In Ukraine, the Psychic Scars of War

Wednesday, March 22, 2023

By Courtney Wise

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Chronic pain patients fall through the cracks of the opioid crisis

Since going through an accident and a botched surgery, Andrea Anderson’s only relief from chronic pain has come from prescription opioids. But they are now harder to get than ever, the San Francisco Chronicle reported – an unintended side effect of efforts to stem the addiction and overdose crisis. “These are life-saving medications to me,” she said. “When you are in the position where you need them, there is nothing else that does what an opioid can do. It is horrific to be trapped in a body with nonstop, untreatable pain.”

That’s Lori Long’s experience, too. She lives with an autoimmune disorder characterized by such agonizing pain that she can’t function in day-to-day life without opioids. After her old physician died, she struggled to find a doctor willing to write her a prescription. “I was treated like a leper from Biblical times,” she said. “No one wanted to touch me, treat me or give me care.” Finally, a doctor wrote a prescription, but for a dose so low, it offers only minor relief. “I still can’t participate in life the way I did when I had better pain relief,” she said. 

Worried they may be prosecuted, pharmacists and physicians are now withholding opioids as aggressively as they once doled them out. It’s so bad that Kaiser Permanente has sent letters to its patients on opioids, telling them their treatment plans are under scrutiny. “It’s very clear that some of the unintended consequences of these proscriptive opioid policies ended up harming patients who were taking opioids appropriately for legitimate circumstances and were experiencing reductions in pain and improvements in life and physical functioning,” said Sean Mackey, chief of pain medicine at Stanford.

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The psychic scars of war as seen in a photo essay of a Ukrainian hospital

Not all casualties of war are physically dead. At Pavlivka, a psychiatric hospital in Ukraine’s capital city Kyiv, soldiers haunted by the agony of their experiences in battle are being cared for in hospitals once reserved for people with schizophrenia and other mental illnesses. Pavlivka’s overflow unit alone holds 100 soldiers. One man, Ruslan, has the same nightmare every night. He dives for a trench, he told Ellen Barry for a story accompanying a photo essay in the Sunday New York Times Magazine, but instead it’s a grave. Once an art teacher and now a  junior lieutenant, Ruslan is plagued by the feeling that something awful is about to happen. 

“All the horrors in Bakhmut are now starting to haunt me,” he said. “It was hell; I live in hell…I would like to lie in a hole somewhere and hide.”

Another man no longer speaks. A fellow soldier was killed in front of him, and two were badly wounded. “He withdrew into himself and doesn’t want anything,” a psychiatrist said.

Russia’s war in Ukraine, Barry notes, “stands out among modern wars for its extreme violence.” Its front lines are barraged by heavy artillery, and troop rotations from the front line are infrequent. “We are looking at a war that is basically a repetition of the First World War,” said psychiatrist Robert van Voren. “People just cannot fight anymore for psychological reasons. People are at the front line too long, and at a certain point, they crack. That’s the reality we have to deal with.”

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Telehealth therapy reaches rural nursing home residents in Iowa

For rural residents, in-person mental health care is hard to come by. There are few providers, and even when they’re fairly close, transportation can be a challenge. In Iowa, small-town nursing homes are working to overcome both barriers by making therapy by video more available. In Knoxville, Iowa, Nancy Bennett allowed Kaiser Health News to peek as she met on an iPad with a psychiatric nurse practitioner 800 miles away in Austin, Texas. Bennett admitted that between her physical ailments and the depression she sometimes feels, she wouldn’t have attended had it not been on video. “There are days when I don’t want to be bothered,” she said.

Demand for telehealth services surged during the pandemic, and insurance rules  eased to accommodate it. Medicare, for instance, paid for 10 times the number of telehealth visits in the last nine months of 2020 as it did in the same period a year before. Encounter Telehealth serves about 200 nursing homes, mostly in the midwest, and conducts about 2,000 mental health visits per month. A bill passed by Congress will allow expanded use of telehealth to continue at least through 2024. 

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In other news…

Spring is here and I can’t wait to open the windows and thaw out from winter. My spouse is talking nonstop about all the things we can “spring clean.” To that end, CBS News spoke to some mental health experts about some of the ways tidying up our physical spaces can benefit our minds.

For Black patients, care delayed can be care denied. Many Black people with mental health problems “don’t get their diagnoses until six or seven years after the onset of their illness,” said Gigi Crowder, executive director of the Contra Costa County chapter of the National Alliance on Mental Illness. The problem goes beyond mental health, of course. More than a quarter of Black Californians avoid medical care because they believe they will be treated unfairly, according to a recent survey from the California Health Care Foundation, Listening to Black Californians: How the Health Care System Undermines Their Pursuit of Good Health. “The system looks at us differently, not only in doctors’ offices,” Michael LeNoir, a Black pediatrician and allergist told Kaiser Health News. 

Daily meditation won’t change the structure of your brain as some previous studies had found, according to a new study published in the journal Science Advances. Still, Yoga Journal reports, other studies show a mindfulness practice can reduce stress levels and symptoms of depression in patients with chronic pain. The ideal amount of daily meditation is a whopping 40 minutes, according to Colleen Gallagher, a qualified teacher of Mindfulness-Based Stress Reduction (MBSR). Thankfully, she says, that’s not where you have to start. She began with sitting for just 5 minutes every day.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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