rehabilitation of participants in armed conflicts and combatants, consisting of psychological, psycho-pedagogical and social actions aimed at restoring, correcting or compensate for impaired mental functions, conditions, personal and social status of citizens who have received trauma in connection with participation in armed conflict and hostilities;
3) vocational rehabilitation participants in armed conflict and combatants, consisting of vocational guidance, vocational education, professional - adaptation of production and employment;
4) social rehabilitation of participants in armed conflict and combatants, consisting of the socio - sredovye orientation and social - home adaptations.
Article 9. Federal basic rehabilitation program for participants in armed conflict and the combatants
Federal basic rehabilitation program for participants in armed conflicts and combatants is part of the basic federal program of rehabilitation of veterans of fighting and includes a guaranteed list of rehabilitation activities, facilities and services provided by parties to armed conflicts and combatants acts for free at the expense of federalnogobyudzheta.
Federal basic rehabilitation program for participants in armed conflict and the combatants and the procedure for its implementation is set by the RF Government.
Article 10. Individual rehabilitation program participants in armed conflict, combatants
Individual rehabilitation program participants in armed conflict, combatants - based on the decisions of the Military Medical Commission or a decision by the State Health Services - Social Expertise complex optimal for parties to armed conflict, combatants and rehabilitation activities, including a separate species, shape, volume, the timing and the manner in which medical, occupational and other rehabilitation measures aimed at rehabilitation, compensation Disability caused by violation of the health disorder of body functions in connection with participation in armed conflict and hostilities, as well as compensation for damaged or lost functions, restoration, compensation abilities of persons with disabilities of armed conflict (war) to carry out certain activities.
Individual rehabilitation program participants in armed conflict, combatants are binding on the relevant state authorities, local authorities and organizations, regardless of the organizational - legal forms of ownership.
Individual rehabilitation of armed conflict (war) from the armed forces suggests the possibility of their occupational rehabilitation at the appropriate positions in the federal executive authorities, where they were before the establishment of disability received military (special) service.
The list of categories of disabled persons of the armed conflict (fighting) and positions in the federal bodies of executive power, which they can perform their military (special) service, defined by the federal executive authority, which provides for military (special) service in conjunction with the Federal executive authority on labor and social development.
Article 11. State Rehabilitation Service members of the armed conflict and the combatants
State Rehabilitation Service members of the armed conflict and the combatants - a set of public authorities, regardless of departmental affiliation, local governments, organizations active in medical, vocational and social rehabilitation.
The coordination of the rehabilitation of participants in armed conflict and the combatants carried out by the federal executive authority on labor and social development.
Federal executive authorities establish guardianship (patronage) on the disabled armed conflict (fighting) for the period of full rehabilitation (life).
Categories disabled armed conflict (fighting) and the procedure for establishing guardianship (patronage) over them is established by the RF Government.
Financing of the rehabilitation activities at the expense of the federal budget, federal and territorial funds of obligatory medical insurance, the Pension Fund of the RF, Social Insurance Fund of Russia (in accordance with the provisions of the said funds), other sources not prohibited by RF legislation. Financing of rehabilitation activities, including maintenance and rehabilitation facilities, is allowed on the basis of co-operation budget and extrabudgetary funds.
Organization and work of the State rehabilitation services to members of armed conflicts and combatants is determined by the RF Government.
Article 12. Organization of medical and psychological rehabilitation of participants in armed conflict and the combatants
1. Medical and psychological rehabilitation of participants in armed conflicts and combatants held in the period of rehabilitation leave, after the battle (special) problems, after the departure of members of the armed conflict, combatants from areas of armed conflict and hostilities.
2. Medical and psychological rehabilitation of participants in armed conflict and the combatants organized by the appropriate federal executive authority and is carried out:
based rehabilitation facilities (structures) of the federal executive body;
on the basis of state (municipal), regional rehabilitation facilities, a list which is approved by the RF Government;
based non-government institutions, designed for rehabilitation.
3. Medical and psychological rehabilitation of participants in armed conflict and the combatants were carrying out tasks in areas of armed conflict and war zones, including those outside of Russia, organized by the executive authorities of RF subjects, and identify those in need in carrying out rehabilitation activities carried out by military authorities, military commissioners, authorities pensions.
Rehabilitation activities with this category of citizens shall be held:
based on the state of the regional rehabilitation facilities, a list which is approved by decision of the Government of Russia, on the basis of rehabilitation facilities (structures) of the federal executive body;
on the basis for this sanatoria, rest homes, tourist centers, rehabilitation centers veterans' organizations, a list which is approved by the heads of regional administrations of Russia;
based non-governmental organizations financed from various sources, including donations from public associations, businesses and individuals.
4. The soldiers - members of the armed conflict and the combatants have received in the course of participation in armed conflict, fighting injuries, concussion, injury or illness are eligible for medical and social expertise during his military service to determine disability »http://www .gazeta.ru/parliament/info/laws/17806.shtml.
We believe that such a law, although it carries a fundamentally new elements and aspects of social - psychological rehabilitation and adaptation of the participants of military conflicts, yet necessary, because He organizes all previous regulations on this issue and gives some definitions of social importance for the adaptation - rehabilitation activities with the military who had visited the war zone.
? 3.2. Psychological and medical rehabilitation of military personnel - members of military conflicts
The problem of providing specialized assistance to victims of the fighting has a population of two important and fundamental aspects: the psychological and psychiatric itself, which necessitates an integrated approach to solving this problem, involving various related professionals (psychologists, psychotherapists, physicians, internist, etc.). This approach, as experience shows, can provide not only timely adequate psychiatric care, but also to address psycho-psihoprofilakticheskie and activities aimed at reducing the severity and intensity of psychological, psychiatric and psychosomatic effects during the conduct of hostilities, as well as the immediate and distant periods after their completion.

Yet, perhaps to avoid the development of post-traumatic stress disorder and psychological trauma of combat. To do this, observe the following principles and rules Khoroshko VK About vsledstviefizicheskogo mental disorders and mental turmoil of war / / psychiatrist. newspaper -1916. -N 1. -C. 3-10.:
To a large extent depends on the prevention of BPL unit commander, chief, he must reduce the effect on personnel psychogenic factors.
First of all, he must build confidence in subordinates in their actions, to provide all necessary personnel, to care for the timely organization of sleep and rest, to be able to provide psychological first aid.
There are different types of response to the shock received in the course of hostilities, which are described in detail by a psychiatrist Khoroshko Ibid.
Type of mental reaction - N o r m a l n a I
Symptoms: involuntary muscle contractions, muscle tension, sweating, nausea, frequent urination, rapid breathing and heartbeat, anxiety, restlessness.
The recommended measures of assistance: individual psycho-physical support, clear guidance underlined positive situational motivations, fellowship with friends.
What is not recommended Fontana D. How to cope with stress: Per. from English. - M.: "Education - Press, 1995: fix excessive attention to this state, to emphasize the seriousness of the situation, ridicule, or remain indifferent.
Type of mental reaction - Reduced activity, depression Alexander YA, Lobastov OS, Spivak, LI, BP Shchukin Psychogenic in extreme conditions. - M., 1991.
Symptoms: People are standing or sitting motionless and conversations with impassive faces. Sometimes there are repetitive movements or monotonous parts of the body blows of what - or object.
Recommended measures of assistance: gently establish contact with them, to ensure that they reported what had happened. We must show participation and to express solidarity. Suggest a simple routine work, to provide warm food and cigarettes.
What is not recommended: excessive exercise compassion, to apply disciplinary action (except in extreme cases), excessive exercise solidarity.
Type of mental reaction - Individual panic
Symptoms: desperate attempt to escape, uncontrollable crying, running in circles.
Recommended measures of assistance: to show the friendly firmness, to give to eat or drink something warm. Suggest a cigarette. Shut off, if there is a need for this.
What is not recommended: use rough measures in isolation, swill, appoint disciplinary action (except in extreme cases).
Type of mental reaction - Hyperactivity
Symptoms: the tendency to disputes, rapid speech, performance of unnecessary work, jump from one job to another, saying the endless advice to others.
Recommended measures of assistance: to speak, required to perform physical work, to offer to eat or drink something warm, light a cigarette. Control. Do not show other senses.
What is not recommended: focus on the status of a soldier, join him in the dispute, appoint a disciplinary action.
Type of mental reaction - reaction with a predominance of the physical components
Symptoms: nausea, vomiting, functional paralysis.
Recommended measures of assistance: to show their interest, offer a simple, not hard work to create the necessary conditions for medical evacuation point.
What is not recommended: the victims say that with them nothing serious happened, blame and ridicule, to focus attention on their sostoyanii.Vazhnaya role in increasing resistance to stress is given physical training. We are constantly engaged in physical training of individuals develop positive changes in the body, including in the functional state of the systems at greatest impact of psychogenic factors. The most important of these is the increasing efficiency of cardiac activity, improvement of pulmonary ventilation, reduction of adipose tissue, reducing blood pressure.
Another factor in increasing resistance to stress is individual and group combat training, the degree of possession of weapons and military equipment. The sense of self-confidence, knowledge, in his arms, his comrades, commanders, the correctness of the decisions and the military task and, finally, relevance and significance of common cause can significantly increase resistance to stress.
Commanders of units should be able to promptly identify persons with signs of psychotrauma under which they should be evacuated from the battlefield. The criteria for the removal, in particular, is the inability to perform functional duties, biased assessment of the impending danger, the demoralizing effect of trauma on the personnel of the unit, the threat to their security by others.
The practice of participation in combat soldiers previously received BPT showed that the likelihood of their BPL again 1.5 times higher than that of soldiers of the same combat experience, but have not received BPT. Therefore, people who received BPL should not be used for combat zadaniy.Osnovnymi principles of psychosocial rehabilitation are Aleksandrovskij YA, Lobastov OS, Spivak, LI, BP Shchukin Psychogenic in extreme conditions. - M., 1991.:
1. Timeliness. Rehabilitation should begin immediately after the end of hostilities, even if the break in service and combat activity of the temporary.
2. Where possible, the preservation of the units.
3. Orientation to work with staff to recognize the high value their task and appreciated their service and combat activity, demonstrated with the best combat skills, even if the overall outcome of the fighting was unsuccessful in nature.
4. Creating the atmosphere of care, psychological support troops by commanders, the alignment of their relationship to the military for causing earlier misdemeanors and violations.
The initial period of rehabilitation work is directed at the gradual withdrawal of troops from the consciousness of involvement in a combat situation. This period is characterized by a significant level of combat stress vysokostimulirovannoy mental and physical energy. All this potential needs to be implemented. In other words, the stored energy should be out. For this purpose, necessary to organize classes that require physical exertion, but not exceeding the amount of total load, the program of training. In this period should be the method of observation to diagnose mental states with a view to early identification of soldiers with signs of immediate post-traumatic mental disorders. The external manifestations of them are diagnosed and treated for anxiety disorders (Manual for Physicians). Ed. YA Alexander and others Copyright 1989 by American Psychiatric Press, Inc.:
· Modified the usual stereotype of behavior of the soldier on the opposite. Earlier, outgoing, energetic soldier becomes closed, unsociable, tends to privacy. Conversely, a previously closed, seasoned soldier appears uncharacteristically mobility, sociability, talkativeness, often unreasoning joy;
· Irritability soldier, turning into open aggression with hysterical symptoms, tearfulness, often to replace the aggression;
· So-called "off" the person, detachment from everything happening around you, the frequent and prolonged static postures, eyes, loss of interest in living units, an indifference to their comrades and their occupations, lack of self-interest and occupation.
In the provision of specialized psychological and psychiatric care the main method in the period of active hostilities in the immediate period after their completion was psychopharmatherapy. Analysis of the results of treatment showed that for the relief of acute psychotic symptoms, the most effective among the neuroleptics were chlorpromazine, atakzhe eglonil and sonapaks that have not only antipsychotic, and antidepressant and vegetostabiliziruyuschim effect. Among the most effective tranquilizers in victims showed phenazepam, Xanax, clonazepam, which allowed nausea feelings of fear, anxious depression, anxiety-vegetative and anxiety-phobic manifestations. Were widely adopted, particularly those with Psycho syndromes, nootropics (Aminalon, piracetam, atsefen). For relief of psychogenic epileptiform syndrome, as well as various types of paroxysmal states, most preferably the use of carbamazepine, having not only anticonvulsant but also vegetostabiliziruyuschim action. Depressions tend to successfully respond to treatment amitriptyline. Attention was attracted by the fact that the therapeutic effect of the survivors was achieved in the appointment of drugs at much lower doses than is usual in clinical practice.
It should be noted the need to apply at each stage of comprehensive mental health care measures, including, along with psychopharmatherapy therapy and reflexology to improve the protective and adaptive reserve capacity of an organism, methods of psycho-social support and social and labor rehabilitation of victims, affecting the various links in the pathogenesis of mental disorders arising in Emergencies, including its biological, psychological, and (indirectly) the social arrangements.
"The organization of this type of specialized care particularly important to identify the active principle became affected with various forms of mental disorders at different stages of their formation due to the fact that the victims there was a certain degree of anosognosia, and this contingent is disabled seek medical help, not critical to current events and their own health, seek to show themselves in the best light and to hide the problems associated with mental health is "Iadov VA Structure and encouragement by social anxiety consciousness / / Sociological Journal. 1997. Number 3 ..
However, the main efforts of rehabilitation should be in this period focused on special events held by psychologists, psychiatrists, health professionals, and in the first turn on the psycho diagnosis, psychophysiological examination, medical examinations and work on psihoregulyatsii, correction, actions of psychotherapeutic nature. In the first place in the field of attention of specialists to get soldiers with signs postravmaticheskih reactions, which they observed at the initial stage of rehabilitation immediately after the end of hostilities. But it must be borne in mind that these reactions can be delayed in nature and occur over a significant period of time after receipt of mental trauma in virtually any soldier. Diagnosis of mental states, the level of neuro-psychological activities conducted by psychologists and psychiatrists, should be the main content of work during the medical examination of personnel after his return from areas of military tasks. Particular attention should be paid to conduct interviews as a group and individual, in the course of which needs to be oriented to the problems encountered in the process of readjustment to normal conditions of life. As well as psychological aspects of this period, make it clear that this is quite a natural process, which ultimately will find peace of mind and psychological comfort, lack of which currently is not something uncommon and should not cause alarm and fears for their future.
? 3.3. Technology social work with the participants of military conflicts on their psychosocial adjustment to civilian life
The current situation in Russia today can be counted troops to socially vulnerable groups. The soldiers, charged with defending the state, themselves in need of social protection and assistance, are the objects of social work.
The main purpose of social work - the implementation of social integration: a person back from the border situation of anomie in the social norm, to stabilize the social status, to send personal resources to the active construction of social reality environment. "Social integration of the military is the concept, Synthesizing the implementation of personal, property, political rights and social interests, education and social services, psychological support, housing services. The legislative acts and the current organization of social protection of servicemen and veterans are inadequate and need further development and improvement "Trebukhov SN, Trifonov BA, Bunkova OA "On the types of psychological response of the wounded from the combat signs of psychological trauma. / / Collection of "Current issues of treatment of mental illness", Chelyabinsk, 2002 ..
Organizational culture, professionalism and expertise of social services do not meet the current situation, we need a more extensive system of social support technologies, address the regional dimension of social protection. The formation of social integration in the future will exploit the potential of the military to stabilize the society, the development of democratic reforms, the strategic objectives of national security.
Socio-psychological adaptation to the new living environment includes the levels of various objectives and means of implementation: the socio-psychological compensation for the crisis nature of the dismissal; correction value-normative bases of behavior, the formation of effective behavioral strategies. The correct form of work with the officers serve special adaptation courses, integrated into the curricula of vocational retraining.
As a result, the success of socio-psychological adaptation of the military reserves is a problem, and personal and public, as well as the solution to this problem provides an opportunity to move to new activities, social roles, status, ensures the effectiveness of the trained professionals, helping to successfully compete in the labor market. Professional retraining of military remains the most general form of organizational adaptation of the officers discharged, a means of integrating them into a new system of social and labor relations.
Painting mental state and behavior, known as "post-traumatic stress syndrome" describes a certain mode of existence in this world. Our society as a whole, and the medical community in particular, have made their opinions about this mode of existence and described it as a disease, medical experts say is not simply about post-traumatic stress, but the "post traumatic stress syndrome." Program psychological care to veterans are often called "promotion of social adaptation, but one of social adaptation is not enough that a person has ceased to be afraid, worried.
If today's circumstances of life are strongly affected by stirring memories, behavior, thoughts and feelings that came as a legacy from the past, it is important to honestly acknowledge their existence, even if some it may seem "crazy." Gradually learning how to "traumatic events" impact on your life, you also come to understand that healing - the process is deeply personal and covers almost all areas of your life, and therefore can not be reduced to a mere "social adaptation".
Principles of therapy and correction of PTSD Principles of therapy and correction of PTSD / / WWW.PSYHELP.RU
o The immediate commencement of treatment after psychotrauma for the purposes of preventing the development of chronic forms of PTSD
o Integrated long-term treatment, including pharmacotherapy and psychotherapy.
o Individual psychotherapy.
Main objective: to help the patient understand the true nature of his problem, to achieve resolution of internal conflicts and crises in life.
Soldiers with similar symptoms need to provide medical and psychological assistance, special events psychocorrection and psychotherapy. In the manifestation of involvement, concern and interest in their feelings to a sufficient extent can be concluded first necessary assistance to them. In individual interviews with these soldiers should be allowed to express them all sore, carefully listen to them, showing the interest of their stories. The next step is useful to clarify what happens to them and that they are temporary experiences that are inherent to all who were in combat. In addition to these soldiers to form a sense of camaraderie and confidence that he understands and is always willing to help him. The most important thing - to prevent the emergence of feelings of loneliness and the involvement of people in this sense.
The approach of psychotherapeutic training, which includes six components Fontana D. How to cope with stress: Per. from English. - M.: "Education - Press, 1995:
o correction is most common misconceptions about the stress response;
o the provision of patient information on the general nature of the stress response;
o focusing on the role of excessive stress in the development of disease;
o bring the patient to self-awareness of the manifestations of stress response and the characteristic symptoms and PTSD;
o development of the patient's ability to self-analysis to identify the specific stressors for him;
o clinician patient communication about the active role it plays in the treatment of excessive stress.
It is important to teach the patient relaxation techniques, as well as anxiety and stress is often accompanied by his long time after injury.
4. Group psychotherapy.
Main objective: to help the patient cope with feelings of guilt, the state of helplessness and powerlessness, emotional alienation, irritability, anger, and find a lost sense of control over others, the state of helplessness and powerlessness. Very important support group, in which the patient will help to better understand the meaning of the traumatic event and its consequences. For example, in the U.S. for many years there is a support group of veterans of the Vietnam War, in Kiev - a group for victims of violence.
5. Family psychotherapy.
Should tell the relatives of the clinical features of PTSD, the experiences and feelings of the patient, the principles of behavior relative to the situation. Be sure to inform them about the duration of the course of the disease and the possible «flasbacks»-effect. Since close relatives should also conduct psychotherapy sessions, because very often the behavior of the patient may contribute to the development of their border mental disorders.
Work with families must be carried out directly in the performance of the service-combat missions when the incoming information from the areas of action quickly and timely in the extent possible shall be communicated to members of military families, widely publicized the successful implementation of performance-combat tasks, examples of courage, determination, good performance of military duty . In conversations with family members they are issued the following recommendations Andryushchenko AV, posttraumatic stress disorder in cases of loss of the object of extraordinary significance http://www.consilium-medicum.com:
· Attentive and interested hearing stories of his partner that he had to endure. It is very important to this man speak, especially when the moral support of his family and loved one. Need to share their experiences during the absence of her husband and family members;
· Try to help psychologically to return to normal, habitual life;
· Show patience and attention to the problems of her husband, which inevitably arise combat stress, to his psychological problems to increased irritability, possible long-term depression, etc. This is a temporary phenomenon, it is necessary to help him cope with them;
· Be aware that during the time of separation, associated with the implementation of the husband of combat tasks, both spouses have changed somewhat. Need some time to get accustomed again to each other. Returning to her husband's habitual living together can not proceed without complications, understanding and patience;
· Special attention should be given to children. It is important that when you restore your usual relationship with her husband they were not left without proper care and attention;
· Create a favorable intimate atmosphere. Give your partner understand that you need it and that will go to meet him;
· Not encourage the use of alcohol husband. Try to tactfully let him know that it is detrimental to him, your relationship and in general for the family.
6. Marital psychotherapy.
Main objective: to help spouses adjust to the changes that have taken place for both. In its conduct should be considered sexual problems of veterans relating to their military background (homosexual behavior in the isolated military zones, violence, women in the occupied territories, brought forward sexually transmitted diseases, contact with prostitutes, etc.).
7. Socio-historical correction.
Main task: Relief of feelings and reactions of protest against social neglect.
Ways to achieve: Discussion of the historical situation and recognition of veterans in the media, social approval of the parties to the hostilities, the stimulation of social activity and demand.
Adaptation should basically have a set of measures to build support for military personnel to perform their combat missions, both in the sphere of socio-legal relations, as well as in the field of social psychology, moral relations. This differs from the adaptation of rehabilitation.
In other words, should be implemented in varying degrees, these people need public recognition, performed their duty and their public support. Unfortunately, it should be noted that not always the public opinion in the state was objectively to evaluate the activities of combat troops. Examples of this are taking place with respect to the veterans of the "Afghans" in the first months of armed conflict in Chechnya, public opinion was formed not in favor of support of the troops, but rather the contrary.
This stage adaptation fraught with interpersonal conflicts between / within the military teams, where part of the military did not directly participate in the performance of combat tasks and there was all this time in place of permanent deployment. The resultant irritation over equals people, but no survivors of what had to go through them often creates aggression, not only among soldiers, sergeants on call, but also to the officers. From this perspective, we must devise and organize a solemn ritual of meeting with the removal of the Banner and the holding of the meeting, returning soldiers must feel the true heroes of the occasion.
For structures to work with staff at the time the special direction of their activities should be the preparation and conduct of mass cultural and recreational activities to promote the combat activities of personnel committed feats of courage, faithful execution of their military duty, not just individual soldiers, but and units, crews, calculations. Forms of work: thematic evenings, parties, portraits, evening celebration in honor of heroes, courage, and so the evening
To participate in these activities should involve representatives of local authorities, the public, parents, relatives, family members of military personnel, effective use of footage in the area of video, documentary photographs.
Another negative symptom of maladjustment troops when they return to normal conditions of service is a possible manifestation of conflict between the soldiers, sergeants and officers who were not with them "there" when the statute is a legitimate demands of the latter may not always adequately perceived by their warring subordinates. It is necessary to show enough sensitivity and understanding of the psychological attachment to their military commanders greater credibility in the eyes of their subordinates. Advisable at the initial stage of rehabilitation, leave the levers of control combat units in the hands of their commanders.
All these negative effects of performance of combat tasks in circumstances involving a risk to life, are the subject of special psycho-social rehabilitation activities carried out by psychologists, medical and social workers.
Painting mental state and behavior, known as "post-traumatic stress syndrome" describes a particular mode of existence in this world. Our society as a whole, and the medical community in particular, have made their opinions about this mode of existence and described it as a disease, medical experts say is not simply about post-traumatic stress, but the "post traumatic stress syndrome." The dominant position of the society regarding the ex-war suffering from post-traumatic stress disorders (PTSN), the conviction that we need to divert the attention of the veteran from traumatic events that led to the PTSN, and thus help it "become normal," to adapt his way to accepted standards of conduct . No wonder in recent years often talk about the need to create programs to promote social adaptation. A running, long-standing post-traumatic stress disorder is difficult to treat. Not only because chronic diseases in general difficult to treat, but also because of the nature of suffering: for doctors, too, seem to be people who are sick, unable to understand them. In the USA, effective assistance to individuals, has long suffered from PTSD, is provided through a network of specialized public institutions. Similar in Russia yet.
The idea implicit in this title, suggests that a mental trauma a person must change their behavior so as to merge with the bulk of their fellow citizens. The "bulk" means the moderate majority of citizens who hold broadly similar views on what behavior is socially acceptable and what is not.
However, "social adaptation" is unlikely to help a man detained for a long time in extreme conditions, to return the peace of mind and joy of life. This approach may convince the veteran that he should recover to change their behavior to become like everyone else, "normal" and therefore cease to act, think and feel in their own way, "not all".
The majority of veterans who are trying to adapt, to accustom themselves to the "normal" behavior, the main difficulties arise from the fact that they offer as a treatment simply forget the past. And this often means that the memory would be lost not only the ugly images of war, but also the lessons of generosity, discipline, honor and courage. This path does not lead to integrity.
In fact, this approach offers to treat the symptoms of the disease rather than its cause and purpose of such treatment should not be health, and compliance with generally accepted norms of behavior. Therefore we can assume that the path of "social adaptation" is unable to lead to true healing.
For many veterans of the last war is still present in their lives. Related to war experiences and memories for them are real here and now. So, to implement the recommendation "whether here and now, they need to remember what it was before.
Experience - a rich source of knowledge about our own strengths and weaknesses.
The true physical and mental health is not how to fit someone else's norms and standards, and to come to terms with himself and the real facts of his life.
Another negative consequence of this approach is that the patients believed in him, unable to bring himself to act, think and feel as "accepted" in our society come to despair and lose hope in recovery. In fact, on the way to true and not illusory healing, not so important to behave "like everyone else, but it is very important to be very honest with yourself, appreciating what is happening in my life at the moment. If today's circumstances of life are strongly affected by stirring memories, behavior, thoughts and feelings that came as a legacy from the past, it is important to honestly acknowledge their existence, even if some it may seem "crazy." Gradually learning how to "traumatic events" impact on your life, you also come to understand that healing - the process is deeply personal and covers almost all areas of your life, and therefore can not be reduced to a mere "social adaptation".
Similarly, and "social adaptation" approach to the problems of people who had lived beyond normal human experience, keeps within the standards of values that are inherent in conventional, far from the danger of life. The correct action requires a violation of artificial boundaries that we have set: the painful events that are generated by an extreme situation, should be treated with non-standard methods, going beyond the artificial scheme of "social adaptation".
The most important that you should know about post-traumatic stress: even after years of confusion, fear and depression, we can regain a balance in life, if you put in front of the goal and aggressively go for it. This is proved by the example of many survivors of trauma and has long suffered from post-traumatic painful phenomena. Having learned to recognize the consequences experienced extreme circumstances, people understand that they are quite normal that the painful phenomena - the natural result of the difficult events in the past. This understanding leads to the internal adoption of what has happened in my life, and to reconciliation with himself.
Healing is and is to come to terms with himself, to see myself as really are, and making changes in their lives, not act contrary to his or her identity, and in alliance with it. This is the real task of healing. Change the past man can not: it does not make it more beautiful, or at least less ugly, but his real feelings and ideas about themselves, about the past, on what the meaning laid down in it - may be others.
? Conclusion
So, speaking of post-traumatic stress, we mean that a person has experienced one or more traumatic events that have profoundly affected his psyche.
These events are so dramatically different from all previous experience or inflict
such severe pain that people responded to these violent backlash. Sanity in such a situation, naturally seeks to alleviate the discomfort: a survivor of a similar reaction, fundamentally changes its attitude towards the world to live became a little easier.
If the injury was severe or traumatic events occur repeatedly, a painful reaction can persist for many years.
Just as we have become immune to certain diseases, our mind generates a special mechanism to protect themselves from painful experiences.
"Combat reflexes" did not seem unusual, until the man was in the area of hostilities. But back home, found himself in an environment where such reflexes are produced, at least, a strange impression. A thousand times, directly and indirectly, in many ways a man pointed out that it is time to stop behaving like a war. But no one explained the veteran how to do it.
For those few veterans, who were lucky, the house became a place where they waited for love, where they feel safe and able to calmly reflect on experiences, discuss it with friends. This atmosphere allows one to analyze his feelings, and then internally to take their experience and come to terms with the past, to move through life more.
Unfortunately, this happy scenario is not typical for the majority of returnees from the war. According to the stories of many veterans, returning home was equally, if not more severe than the military experience: no one with whom to have a heart, never felt completely safe, and it was easier to suppress emotions than to allow them to break out, with the risk losing control. In this situation, the mental stress for a long time does not find an outlet.
Thus, we can conclude that post-traumatic syndrome members of local military conflicts is the personal crisis with all its attributes, and thus, like any psychological identity crisis, in need of therapy.
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? Appendix 1.
Fig. 1. Scheme of formation of combat stress disorders.
Психосоциальная помощь в реабилитации и адаптации участников вооруженных конфликтов

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