Chernobyl Liquidators' Health
as a Psycho-Social Trauma

4.4. Post-traumatic stress disorder (PTSD)

       PTSD is considered to be a specific anxiety disorder caused by stressful (“distressful”, in terms of Selye (1992). — S. M.) or traumatic event (Baker and Karasek 1995: 396).
       The trauma may be of 2 types:
— massive and discrete (e.g., an accident), or
— consisting of episodes (e.g., of dangerous work processes, in the case of occupational health approach).
       The symptoms include, first of all, a repeated “re-living” of the traumatic event, and sleep disturbances, detachment from others, emotional blunting, trouble concentrating. The recurrent symptoms of PTSD may make an individual a disabled person. The authors stress that recognition of the psychological trauma caused by the event is important to avoid unnecessary, costly, and, in certain cases, detrimental medical diagnostic evaluations (Baker and Karasek 1995).
       This is a very brief, introductory description of PTSD — the concept which has drawn my exceptional attention in the course of this study. Before dealing in detail with PTSD (including its causes, mechanism and consequences, and even with the history of its recognition as a disease), I need to justify this.

       There are several very important reasons to consider the PTSD framework as extremely relevant, important and needing special attention and extensive informing in the case of the Chernobyl liquidators. These reasons are:
       1. All the frameworks previously mentioned concentrate first of all upon harmful factors of the environment, and mechanism of their impact upon human physical and mental health. However, they do not deal with the consequences of this impact in much detail. The PTSD framework is reported to embrace essential share of these consequences, and thus, it to a certain extent complements, completes the previous approaches.
       2. The concept of PTSD sums up a vast experience of recognition, diagnosing and treatment of psychological trauma. Analysing of the Chernobyl liquidators' case within this framework seems to be very productive from different perspectives.
       On the one hand, the PTSD framework seems to be general enough to embrace the Chernobyl liquidators' case (and, thus, to connect it to experience gained in other cases), and, on the other hand, it is concrete and developed enough to result in clear-cut mitigation measures in this case.
       In particular, Chernobyl experience of the liquidators in many aspects is similar to that of combat veterans, as I have pointed out earlier. Thus, “the traumatic neuroses of war” (Herman 1997) — an important, one of the best studied cases of PTSD, which was crucial for its recognition as a disease — may be expected to be the closest one to the case of the Chernobyl liquidators, in terms of psychological and social trauma received.“Connection” of a part of Chernobyl experience to the framework of PTSD may give a positive feedback on further development of this latter, for at the moment Chernobyl case seems to be totally unnoticed in the mainstream PTSD literature. For example, two recent books, dedicated to the PTSD, and traumatic stress in general, respectively (Herman 1997; Van der Kolk, McFarlane and Weisaeth 1996), did not even mentioned the word “Chernobyl” in their — in the other respects quite extensive — subject indices! This case is not even touched upon in them. It can serve as one more indicator of how neglected, poorly studied and poorly reflected in the international literature are the psychological problems of Chernobyl survivors. Meeting “the Chernobyl challenge” may advance further both theory and practice of the PTSD and traumatic stress frameworks.
       3. The experience of dealing with psychological trauma does not seem to be widely known for the practical workers of various positions, dealing with Chernobyl aftermath. This circumstance seems to be especially relevant (but not limited) to the post-USSR.
       In the post-USSR space, with its traditional (totalitarian and post-totalitarian) lack of attention to human psyche and limits of its sustainability, PTSD (called there “post-traumatic syndrome”) is a relatively new concept. It was brought to the public's and specialists' attention after the Afghan War of the USSR (1979—1989), and not much is known about the notion except for the name and some (often — vaguely formulated) symptoms. This is true not only to the general public but for the specialists as well: no separate handbook on PTSD has been published in Russian yet. PTSD is described only in the chapters of the handbooks on psychiatry. There is almost no practice of its treatment. Though some of this experience was gained with Afghan War veterans, it seems to have had no substantial impact on the Chernobyl case.
       For all these reasons, I will deal in detail with the PTSD, and will start with the history of “discovery” of PTSD — the history of its formal recognition as a disease. I expect a similar process should take place (or rather is already underway) in the post-USSR countries in respect to the Chernobyl-affected, including the liquidators, in order to gain an adequate picture of their injury, and to improve its treatment.

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