PTSD and the Soviet Culture
Posted on February 23rd, 2017
Dr Ruwan M Jayatunge
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after an individual has experienced or witnessed a major trauma. DSM-IV-TR Criteria for Posttraumatic Stress Disorder highlights that the person has been exposed to a traumatic event in which both of the following were present: (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) The person’s response involved intense fear, helplessness, or horror. The traumatic event is persistently re-experienced by the victim and he / she is persistently avoiding the stimuli associated with the trauma. In addition the victims have numbing of general responsiveness.
It has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as ‘railway spine’ and ‘shellshock (Jones et al., 2003).
PTSD is predominantly a Western culture-bound disorder. The Western culture regards PTSD as an individual disorder with unique symptoms. Some experts view PTSD as a culture specific entity. Cross-cultural applicability of the posttraumatic stress disorder (PTSD) category is still under debate. Hinton & Lewis-Fernández (2011) indicate that although substantial evidence of the cross-cultural validity of PTSD was found. However, evidence of cross-cultural variability in certain areas suggests the need for further research.
Ethno -cultural studies of PTSD offer an opportunity to identify the universal and the culture-specific aspects of the PTSD experience by comparing ethnocultural group differences in the distribution, expression, and treatment of PTSD (Marsella et al., 1992). According to Young (1997) PTSD is not a timeless or universal phenomenon, nor is it a discovery. Rather, it is a cultural product. PTSD cannot be separated from the routines, technologies, and patterns of thinking through which it is encountered.
However trauma is a near universal experience and the Soviet society too impacted it in great proportions. The Soviet society faced rapid changes within short periods. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent “totalitarian” regime, reformed and stagnated under “mature socialism” and then embraced capitalism and “managed democracy” at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry’s relationship with them (Healey, 2014).
Russian life and the people are full of paradoxes and contradictions that are not easily understood by the Western mind (O’Neil, 1993). Karyani (2014) hypothesizes that in collective societies such as in the former Soviet Union strong cultural and social buffers created against ailments like PTSD. Therefore in manmade or natural disasters populations were less affected. Brooke (2014) states that the role of community is crucial in understanding the PTSD and societies with strong local communities with strong cultural identity the incidence of PTSD is rare.
No culture is immune to psychological trauma and each culture has different ways of interpreting as well as reacting to psycho-trauma. Culture has an immeasurable impact on trauma that can range from differences in interpretations of traumatic events to symptoms of disordered behavior to societal norms about interventions (Baldachin, 2010).
The Soviet people encountered multiple traumatic events that created a collective trauma among its population. However it is reasonable to believe that the Soviet people had some protective mechanisms against psycho trauma which may have acquired through historical experiences (desensitization) and living in a collective culture dedicated to a common social constructive course.
According to O’Neil (1993) some individuals in the Soviet Union “living in the double” meaning that there were two distinct personalities within the same person that could be activated depending on the situation. One personality conformed to the politically correct Socialist principles and another one reflected his/her own personal viewpoints. A number of contacts admitted that this dual personality was very common and a product of the Soviet state’s continuous monitoring of individuals. This separation of personalities or “double life” was being discussed openly and had diminished somewhat after the Coup d’ etat of August 1991. The disbanding of the KGB and the Communist Party gave the people some confidence that they could be individuals without fear of harassment. Yet, this double life has been operating for many decades and raises special clinical questions about Russian interpersonal relations and conflicts. Formation of two distinct personalities within the same person sometimes acts as a buffer against psycho trauma.
The PTSD symptoms that the Soviets experienced were not hundred percent matching as the PTSD symptoms that are seen in the Western World. The Soviet PTSD sufferers used to internalize their symptoms and often these symptoms were manifested as vague psychosomatic reactions. They presented with emotional numbing, social isolation, and fear of authoritative figures, deep suspicion, and sense of foreshortened future, heavy alcohol / tobacco addiction, poor social attachments and somatization. The stress related physical symptoms frequently manifested as gastric ulcers. The PTSD affected populations often used the term Yazva (gastric and duodenal ulcers) connecting their physical symptoms.
Suicide and self-harm were common among the Soviet people who were affected by PTSD. The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984 (Värnik et al., 1992). The Soviet Authorities concealed the actual figures of suicides. As indicated by Wasserman, and Värnik (2007) reliability of statistics on violent death and suicide in the former USSR was often questioned. In some Soviet republics suicides were under reported.
Addictions were widespread. PTSD victims used to drink Vodka / homemade illicit liquor (Samagon) in large quantities. Some used toxic substances (household cleaning chemicals) as substance of abuse. Family break ups, child abuses recorded in large proportions. But all these maladies were not addressed appropriately and frequently kept in secret. The young generation who were tormented by social and economic cataclysm later became the members of the underworld gangs or became the supporters of the neo Nazi groups in Russia.