Maria Dolgopolova: I also wanted to share something that might be relevant to our listeners who have never been involved in terrorist attacks or shocking upheavals, and hopefully, never will be. The thing is, any significant stress, chronic stress, can cause quite vivid effects. Again, since I cannot disclose any symptoms of my clients, I can share a valuable personal story. I experienced stress not related to violent intrusions or anything like that. It was just accumulated stress, fatigue, reality challenges exceeding my capabilities, and I was sleeping less, eating less, handling various tasks. I had a very interesting stress reaction a year ago that I had never experienced before. On particularly peak days in terms of workload, fatigue, and mental exhaustion, I would go blind. I was completely blind, like a mole. In general, my eyes are my weak spot, but I see well enough both near and far without glasses. My vision issues are more like nuances of weakness, but I can see everything I need to. Here, I realized that I couldn’t see up close, far away, on my phone, or read signs. Everything was gone! So, the first thing I assumed was that it wasn’t related to medicine but was some kind of bizarre stress effect. Firstly, because this symptom was inconsistent. Vision problems typically either worsen dynamically or maintain some constant amplitude. I couldn’t subjectively measure the level of cortisol in my body; I didn’t have any sensors attached. But based on my intuitive feelings, the correlation of vision was with cortisol, not with any other medical condition.
I wanted to share this as a remark from my clinical experience. There is a whole block of disorders in psychiatry described as somatoform disorders. These can be various pain syndromes or numbness. Physical things happening in the body, but if a person goes to diagnose them with real doctors, the doctors won’t find anything. They’ll say you don’t have any diseases. Another surprising thing is that organs in our body, without changing their structure, can start functioning differently due to a stress. This can lead to real pain sensations with no actual diseases capable of provoking such a pain. It’s important to understand that a severe stress and our prolonged anxious states and depressive states can cause a whole range of such pseudo-medical problems. And this should be understood and taken into account.
There is a fine line between a normal reaction to abnormal events and a normal reaction that still needs to be addressed separately—like dealing with anxiety disorders or depressive disorders. If such bright, somatoform symptoms persist for more than a month, they need to be addressed separately.
Olga Kostina: Yes, and there’s an interesting point here. Everyone wants to achieve happiness, for it to just happen. However, happiness and a lot of insights always come only in a crisis. During nirvana, no insights or ideas can be gained. This event also led me to many reflections, both personal and professional. I noticed that, strangely enough, a person with a delicate sensitivity suffers much more in such an event. A person with thicker skin, perhaps, will get through this event more easily. People with great imagination tend to build up scenarios, and the brain cannot be stopped. Moreover, the brain, particularly the hippocampal area, does not distinguish between real events and fantasies, especially if it was related to a specific event.
I even went to the movies after that event to cope with the stress.
Maria Dolgopolova: You were diligently rewriting your traumatic film.
Olga Kostina: I’m not sure if I succeeded because I went to see a film related to the Civil War. The main character was a photojournalist, and I kept putting myself in those circumstances throughout the film. For a week after that, I kept thinking about how soon the feeling would pass that someone was aiming at me. I felt like they would shoot right now. I felt it by my skin. These are details of a somatoform disorder. I feel it again now. But no one is aiming at me.
And yes, there can be pain. It might seem like it, but at that moment... I don’t know how good it is to expand this abundance of impressions because it pulls me in. The story is still very fresh and pulls me back into those experiences. You can get a lot of impressions without being injured, feeling as if you were almost hit. Whether you’re hit or not depends just on a bullet passing by.
Maria Dolgopolova: You mean in terms of the intensity of these interesting reactions, like when you go and...
Olga Kostina: Yes, and then it can indeed lead to the development of some entirely phantom but almost real pains in the body, and this, indeed, needs to be addressed. The line here is very thin. But somatoform disorders are generally a vague thing. In our psychiatry course, we were told that this is a very fine line because it is never fully possible to understand if a person is really in pain or not. Because technology does not register any event, it nevertheless exists. It is very important to support oneself, on one hand, acknowledging the symptom, recognizing that it exists, not pretending it doesn't. And staying on that fine line to avoid falling into madness, which it strongly pulls you towards. Because something is happening in the body, nothing is clear, everyone says that "you are fine", and paranoia and madness increase: “How come, I am in pain.” So you need to check, while at the same time allowing that it could be a psychosomatic effect, and then dealing with it. By the way, when they say: "Oh, it's psychosomatic," it doesn’t mean it doesn’t need to be addressed and treated. In your example, you practically stopped seeing, while the organ of vision is physically fine. Nerves are fine, optically everything is fine, the brain is fine, but you can’t see. And this is something that also needs attention because from the psychosomatic severity of an attack, you can theoretically die being perfectly healthy functionally.
In all of this, I think it’s important to acknowledge these damages that can’t be touched or registered, while not fully falling into madness. Some damage has occurred, and it definitely exists, no matter that, in fact, it doesn't.
Maria Dolgopolova: Another aspect I wanted to discuss relates to activation energy and initiative, as well as mood and emotions, that under stress, during shocks, or processing some difficult emotional experiences, our reactions and mental processes can slow down significantly. We start doing things inexplicably longer or can't concentrate on them at all. This is a very typical reaction to shock, and people can even go to a psychologist after a month, shocked that they can't concentrate on ordinary tasks. Or they can concentrate but do what they usually do much slower. Writing letters takes much longer, going to the store takes much longer, getting ready, dressing up — everything they usually do. This is actually a frightening state that drives people to exhaustion and thoughts like, "Have I gone mad? When will this end? How can I live with this? Will it stay with me forever?"
Olga Kostina: Yes, and I have such a personal experience. One of my children is allergic, so I have to cook food in a certain way because my daughter can't cook for herself and has to eat something specific. And I remember the day after the Crocus event, an apply pie, which usually takes 20 minutes to prepare, maybe 15, took me 4.5 hours. It's inexplicable how that happened. I wasn’t distracted, honestly. Two days later, I baked the same apply pie in 2.5 hours, thinking, "Aha, there is some progress." It got easier, but it was still inexplicable. In moments of escape, I found that a second is very long. People who work in radio know that five seconds is a lot. You can pour coffee and get back to the console in ten seconds. But this was the opposite phenomenon, not when many events happen in one second, but when you seem to be focused on what you need to do, simple movements, but they take hours. And I think I even contacted you, Masha, back then, saying, “What’s going on? I spent 4.5 hours cooking an apple pie, and I’m usually quick and precise, doing everything fast.”
Maria Dolgopolova: Did it took 10 minutes to type a two-sentence message to me?
Olga Kostina: Well, maybe it didn't extend to the text for me, but to some actions, yes. Some communication parts remained almost unaffected, but other parts suffered. It’s clear why: the sensory system, the whole body, is overloaded. But I can't say what helped me get out of it. Most likely, a perspective that it’s normal. You just have to wait it out, indeed.
And Masha always helps me in this sense because we have slightly different views on simple things. In my family, everyone always has very high standards for themselves and others, even higher for themselves. So I always feel like I need to be faster. Masha always brings me back to reality. I tell this to my clients too, but I can’t apply it to myself. It just doesn't work. It's something where you really need to give yourself time without figuring out to what extent and what is happening to you. You are completely unharmed. Ironically and terribly, it seems that someone who has been wounded, to various degrees of severity, will experience the event very painfully and with difficulty, but psychologically, it will be easier. Because they have a concrete wound, it hurts, there are stages of healing, stages of adaptation.
Maria Dolgopolova: Well, some focus emerges, like, here I am, and here is my wound...
Olga Kostina: Yes, yes, and it heals better because there is some actual damage that you can pay attention to. Honestly, I have the impression that we practically didn't suffer, except for a severe fright and some amount of imagination regarding it. But the abundance of symptoms and the severity of the condition indicate that we actually did suffer. And this should be acknowledged.
Besides, the Investigative Committee gave us a document stating that we are victims. I occasionally looked at that document in the first couple of days...
Maria Dolgopolova: Listen, that's a useful document. I think trauma therapists should also obtain a report with a detailed description of events, stating that you participated in such and such event, this and that happened, and... the report sais: you are a suffering party.
Olga Kostina: Yes, that's actually a good idea.
Maria Dolgopolova: What if someone didn't reach the Investigative Committee?
Olga Kostina: A lot of people don't take it. I know that this document doesn’t give any benefits or privileges, it’s not needed in life. But I understand that having it, being able to look at it... I actually did that the first week. Because the dissonance of how life circumstances suddenly changed doesn’t allow you to comprehend it. And I think that a lot of psychotic reactions can occur at this point, in the inability to comprehend. And you need to be kinder to yourself, somehow. I need this advice too: be less demanding, kinder.
Because I, in turn, once again find balance through you. You say I quickly went to the theater and the cinema. And I’m already thinking: "Why did a whole month pass? I should have already shot some concert and checked if I can enter a concert hall with a camera, or if I won’t be able to." Well, this question still exists. After visiting the theater, it’s slightly less acute. At least I found out that I can sit through a concert.
Maria Dolgopolova: In my eyes, you are very quick and very responsible in processing your traumatic experience.
Avoidant behavior can actually greatly exacerbate these things, prolonging them. People don’t even know this; they just feel they’d better lie down, not go anywhere, and so they lie down...
I had a simpler story, nothing out of the ordinary. I was engaged in horseback riding, show jumping. I often fell off the horse because I was learning difficult jumps. It’s normal to fall in this sport. This is typical. And then I fell, and my coach saw that I was scared and didn’t want to get back on the horse. He ran after me with a stick. It was very funny because he tried to mechanically force me back on the horse so that I would be more afraid of him than of getting back on the horse.
Olga Kostina: That's a great method. Interesting, really interesting.
By the way, amid such traumatic experiences, the concept of "fighting fire with fire" seems to hold true. Many things that bothered you before become less significant because they are simply incomparable.
Maria Dolgopolova: I should also comment that we’re not only talking about shock traumas or terrorist attacks here. We’re talking about the psyche, and this problem of energy, activation, initiative, and their loss, reduction, and slowdown, unpleasant and uncomfortable for a person, can occur from any purely internal psycho-emotional upheavals.
So, when we fall into some internal crisis or are processing something, maybe even purely internal, our psyche begins to produce such strange reactions. The only point is that I’m not saying these reactions are always normal and shouldn’t be addressed. If there are signs of depressive disorders or anxiety states, it sometimes makes sense to check for the latter. I should probably mention this now because it’s unclear where our conversation will lead.
I would still note that sometimes it’s helpful to check yourself if you haven't been through significant external shocks or significant internal upheavals, if you haven’t recently experienced the loss of a loved one or the collapse of a beloved area of life or something like that... If you haven't had such obvious triggers, but you notice a decrease in energy, that even on the calmest and least burdened day you can’t enjoy your favorite activities, and this lasts for more than a month. Maybe you have combined sleep and eating disorders or a chronic lack of energy and a low mood. These things should be checked because they can be either depressive disorders or depressive mixed with anxiety. Waiting them out is a poor strategy for overcoming them.
Olga Kostina: Yes, because they can enter a more chronic phase, which is characterized by internal stabilization. This means it starts to sustain itself, and then it becomes much harder to get out of that state.
I think there’s also an important point that in our society, in the post-Soviet space... I haven’t lived in other countries for long periods, though I’ve traveled a lot. So, it’s hard to pinpoint this from a few months of living abroad. Therefore, I don’t know how strong this is in other societies, but in the post-Soviet space, there is a clear message of “Oh, what happened to you? What’s the big deal?” This devaluation of any emotional and psychological issues can be very severe. Almost every one of my clients, with rare exceptions—apparently... It seems I met mostly responsible, anxious people who self-diagnose themselves and say, “Nothing happened. There’s no reason for such reactions. Where does it come from?” Clients don’t immediately tell their stories; there’s a backstory. And you think, “Maybe this person is completely fine... On the surface, there’s nothing.” But when it comes to the central part of the story, I’m often horrified. I say, “You call this ‘nothing happened’?!”
Even though I have a lot of heavy, varied, traumatic, and extreme experiences, I’m sometimes shocked because it surpasses my own experiences. And at this point, the person says, “Well, what happened to me?” I think it’s really important to pay attention to what’s happening inside the body and the psyche. If, within a month, some effect occurs, it would be good to start investigating it. Maybe something happened in the body, maybe there was an event you didn’t recognize as traumatic, but it was essentially so. It’s good to sort it out because there’s no smoke without fire. Nothing happens for no reason, something definitely happened, even if the event seemed insignificant.
Maria Dolgopolova: I also wanted to share that when I considered my "free associations" for today’s topic, I thought about hallucinations. Among all psychological reactions, the appearance of auditory and visual hallucinations should raise concern. But if it’s really about a shock trauma, I think even hallucinations in the first month are normal. But again, if you haven’t been involved in anything extreme, hallucinations shouldn’t be ignored. You shouldn’t tell yourself, “Maybe I’m special, maybe I have a good connection with God” or something else. It’s quite dangerous.
Psychiatric disorders that involve hallucinations need to be treated, or you might end up living out of your mind. It’s really dangerous. However, there’s a paradox I’ve often encountered in my practice: some people, within the framework of hypochondria, are very afraid that they’ll start having hallucinations. Essentially, they fear that schizophrenia will be diagnosed or triggered during their lifetime. Because people often think about it, it becomes a subject of their fear. They might experience pseudohallucinations.
If it’s a specific fear and anxiety, you will scan yourself: “Do I see hallucinations or not?” This anxious, agitated mind will generate such images and fantasies that make it unclear whether they’re hallucinations or not. But in this case, it’s a relatively simple thing to diagnose. If you have hypochondriac fears about having hallucinations or schizophrenia, seeing a psychiatrist can help. Psychiatrists often send such people home without any medications, saying, “Sorry, you don’t have enough symptoms, no schizophrenia, go home.” But of course, it’s a scary step to check, because usually, the person is already convinced that he definitely has schizophrenia, and when he goes to the doctor, he will definitely be hospitalized and everything. He doesn’t imagine that they will be diagnosed with hypochondria and told, “No, nothing like that is foreseen.”
Olga Kostina: Yes, and it’s worth noting that schizophrenia is characterized by the person not doubting their status. They are absolutely sure that all their experiences are completely adequate. I have experience with people with clinically diagnosed schizophrenia who spent some time in hospitals. And they seem “fine.” Well, some moments occur, but generally, they aren’t much different from regular people. It’s truly different.
As someone who has self-diagnosed with somatoform disorder since childhood because I’ve always been bothered by wandering, mysterious sensations in my body and elsewhere, I can say that the line between schizophrenia and everything else isn’t that clear. I grew up in a psychiatric environment, so this fear that something is wrong with me is familiar. Sometimes there’s a peculiarity in how the brain works. For example, when you’re driving and a fast billboard passes by, you can read almost anything on it. I’ve gotten used to finding it funny, and it’s not a reason to think it’s schizophrenia; it’s a constantly present factor.
Talking to a psychiatrist can help in this sense. There’s no need to be afraid of. Our new psychiatry law has almost eliminated punitive psychiatry. Even someone with a real...
Maria Dolgopolova: There are private psychiatrists who won’t record it anywhere, in any case.
Olga Kostina: Perhaps this again comes down to treating our individual characteristics, which are different for everyone and definitely exist, with some kindness and rather seeking help than trying to eradicate or fix something. Because I still believe that some aspects of our makeup cannot be eradicated. And, in general, the concept of normalcy not only doesn’t exist, but it’s very broad. There are people with strange sensory characteristics, like mine, but who are fully functional and highly critical. There are absolutely healthy people who have no emotional, psychological, or somatoform peculiarities, closer to the standard norm, but may have an imprecise perception of certain objects. And there’s a big question: who is more accurate in perceiving the world? It’s hard to answer. So, it would be good to be kinder to ourselves first and still seek support and help from a professional.
