http://tiukraine.org UKRAINIAN VETERANS INVOLVED IN CRIMINAL JUSTICE: ASSESSMENT OF READJUSTMENT NEEDS OF CRIMINAL JUSTICE-INVOLVED VETERANS ВЕТЕРАНИ, ЗАЛУЧЕНІ ДО КРИМІНАЛЬНОГО ПРАВОСУДДЯ: ВИВЧЕННЯ ПРАКТИКИ РЕАБІЛІТАЦІЇ ВЕТЕРАНІВ, ЯКІ ВЧИНИЛИ КРИМІНАЛЬНІ ПРАВОПОРУШЕННЯ

1. RESEARCH
[ENG 1-35 pages / UKR 36 -83 pages ]
UKRAINIAN VETERANS
INVOLVED IN CRIMINAL JUSTICE:
ASSESSMENT OF READJUSTMENT NEEDS OF CRIMINAL
JUSTICE-INVOLVED VETERANS
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2. UKRAINIAN VETERANS INVOLVED IN CRIMINAL JUSTICE: ASSESSMENT OF
READJUSTMENT NEEDS OF CRIMINAL JUSTICE-INVOLVED VETERANS
1. INTRODUCTION
Today, in Ukraine, there is a significant increase in the number of militaries
that received physical and psychological injuries. Participation in combat
operations causes an acute stress reaction in a person and has a devastating effect
on his psychics [1]. Social adaptation of militaries in peacetime will require the
consolidation of efforts of state bodies, the creation of a system of appropriate
institutions for psychological readjustment and the affirmation of a positive image
of a war veteran in society.
As world practice shows, as a result of psychological injuries received during
combat operations, war veterans in peacetime quite often find themselves
involved in the criminal justice system. Accordingly, the criminal justice system of
Ukraine should develop a special approach to the criminal responsibility of such
especially vulnerable groups of the population as war veterans, who suffered a
traumatic effect on their psychics during combat operations, for criminal offenses
committed by them in peacetime. A special approach to the criminal liability of
war veterans is caused by the necessity to protect the health of war veterans, to
form and support an unambiguously positive attitude towards war veterans,
which directly corresponds to goal 11.2. "Memory and Respect" of the Program of
Activities of the Cabinet of Ministers of Ukraine, approved by Resolution No. 471
of the Cabinet of Ministers of Ukraine dated June 12, 2020 [2].
The purpose of this study is to analyze the legislative acts of Ukraine and
foreign countries, special scientific literature and judicial practice regarding the
criminal responsibility of war veterans to form a special approach to the criminal

3. responsibility of war veterans and to make proposals for improving the current
criminal legislation of Ukraine.
2. PRESENTATION OF KEY RESEARCH FINDINGS.
For the first time in the scientific literature, it was A. Kardiner who
described the characteristics of changes in the psychics of people who took part in
combat operations [3]. In 1941 A. Kardiner named excitability and irritability as
symptoms of the so-called "chronic military neurosis"; unrestrained type of
response to sudden stimuli; fixation on the circumstances of the traumatic event;
departure from reality; tendency to uncontrolled aggressive reactions [4].
After the war in Vietnam in 1980, a group of authors led by M. Horovyts
proposed the concept of posttraumatic stress disorder (PTSD) to denote military
neuroses, which received an international application [5]. The above-mentioned
authors described the symptoms of PTSD as follows: 1) excessive excitement
(sleep disturbances, anxiety, obsessive memories, phobias related to war); 2)
periodic depression (absence or significant reduction of feelings, feeling of
hopelessness); 3) various physiological reactions (paralysis, blindness, deafness,
seizures, nervous tremors) [5, 6].
The specified diagnostic criteria for post-traumatic stress disorder were
used to develop the Diagnostic and Statistical Manual of Mental Disorders, which
had several editions. A traumatic event is defined in the Fifth Edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [7] as an event (or
series of events) during which a person has experienced personal or mediated
exposure to actual or threatened death, serious injury or sexual violence. There is
a wide range of psychological responses to traumatic events, ranging from normal,
temporary, non-debilitating symptoms to transient, acute, time-limited, and

4. clinically significant clinical disorders to a persistent disorder (PTSD) that can
become chronic if untreated [8].
According to rubric F 44.88 of the code list of the Tenth Revision (version
2007) of the International Classification of Diseases (ICD) [9], developed by the
World Health Organization post-traumatic stress disorder (PTSD) can develop as a
result of an event that traumatized a person's psychics and goes beyond ordinary
human experience. PTSD leads to pathological changes in the personality of
veterans and their partial or complete inability to adapt to peacetime conditions.
Analysis of special literature on psychology shows that the involvement of
war veterans in criminal justice is more often associated with PTSD
[10,11,12,13,14,15,16,17].
PTSD is a mental disorder that may arise after a direct personal experience
or experience as a witness of an event that poses a perceived threat of death or
serious injury [18]. The Diagnostic and Statistical Manual of Mental Disorders, 5th
Edition (DSM-5) states that PTSD can have an acute onset as early as 6 months
after the traumatic event, or can be delayed if its onset is recorded more than 6
months after the event. If the symptoms persist from 2 days to 4 weeks, the
diagnosis is acute stress disorder; if the symptoms last more than 1 month, the
diagnosis is PTSD [19]. However, according to some researchers, PTSD symptoms
usually begin shortly after combat stress, even on the same day [20]. The
symptoms that characterize PTSD occur after such emotional traumatic exposure
and include re-experiencing the traumatic event through flashbacks and
nightmares, avoidance of things associated with the trauma, and hyperarousal
(exaggerated fear and difficulty sleeping and concentrating) [21].

5. Therefore, PTSD occurs in a combatant not during his participation in
military operations (an event that causes an acute stress reaction), but after the
end of the latent period, which lasts usually from 2 to 6 months from the moment
of receiving a psychological injury, when the human psychics was able to get out
of a state of acute stress.
PTSD contributes to the formation of a specific attitude of a combatant to
other people, complicates his adaptation to peacetime conditions and affects his
entire future life [22,23,24,25].
Due to the stress experienced in the war, combatants lose interest in family
and social life even in peacetime, their senses of justice, anxiety and suspicion are
exacerbated, which can lead to unpredictable explosive reactions even to minor
mental stimuli.
PTSD is associated with numerous psychosocial conditions, such as violence
and aggression, relationship problems, reduced quality of life, problems with the
law, and homelessness. Research shows that PTSD can cause significant distress
and functional impairment. Various interrelationships of PTSD with other physical,
mental, and social consequences can interfere with a veteran's adjustment to a
peaceful life.
Numerous scientific studies of veterans’ PTSD [26,27] have found a link
between combat-related PTSD and increased violence by the veteran toward his
partner and other family members. Domestic violence is significantly increased in
families of veterans with PTSD. In association with alcohol and drug consumption,
the behavior of veterans diagnosed with PTSD is characterized by significantly
more anger, hostility and aggression than veterans without PTSD [28,29].

6. The course of PTSD symptoms varies greatly depending on the situation and
the individual. Some combatants may even make a full recovery, while in respect
of others a persistent mental disorder may develop which has as a consequence
the inability of the person to work [30].
Studies of the rates of PTSD in military veterans of various wars show that
every fifth combatant in the absence of any physical injuries suffers from
neuropsychiatric disorders, and among veterans who have suffered physical
injuries and mutilations - every third [31].
According to research conducted on American veterans of the War in
Vietnam, 15.2% of military veterans had severe PTSD, and another 11.1% had
isolated symptoms of such disorders. According to other data, approximately 25%
of American Vietnam veterans develop adverse personality changes after
receiving psychological trauma. By the beginning of the 1990s, about 100,000
veterans of this war committed suicide, 40,000 have a closed, almost autistic
lifestyle [23]. Conclusions regarding mortality are ambiguous but generally show
that PTSD is associated with an increase in general mortality and mortality due to
accidents [8].
PTSD is one of the most commonly diagnosed mental illnesses of U.S.
combatants after Afghanistan (Operation Enduring Freedom (OEF)) and Iraq
(Operation Iraqi Freedom (OIF) [32,33,34,35,36,37]. According to the Committee
on the Assessment of the Readjustment Needs of Military Personnel, Veterans,
and Their Families, Board on the Health of Select Populations, Institute of
Medicine, the prevalence of PTSD in military veterans involved in special
operations in Afghanistan and Iraq ranges from 5% to 20% [38].

7. Some risk factors for PTSD of veterans are the young age of military
personnel (reservists are older); combat impact; their loneliness or divorce;
previous traumatic impact (especially physical abuse in childhood and other
adverse experiences). PTSD often is accompanied by several other mental health
conditions, such as depression, anxiety disorders, and alcohol/drug addiction
[38,39,40,41].
Although an accurate estimate of the prevalence of PTSD among the
current population of U.S. veterans, in general, has not yet been established, a
1.5- to 3.5-times increase in the risk of PTSD is diagnosed in connection with the
involvement of combatants in active military operations, regardless of the era of
the war [42].
The prevalence of war-related PTSD is 17.0% in men and 15.2% in women
[43]. Regardless of the specific assessment, research suggests that some veterans
continue to experience PTSD into old age [8].
Numerous studies of U.S. veterans who have PTSD show that this mental
disorder may be the cause of their vast problems with the law. In particular, a
study conducted by Highfill-McRoy et al. (2010), regarding the behavior problems
of Marines with PTSD who were deployed to Iraq, Afghanistan, or Kuwait, was
found that Marines with PTSD were 11 times more likely than their counterparts
who did not have a psychiatric diagnosis, committed serious crimes that led to
dismissals and criminal punishment [44].
The results of the study by Kulka et al. (1990) found a direct relationship
between a diagnosis of PTSD of Vietnam veterans and their arrest and
imprisonment. Specifically, 45.7% of Vietnam veterans with PTSD had been
arrested or imprisoned more than once in their lifetime compared to 11.6% of

8. veterans without PTSD; 11.5% of veterans with PTSD were convicted of a serious
crime [45].
War stress reactions and their impact on subsequent PTSD related to the
1982 Lebanon War were examined 20 years later after the war. Veterans as a
result of combat trauma had PTSD, psychiatric symptoms and distress, social
dysfunction and health problems [46]. The study has found that more than half of
the veterans (131 out of 214) with a combat stress reaction had PTSD. At the same
time, the indicators of post-traumatic stress disorders decreased 3 years after the
war and increased again 17 years later; 23% of veterans without combat stress
reactions reported delayed PTSD [47,48].
For Ukraine, the problem of veterans with PTSD is extremely relevant.
According to the data of the Scientific and Research Center for Humanitarian
Problems of the Armed Forces of Ukraine, a very high level of psychological
problems is observed among Ukrainian militaries who participated in the war in
Donbas. If the average statistical index of psychogenic losses among militaries
amounts to 10–25%, then the war in Donbas became the reason that 80% of
Ukrainian militaries involved in the combat operations suffer psychological injuries
due to the intensity of war and the time spent in the military zone [49].
A study of the signs of PTSD of veterans involved in the war in Donbas,
conducted by L.Y. Humenyuk, O.V. Fedchuk, revealed the peculiarities of their
behavior: conflicts in the family, with relatives, colleagues at work, outbursts of
anger, mental instability when the most insignificant losses, difficulties push a
person to commit suicide; special types of aggression; fear of being attacked from
behind; guilt for staying alive, etc. [50]. Signs of PTSD are observed in every fourth

9. participant of the war in Donbas [51]. In addition, problems with alcohol or drugs
are characteristic of many veterans [52].
The consequences of the war in Ukraine on the psychological health of our
defenders cannot yet be assessed, however, they for sure will be disappointing.
In connection with that, there is a strong need to develop effective legal
mechanisms for the adaptation and socio-psychological readjustment of war
veterans in Ukraine. Today, the legal framework for social protection and pension
provision of war veterans and their family members is the Constitution of Ukraine,
laws of Ukraine On the status of war veterans, guarantees of their social
protection, On social and legal protection of militaries and their family members,
On the status of military service veterans, veterans of internal affairs bodies and
certain other persons and their social protection, On mandatory state pension
insurance, On pensions for persons discharged from military service and certain
other persons and other legislative acts of Ukraine.
According to Art. 4 of the Law On the status of war veterans, guarantees of
their social protection [53], war veterans are persons who participated in the
defense of the Motherland or military operations on the territory of other States.
War veterans include participants in military operations, persons with disabilities
as a result of war and participants in the war.
In Ukraine, Art. 3-1 (1) of the Law On the status of war veterans, guarantees
of their social protection, provided the creation of a Unified state register of war
veterans (hereinafter - the Register), which should accumulate information about
war veterans, persons who have special merits to the Motherland, injured
participants of the Revolution of Dignity, family members of such persons and
family members of deceased war veterans, family members of deceased

10. Defenders of Ukraine. However, this Register does not exist today, and therefore
the number of persons who have the status of war veterans is unknown. The
absence of such a Register, as well as information on the nature of problems and
needs of war veterans, makes it impossible to form a high-quality state policy
regarding veterans and their families. Today, information about war veterans in
Ukraine is stored in two unrelated registers - in the Unified state automated
register of persons entitled to benefits, which is filled out by the Ministry of Social
Policy of Ukraine, and in the Unified register of participants in anti-terrorist
operations, responsible for which is Ministry of Veterans Affairs of Ukraine.
War veterans in Ukraine receive support in the form of benefits and services
provided by an extensive system of central executive bodies, which are guided in
their activities by outdated and contradictory legal acts. Before the beginning of
the war in Ukraine, no comprehensive approach to the improvement of the
system of social protection of war veterans and militaries was proposed. Veterans
of the armed conflict in the East of Ukraine had the status of combatants and
corresponding state guarantees at the level of veterans of other wars, regardless
of the difference in needs and age. According to statistics, 4 % of the population of
Ukraine in 2020 were war veterans [54].
According to Art. 11 (1)(6) of the Law of Ukraine On social and legal
protection of militaries and their family members [55], persons specified in Art. 3
(1) of the Law of Ukraine On social and legal protection of militaries and their
family members (militaries, conscripts and reservists who called to training (or
testing) and special meetings, and members of their families, members of
voluntary formations of territorial communities during their participation in
events for the preparation of voluntary formations of territorial communities, as

11. well as their performance of the tasks of the territorial defense of Ukraine), who
took a direct part in the anti-terrorist operations, in the implementation of
measures to ensure national security and defense, repelling and deterring the
armed aggression of the Russian Federation in the Donetsk and Luhansk regions,
in the implementation of measures necessary to ensure the defense of Ukraine,
the protection of the safety of the population and the interests of the state in
connection with the military aggression of the russian federation against Ukraine,
whether they performed official operational tasks in extreme (combat) conditions,
have the right to free psychological, medical and psychological rehabilitation in
the relevant centers with reimbursement of the cost of travel to these centers and
back.
Psychological assistance is organized by the psychological services of
military units (subunits), and in case of need, it is provided in military medical
health care institutions under the procedures approved by the central bodies of
the executive power, which coordinate the work of the military units and law
defense bodies under the laws of Ukraine.
However, today this system does not meet the challenges that Ukraine has
faced and that will appear after the end of the war. In connection with this, it is
already necessary to propose legal mechanisms for the psychological protection of
war veterans. This task requires a study of the more progressive experience of
foreign countries on this issue.
Turning to the experience of foreign countries, such as Israel, the USA and
France, allows us to conclude that these countries have developed effective
mechanisms for the psychological protection and readjustment of militaries from
combat stress. Thus, in the Israel Defense Forces (IDF), which is one of the most

12. combat-ready and technological armies in the world, the "System of Psychological
Protection of Israeli Militaries" was created to raise physically and psychologically
healthy soldiers [56,57].
The U.S. Armed Forces have an effective combat stress control system,
which includes regular control of combat stress with a set of psycho-prophylactic
measures, combat stress monitoring during combat tasks, and work organization
in the post-stress period [58].
In the French Armed Forces, by the Concept of psychological support (the
French doctrine of "frontline doctors") [59], medical and psychological support is
provided to militaries during military operations, as well as further support to
optimize the performance of duties by militaries and harmonize relations between
militaries and members of their families [1].
An important part of the program of socio-psychological readjustment of
militaries (veterans) in Ukraine should be the development of special legislation
regarding the specifics of the criminal responsibility of veterans with PTSD for
criminal offenses committed by them (further - veterans involved in criminal
justice).
The preparation of such legislation should consider the experience of
countries that have introduced a special approach to war veterans in the criminal
justice system at all stages: from arrest to the appointment and execution of
punishment.
It should be noted that the USA pays a lot of attention to the readjustment
of veterans involved in criminal justice. According to Section 101(2) of the United
States Code [60], the term “veteran” means a person who served in the military,
naval, air, or space service and who was discharged from the service under

13. conditions other than dishonorable. The term “justice-involved” veterans is used
to refer to former members of the military who have been detained or are under
the supervision of the criminal justice system from their arrest until their eventual
incarceration.
Historically, the evolution of views on the criminal justice system regarding
veterans with mental illness has occurred in several stages in the USA. In the first
stage, the attitude of the justice system toward veterans was not selective, i.e., a
veteran, like any other person, went through the same procedures from arrest to
imprisonment or probation in case of committing a criminal offense.
The second stage was characterized by the recognition of a special painful
condition of a veteran sentenced to imprisonment with a mental disorder.
Veterans with the need for psychiatric treatment were transferred, but only
temporarily, from prisons to mental institutions.
Over time, in the American criminal justice system, the so-called
“restorative strategy”, was introduced, which involves declaring the insanity of a
person who has a serious and chronic mental illness that deprives him of the
ability to understand the meaning of his actions and/or control them. Such a
person is placed in a psychiatric institution and can be sentenced only in case of
his complete recovery.
Such a specialized approach in the criminal justice system to veterans with
psychological diseases simultaneously has a positive effect on the readjustment of
veterans and the safety of society [61].
Under the "Kurt Memorandum" [62] (the " The Memorandum"), issued by
the U.S. Deputy Secretary of Defense on August 25, 2017, protections for veterans
who were discharged from the armed forces due to mental illness and/or sexual

14. trauma sustained during military service were significantly expanded. The
Memorandum provided clear guidance to specialized military correctional
facilities regarding discharges due to mental health conditions, traumatic brain
injury, sexual violence, or sexual harassment. This Memorandum provides a
reasonable opportunity to assist each veteran if his or her criminal offense was
caused by mental illness and/or sexual trauma. The Memorandum focuses on
issues related to mental health conditions such as post-traumatic stress disorder
(PTSD), traumatic brain injury (TBI), sexual violence or sexual harassment. In
particular, an important innovation to the U.S. policy regarding veterans was the
rule of paragraph six of the Memorandum, according to which evidence of a
veteran's misconduct can be evidence of his mental state, which can be confirmed
not only from official sources (a doctor's diagnosis of a mental illness, documents
that connect the diagnosis with the military service) but also based on a wide
range of non-military evidence, including the testimony of the veteran himself
about the presence of a mental condition and the statements of his relatives
(2017, Attachment p.1, 6).
This presumption became a part of a broader public consensus – a shift of a
paradigm aimed at limiting mass incarceration and understanding the real causes
of veterans' criminal behavior through their treatment and observation [63].
In the USA, veterans represent a significant part of the population involved
in criminal justice, which is from 9% to 10% of arrestees, imprisoned and the
population under community supervision [64].
A study of historical trends in the treatment of veterans involved in the
criminal justice system found that between 1985 and 2000 the number of
incarcerated veterans increased steadily. However, according to data from the

15. Bureau of Justice Statistics, starting in 2000, their number began to decrease,
which was related both to demographic issues and directly to the work of the U.S.
Department of Veteran Affairs [65].
In the United States, the Department of Veteran Affairs is the second largest
federal department and consists of three divisions: Veterans Health
Administration, Veterans Benefit Administration and National Cemetery
Administration. Since 2007, the Department of Veterans Affairs has regularly dealt
with veterans involved in the criminal justice system, as well as with veterans with
civil legal problems. To meet the justice-related needs of veterans, the
Department of Veterans Affairs implements programs to reintegrate veterans after
incarceration and programs that allow veterans involved in the criminal justice
system to replace incarceration with treatment [64].
After special military operations in Afghanistan and Iraq, the U.S. criminal
justice system responded to the increase in the number of veterans involved in
justice by creating the position of Veterans Justice Outreach Specialist within the
structure of the Department of Veterans Affairs [66].
The Substance Abuse and Mental Health Services Administration (SAMHSA)
is also involved in the protection of the psychological health of veterans. SAMHSA
is an agency within the U.S. Department of Health and Human Services that leads
public health efforts to improve the nation's behavioral health. SAMHSA's mission
is to reduce the impact of substance abuse and mental illness on American
communities [67]. SAMHSA's mandate has been implemented since the 1990s
using the Sequential Intercept Model (SIM), which clarifies five points when it is
possible to intervene in the standard judicial process for crimes committed by

16. persons with mental disabilities and psychological disorders with the help of
actions in the community to avoiding their traumatic entry into the criminal
justice system [68]. The Sequential Intercept Model (SIM) provides an opportunity
at the community level to develop mechanisms to remove persons with mental
disorders from the criminal justice system and help them receive appropriate
treatment in the community [69].
At the federal level, SIM was also introduced when the U.S. Department of
Veterans Affairs began to use SIM in its policy to prevent veterans with mental
illness from entering deeper into the criminal justice system. The U.S. Department
of Veterans Affairs has developed a special program called “Veterans Justice
Outreach” to collect information necessary for the treatment of veterans and
transmit relevant information to local courts and prisons to ensure that veterans
have access to health care [70]. SIM can be extended not only to individuals with
psychological disorders but also to other populations, such as veterans, who use
psychotropic substances.
Protection of the rights of justice-involved veterans with PTSD in the United
States is ensured by a system of specialized agencies: from specially trained police
officers to the Veterans treatment courts, as well as separate places of detention
for veterans [71].
In the United States, the criminal justice system for militaries is separate
from the courts of general jurisdiction. At the same time, cases involving veterans
are usually also heard in courts of general jurisdiction, but with special
procedures. Also, in many states, special courts were created for crimes related to
the use of narcotic and psychotropic substances by veterans (Veterans treatment

17. courts). In particular, the first U.S. Veterans treatment court was established in
2008 in Buffalo, New York.
The creation of Veterans treatment courts was the result of a change in the
approach in American society to veterans, which testified that a supportive and
preventive response to their criminal offenses is a more adequate behavior than
punishment, as was the case with veterans of the Vietnam War. So, as practice has
shown, the approach to veterans which is aimed at their health care allows them
to avoid problems with their imprisonment, homelessness, various types of
addiction, poverty and social isolation in American society, confirming the positive
status of a veteran in society [72].
In the USA a system of institutions has been created, which are oriented to
take into account the psychological or mental state of a veteran and are aimed at
replacing the traditional punitive approach to veteransб who have committed
criminal offenses, to their adaptation to a peaceful life [73].
The model for protecting veterans in the USA, who have severe PTSD, in
addition to the above advantages, also has disadvantages. In particular, the
veterans’ court system, which primarily hears only non-violent crimes, excludes a
large number of offenses committed by veterans with PTSD. Therefore, according
to G. Gambill, the right to participate in court programs for veterans should be
based not on the category of crime, but on whether the cause of the crime was a
mental health disorder connected with military service [74].
In the United States, when considering a criminal case in court against war
veterans who have PTSD, two defenses are used: 1) defense based on insanity (the
affirmative insanity); 2) defense in case of impossibility of proving the defendant's
lack of insanity.

18. Proving the fact of a person's sanity is an extremely difficult task for the
defense, which requires an individual approach to each case with the examination
of a large amount of evidence. At the same time, it is attractive for the defense
that the use of a defense strategy based on proof of insanity can result in the
release of a person from criminal liability. However, at the same time, it can also
lead to a person being found guilty of a crime committed, even without taking into
account the presence of PTSD, without reduction of punishment [75].
In the practice of federal courts, cases of proving the defendant's insanity
based on PTSD, although not often, do occur. In the United States, approaches to
insanity have repeatedly changed. At first, insanity was asserted only based on
cognitive deviations [76], later it was based on the Model Penal Code (MPC) Test,
proposed in the 1970s by the American Law Institute (ALI), which involves the
study of cognitive and volitional abilities of the defendant. However, the Model
Penal Code Test was rejected because it was used to acquit John W. Hinckley Jr. of
the 1981 attempted murder of President Ronald Reagan [77].
Therefore, the Insanity Defense Reform Act of 1984 established a legal test
that focuses on the defendant's cognitive deviations [60].
If a veteran suffers from PTSD, certain benefits apply to him in the criminal
justice system. When a defendant with PTSD is not found to be insane, he or she is
usually found guilty of a less serious crime, as was, for example, in the cases State
v. Lowe [78], State v. Walkup, etc. [79].
Criminal cases of veterans with PTSD resulting from combat trauma are
mostly resolved based on an agreement between the prosecutor and the suspect
to plead guilty. If the veteran does not have a probationary period, the prosecutor
and the attorney conclude an agreement to plead the veteran guilty. At the same

19. time, by agreement with the prosecutor, the veteran may be found guilty of
committing a less serious crime than he was charged with, which makes it possible
to receive a shorter imprisonment term, etc.
In cases where a veteran commits a crime of a non-violent nature and if the
veteran’s PTSD is confirmed, parole or medical treatment may be used instead of
imprisonment, even with a full dismissal of the charges by the prosecutor, but
only in case of absence of previous convictions.
If a criminal case of a veteran is being considered in court, PTSD is used for
defense and is a basis for mitigating the veteran's liability.
PTSD as evidence used by the defense can be the basis for recognizing a
veteran’s insanity or diminished capacity, his/her unconsciousness, or
self-defense, as well as for sentencing mitigation.
The fact of PTSD must be officially proven. To use PTSD as a defense at the
time of committing the criminal offense the veteran must have an official
diagnosis of PTSD. In 2010, the requirements for PTSD disability compensation
were significantly reduced. Veterans no longer need to obtain proof that the event
that caused their PTSD occurred. Therefore, after 2010, PTSD diagnosis can be
received not only by combat veterans but also by all other veterans who
experienced stress as a result of war or terrorist activities [80].
In addition, it is important that the crime committed by the veteran had a
relation to his/her PTSD diagnosis. That means that the crime of the veteran was
committed by mistake because of his/her perception of a critical situation similar
to the events experienced during the war.

20. Sometimes the wrongful actions of a veteran with PTSD can be determined
to be self-defense if the veteran mistakenly perceived the situation as one that
threatened his life or health [81,82].
However, the study of U.S. precedent law (based on appellations) about
PTSD cases shows the ambiguous attitude of the court system to the responsibility
of veterans. PTSD is unequivocally recognized by U.S. courts as a defense. At the
same time, the courts do not issue a decision based on the presence of PTSD, if
the expert's opinion does not give an unambiguous answer to the question of the
direct connection of PTSD with the committed crime (dissociative memories,
symptoms of hyperarousal, etc.) [83, 84].
When the standard for one of the comprehensive defenses is not met, PTSD
is used as a partial defense or mitigating circumstance individually in each case
[85].
It should be noted that even before PTSD was officially recognized as a
diagnosis, traumatic stress such as war traumatic neurosis was also successfully
used as grounds for the defense of a person who committed a crime. In Houston v.
State [86] in the Alaska Supreme Court in 1979, the defendant, an Army sergeant,
shot and killed a man who he thought was going to take out a gun. At trial, a
defense expert testified that Mr. Houston had a traumatic war neurosis and severe
alcoholism and that the shooting occurred while he was in a state of dissociation.
But the court denied the petition of the defendant for the insanity defense, and
he was convicted of second-degree murder. The appellate court overturned the
decision of the court of the first instance and sent the case for retrial, finding that
the evidence of the defendant's insanity was not properly investigated.

21. The official recognition of PTSD as a diagnosis in 1980 in The Diagnostic and
Statistical Manual of Mental Disorders, Third Edition (DSM-III) caused its
widespread use by courts as a basis of defense in both violent and non-violent
crimes [87,88,89,90,91,92,93,94].
PTSD became the basis for successful insanity defenses. In State v. Cocuzza
[95], the defendant, a Vietnam veteran who assaulted a police officer, was not
found guilty because of his insanity. Mr. Kokuzza claimed that he thought he was
attacking enemy soldiers, and his testimony is supported by the police officer's
testimony that Mr. Kokuzza was holding the stick as if it were a rifle.
A Vietnam veteran in State v. Heads [96] was convicted in the first instance
of murdering his sister-in-law's husband after he entered the victim's residence in
search of his wife and began firing a gun. On appeal, his conviction was
overturned on several grounds. In a subsequent trial, he was acquitted on the
grounds of insanity after evidence of PTSD was examined. The expert testified that
the veteran had post-traumatic stress disorder, that he had experienced at least
one prior dissociative episode, and that the scene of the shooting and Vietnam
were very similar.
In the case State v. Wood [97] the District Court in Illinois in 1982 found the
defendant, a Vietnam veteran, not guilty by reason of insanity in the shooting of
the brigadier at the plant where he worked. The defense provided evidence that
the veteran had PTSD caused by his participation in the war. In the case, it was
convincingly proven that the veteran was in a dissociative condition when he used
the weapon after being insulted by his brigadier in front of several colleagues, and
the factory environment was similar to a war zone.

22. In the 1989 Massachusetts case Commonwealth v. Tracy, [98] a Vietnam
veteran accused of armed robbery, was found not guilty by reason of insanity due
to PTSD. The defense argued that the defendant's dissociative state during the
robbery was caused by the sight of the funeral home, which was reminiscent of
his experience in Vietnam.
The Insanity Defense Reform Act of 1984, signed on October 12, 1984, was
the first federal legislation to regulate the insanity defense of persons suffering
from mental illness in the criminal justice system. In addition to changing
approaches to the standards of insanity, there were changes related to shifting the
burden of proof to the defendant to establish a defense with clear and convincing
evidence. A special verdict "guilty but mentally ill" was created, according to
which a person who was already found guilty but mentally ill received appropriate
treatment for any mental illness that arose during the term of the sentence.
Consequently, the insanity defense was extended to persons who were found
insane after being convicted of a crime or while serving a federal sentence [99].
The increased requirements for establishing the presence of a severe
mental disorder as evidence of insanity were set in the M'Naughten Standard,
according to which a defendant is not subject to criminal liability if, due to a
mental illness or other mental condition, the defendant could not understand the
meaning or wrongfulness of his/her conduct [100].
Although in some cases [101] after this reform the defense based on PTSD
was refused, in the vast majority of cases the courts directly recognized PTSD as a
basis for the defense. Thus, in the case of United States v. Rezaq [102], a
defendant accused of air piracy was diagnosed with PTSD based on expert reports,
which is sufficient reason to declare his insanity.

23. The precedent law of the United States shows that there is no falsification
of post-traumatic stress disorder, which was used as a means of criminal defense.
Thus, the study conducted by Appelbaum et al. [103], found that veterans' claims
of insanity based on PTSD accounted for a small proportion of all insanity claims.
It should be noted that U.S. case law in the field of criminal liability of
veterans with PTSD is characterized by an appellate level. Since most PTSD
decisions are not published unless they are appealed, our review of appellate
decisions covers cases in which PTSD criminal defense applications were not
upheld at the trial court level.
Therefore, PTSD in the U.S. criminal justice system is a basis for declaring a
war veteran innocent and exempting him from criminal responsibility, reducing his
sentence or obtaining the right to early release.
3. CONCLUSIONS
Reference to foreign experience shows the effectiveness of applying to war
veterans involved in criminal justice of special approaches to their responsibility
for their crimes. Based on the above, considering international experience, it is
proposed to clarify the grounds of responsibility at the legislative level, as well as
to regulate the grounds that exclude the responsibility of veterans for criminal
offenses committed by them, at the level of a special law on the peculiarities of
criminal responsibility of war veterans.
First, we should note that the possibility of applying to a certain person of
the special legislation on the peculiarities of criminal responsibility of war
veterans must be based on establishing the fact of the direct influence of PTSD,
obtained because of combat stress during the person's participation in the war, on

24. his subsequent criminally punishable behavior during peaceful life. Therefore, the
presence of a veteran's certificate of a participant in a war issued in the prescribed
manner itself is not a reason to apply to him the special legislation on the criminal
liability of war veterans.
Norms on the specifics of criminal liability of war veterans can be
introduced into the criminal law of Ukraine by supplementing its separate articles
with relevant provisions. It is proposed to supplement the second part of Art. 19
of the Criminal Code of Ukraine in the second paragraph with the following
content: "A war veteran is not a subject to criminal liability if at the time of
committing a crime he/she was in a state of insanity caused by post-traumatic
stress disorder (PTSD) received during a person's participation in the war, which is
confirmed by an expert's opinion".
Thus, if a war veteran has PTSD, coercive measures of medical treatment
may be applied to him by court decision (Part 2 of Art. 19 of the Criminal Code of
Ukraine).
If a defense based on insanity caused by PTSD is not possible, then the
provisions of Art. 20 of the Criminal Code of Ukraine on limited liability should be
used. In accordance with part 1 of Art. 20 of the Criminal Code of Ukraine, a
person recognized by the court as having limited criminal liability, i.e., a person
who, at the time of committing a criminal offense, due to his mental disorder, was
not able to fully realize his actions and (or) managing them is subject to criminal
liability. This means that when a direct causal link is not established between the
PTSD caused by the traumatic event experienced by the war veteran and his
subsequent wrongful conduct, then the war veteran will be subject to criminal
liability. At the same time, Part 2 of Art. 20 of the Criminal Code of Ukraine, should

25. be added by the provision that the court must take into account the presence of
PTSD when sentencing. If a war veteran is recognized as having limited criminal
liability based on the presence of PTSD, the norms of criminal responsibility for a
less serious crime or the substitution of punishment for the use of coercive
measures of a medical nature should be applied to him.
The mechanism of criminal responsibility of a war veteran, based on limited
liability, requires the addition of the criminal law with norms on the agreement
between the prosecution and the defendant, which should become an
amendment to the criminal process of Ukraine.
In addition, to Art. 37 of the Criminal Code of Ukraine regarding implied
defense, it is also necessary to introduce provisions on the specifics of criminal
liability of war veterans. In particular, the second part of Art. 37 of the Criminal
Code of Ukraine should be supplemented with the second paragraph of the
following content: "Imagined defense excludes the criminal liability of a war
veteran for the damage caused in cases where the prevailing situation gave the
person sufficient grounds to identify real events with the events experienced by
the veteran during the war, if the veteran was not aware and could not be aware
of the falsity of his assumption, in the presence of post-traumatic stress disorder
(PTSD) of the veteran, which was confirmed on the basis of an expert's opinion,
acquired while participating in the war." Therefore, under the specified
circumstances, implied defense can become the basis for excluding the criminal
liability of a veteran who has PTSD. Also, in the case of exceeding the limits of
protection, which are allowed in the conditions of the corresponding real
encroachment, in the presence of a state of imaginary defense, the veteran is

26. subject to criminal liability as for exceeding the limits of necessary defense (Part 3
of Art. 37 of the Criminal Code of Ukraine).
To date, Ukraine has not implemented special regulations at the legislative
level regarding the specifics of the criminal liability of war veterans who have
PTSD, abuse alcohol or narcotics, psychotropics, etc., and have committed criminal
offenses in connection with this. As the study of legal approaches to the
treatment of war veterans involved in criminal proceedings in the USA showed,
the creation of mechanisms for special legal protection of veterans who, due to
their heroic services to the country during the war, received combat stress and, as
a result - PTSD, requires the introduction of a whole system of legal rules, juridical
presumptions and special bodies, in particular, veterans' courts in the court
system of Ukraine.
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71. Evan R. Seamone Rescuing Soldiers of Misfortune - a Full Spectrum Approach to
Veterans in the Criminal Justice System from Arrest to Reentry. Springfield, IL:
Charles C Thomas Publisher, LTD; 2019, р.5.
72. Michael Allen, (2012), Due process and the american veteran: what the constitution
can tell us about the veterans‘ benefits system, 80 U. Cin. L. Rev.
https://scholarship.law.uc.edu/uclr/vol80/iss2/7
73. Finlay A.K., McGuire J., Bronson J., Sreenivasan S. Veterans in Prison for Sexual
Offenses: Characteristics and Reentry Service Needs. Sex Abuse. 2019;31(5):560-579.
doi:10.1177/1079063218793633
74. Guy Gambill Mounting Social Crisis: Veterans Of Iraq and Afghanistan At The
Crossroads Of Justice. http://www.ejfi.org/Courts/Courts-44.htm
75. Brooke Borders, Veterans Imprisoned by the Violent Shadows of Military War Time:
The Expansion of the Insanity Defense to Include Post-Traumatic Stress Disorder, 36
J. LEGAL MED. 73, 84-5 (2015).
76. Chris Jordan, Conditioned to Kill: Volition, Combat Related PTSD, and the Insanity
Defense—Providing a Uniform Test for Uniformed Trauma, 16 RUTGERS J.L. & PUB.
POL’Y 22, 35-37 (2019).
77. Brooke Borders, Veterans Imprisoned by the Violent Shadows of Military War Time:
The Expansion of the Insanity Defense to Include Post-Traumatic Stress Disorder, 36
J. LEGAL MED. 73, 84-5 (2015).
78. State v. Lowe, 318 S.W.3d 812, 819 (Mo. Ct. App. 2010).
79. State v. Walkup, 220 S.W.3d 748, 755 (Mo. banc 2007).
80. Disability Compensation. https://www.benefits.va.gov/compensation/
81. Zatzick D.F., Marmar C.R., Weiss D.S., et al: Posttraumatic stress disorder and
functioning and quality of life outcomes in a nationally representative sample of
male Vietnam veterans. Am J Psychiatry 154:1690–5, 1997.

33. 82. Collins J.J., Bailey S.L. Traumatic stress disorder and violent behavior, Trauma Stress,
3:203–21, 1990
83. Friel A, White T, Hull A: Posttraumatic stress disorder and criminal responsibility. J
Forensic Psychiatry Psychol 19:64–85, 2008
84. Aprilakis C: The warrior returns: struggling to address criminal behavior by veterans
with PTSD. Geo J L Pub Policy 3:541–66, 2005.
85. Jordan HW, Howe GL, Gelsomino J, et al: Post-traumatic stress disorder: a psychiatric
defense. J Natl Med Assoc 78:119–26, 1986.
86. Houston v. State, 602 P.2d 784 (Alaska 1979).
87. Sparr LF, Atkinson RM: Posttraumatic stress disorder as an insanity defense:
medicolegal quicksand. Am J Psychiatry 143:608–13, 1986
88. Sparr LF: Mental defenses and posttraumatic stress disorder: assessment of criminal
intent. J Trauma Stress 9:405–25, 1996
89. Garcia-Rill E: Gatekeeping stress: the science and admissibility of post-traumatic
stress disorder. U Ark Little Rock L Rev 24:9–40, 2001
90. Hafemeister TL, Stockey NA: Last stand? - the criminal responsibility of war veterans
returning from Iraq and Afghanistan with posttraumatic stress disorder. Ind L J
85:87–141, 2010
91. American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders 236-38 (3d ed. 1980), American Psychiatric Association: Diagnostic and
Statistical Manual of Mental Disorders, Third Edition. Washington, DC: American
Psychiatric Association, 1980
92. Sparr LF, Atkinson RM: Posttraumatic stress disorder as an insanity defense:
medicolegal quicksand. Am J Psychiatry 143:608–13, 1986.
93. Sparr LF: Mental defenses and posttraumatic stress disorder: assessment of criminal
intent. J Trauma Stress 9:405–25, 1996.
94. Garcia-Rill E., Gatekeeping stress: the science and admissibility of post-traumatic
stress disorder. U Ark Little Rock L Rev 24:9–40, 2001.
95. State v. Cocuzza, No. 1484-79 (N.J. Super. Ct. 1981).
96. State v. Head, 2002 WI 99, 255 Wis. 2d 194, 648 N.W.2d 413
97. State v. Wood, No. 80-7410 (Ill. Cir. Ct. May 5, 1982)
98. Commonwealth v. Tracy, 539 N.E.2d 1043 (Mass. App. Ct. 1989).
99. H.R.3771 - Insanity Defense Reform Act of 1983. Summary: H.R.3771 -98th Congress
(1983-1984).
https://www.congress.gov/bill/98th-congress/house-bill/3771?s=1&r=99#:~:text=Ins
anity%20Defense%20Reform%20Act%20of%201983%20%2D%20Amends%20the%2
0Federal%20criminal,distinguish%20right%20and%20wrong%20with
100. Gabel G.F., American Jurisprudence (ed 2). New York: West Group, 2010.
101. United States v. Duggan, 743 F.2d 59, 81 (2d Cir. 1984), United States v.
Whitehead, 896 F.2d 432 (9th Cir. 1990), United States v. Long Crow, 37 F.3d 1319,
1324 (8th Cir. 1994), United States v. Cartagena-Carrasquillo, 70 F.3d 706 (1st Cir.
1995)
102. United States v. Rezaq, 918 F. Supp. 463 (D.D.C. 1996).

34. 103. Appelbaum PS, Jick RZ, Grisso T, et al: Use of posttraumatic stress disorder to
support an insanity defense. Am J Psychiatry 150:229–34, 1993
ВЕТЕРАНИ, ЗАЛУЧЕНІ ДО КРИМІНАЛЬНОГО ПРАВОСУДДЯ:
ВИВЧЕННЯ ПРАКТИКИ РЕАБІЛІТАЦІЇ ВЕТЕРАНІВ, ЯКІ ВЧИНИЛИ
КРИМІНАЛЬНІ ПРАВОПОРУШЕННЯ
1. Актуальність проблеми.
На сьогодні в Україні відбувається істотне збільшення кількості
військовослужбовців – учасників бойових дій, які отримують фізичні та
психологічні травми. Участь у бойових діях викликає гостру стресову

35. реакцію у людини та здійснює руйнуючий вплив на її психіку1
. Соціальна
адаптація військовослужбовців – учасників бойових дій у мирний час
буде вимагати консолідації зусиль державних органів, створення
системи відповідних установ з психологічної реабілітації та
ствердження позитивного образу ветерана війни у суспільстві.
Як свідчить світова практика, внаслідок отриманих психологічних
травм під час бойових дій ветерани війни у мирний час достатньо часто
виявляються залученими до системи кримінального судочинства.
Відповідно у системі кримінального правосуддя України має бути
вироблений спеціальний підхід до кримінальної відповідальності такої
особливо вразливої групи населення, як ветерани війни, які зазнали
травматичного впливу на їх психіку під час участі у бойових діях, за
вчинені ними кримінальні правопорушення у мирний час. Особливий
підхід до кримінальної відповідальності ветеранів війни обумовлений
необхідністю охорони здоров’я ветеранів війни, формування та
підтримки однозначно позитивного ставлення до ветеранів війни, що
безпосередньо відповідає цілі 11.2. “Пам’ять та повага” Програми
діяльності Кабінету Міністрів України, затвердженої постановою
Кабінету Міністрів України2
від 12 червня 2020 р. № 471.
Метою цього дослідження є аналіз законодавчих актів України та
зарубіжних країн, спеціальної наукової літератури та судової практики
2
Про затвердження Програми діяльності Кабінету Міністрів України: постанова
Кабінету Міністрів України від 12 червня 2020 р. № 471.
https://www.kmu.gov.ua/npas/pro-zatverdzhennya-programi-diyalnosti-kabinetu-ministriv-t1206
20
1
Блінов О.А. (2017). Психологічний захист від бойового стресу в збройних силах
провідних країн світу. Проблеми сучасної психології. Вип. 38. С. 38–52. URL:
http://nbuv.gov.ua/UJRN/Pspl_2017_38_6

36. стосовно кримінальної відповідальності ветеранів війни з метою
формування спеціального підходу до кримінальної відповідальності
ветеранів війни та внесення пропозицій щодо удосконалення чинного
кримінального законодавства України.
2. Виклад основного матеріалу.
У науковій літературі вперше опис особливостей зміни психіки
людей, які приймали участь у бойових діях, провів А. Кардинер у 1941 р.3
Симптомами, так званого, “хронічного військового неврозу”, автор
назвав збудливість і дратівливість; нестримний тип реагування на
раптові подразники; фіксація на обставинах травматичної події; відхід
від реальності; схильність до некерованих агресивних реакцій4
.
Після війни у В’єтнамі у 1980 р. групою авторів на чолі з М.
Горовиць для позначенні військових неврозів було запропоноване
поняття посттравматичного стресового розладу (posttraumatic stress
disorder (PTSD)), яке отримало міжнародне застосування5
. Зазначеними
авторами симптоматика ПТСР була описана наступним чином: 1)
надмірне збудження (порушення сну, тривога, нав’язливі спогади, фобії,
пов’язані із війною); 2) періодичні депресії (відсутність або значне
зменшення почуттів, відчуття безвихідності); 3) різні фізіологічні реакції
(паралічі, сліпота, глухота, припадки, нервове тремтіння)6
.
6
Horowitz M.J., Wilner N., Kaltreider N., Alvarez W. Signs and symptoms of
posttraumatic stress disorder. Arch. Gen. Psychiatry. 1980. Vol. 37. P. 85–92; Підчасов Є.В.,
5
Horowitz M.J., Wilner N., Kaltreider N., Alvarez W. Signs and symptoms of
posttraumatic stress disorder. Arch. Gen. Psychiatry. 1980. Vol. 37. P. 85–92.
4
Kardiner A. The traumatic neuroses of war. NY: Paul B.Hoeber, 1941. 258 p.
3
Михальський А.В., Царьов Ю.О. Посттравматичний стресовий розлад: історичний
огляд. Збірник наукових праць К-ПНУ імені Івана Огієнка, Інституту психології ім. Г.
С.Костюка НАПН України. Проблеми сучасної психології. 2011. Вип. 12. С. 687–696;
Kardiner A. The traumatic neuroses of war. NY: Paul B.Hoeber, 1941. 258 p.

37. Зазначені діагностичні критерії посттравматичного стресового
розладу були застосовані для розробки Посібника з діагностики та
статистики психічних розладів, який мав декілька видань. Травматична
подія визначена у п’ятому виданні (DSM-5) Посібника з діагностики та
статистики психічних розладів7
як подія (або серія подій), під час якої
особа зазнала особистого чи опосередкованого впливу до фактичної
смерті або загрози смерті, серйозних травм або сексуального
насильства. Існує широкий спектр психологічних реакції на травматичні
події, починаючи від нормальних, тимчасових, не виснажливих
симптомів до тимчасових, від гострого, обмеженого в часі та клінічно
значущого клінічного розладу до стійкого розладу (посттравматичного
стресового розладу), який може стати хронічним, якщо його не лікувати8
.
Відповідно до рубрики F 44.88 списку кодів Десятого
перегляду (версія 2007 р.) Міжнародної статистичної класифікації
хвороб та споріднених проблем охорони здоров’я (the International
Classification of Diseases (ICD) – відома як МКХ-10)9
,
розробленого Всесвітньою організацією охорони здоров’я, внаслідок
події, яка травмувала психіку людини і виходить за межі звичайного
людського досвіду, може розвинутися посттравматичний стресовий
розлад (далі - ПТСР), що призводить до патологічних змін особистості
9
Міжнародна статистична класифікація хвороб та споріднених проблем охорони
здоров'я. Десятий перегляд. Київ, «Здоров'я», 2001. Т.3. 817 с.
8
VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress
Disorder and Acute StressDisorder Version 3.0. 2017. P.5.
7
American Psychiatric Association. Diagnostic and statistical manual of mental disorders
(DSM-5®). Fifth ed. Arlington, VA: American Psychiatric Association; 2013.
Ломакін Г.І. (2011). Аналіз соціально-психологічних проявів ПТСР в осіб, які приймали
участь у бойових діях. Проблеми екстремальної та кризової психології. 2011. Вип. 10 С.
86–98.

38. ветеранів, часткової або повної їх неможливості адаптуватися до умов
мирного часу.
Аналіз спеціальної літератури з психології свідчить, що залучення
ветеранів війни до кримінального судочинства частіше пов’язується із
ПТСР10
.
ПТСР – це психічний розлад, який може розвинутися у людини
після її безпосереднього особистого переживання чи досвіду як свідка
події, яка становить уявну загрозу смерті або серйозної травми11
. У
Посібнику з діагностики та статистики психічних розладів, 5-е видання
(DSM-5), зазначається, що ПТСР може розпочатися гостро вже протягом
6 місяців після травматичної події, або може бути відстроченим, якщо
11
Brewin CR. Risk factor effect sizes in PTSD: what this means for intervention. Trauma
Dissociation. 2005; 6(2):123-30. doi: 10.1300/J229v06n02_11. PMID: 16150674.
10
Andrea K. Finlay and others. A scoping review of military veterans involved in the
criminal justice system and their health and healthcare.
https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-019-0086-;
Backhaus, A., Gholizadeh, S., Godfrey, K.M., Pittman, J., & Afari, N. (2016). The many wounds
of war: The association of service-related and clinical characteristics with problems with the law
in Iraq and Afghanistan veterans. International Journal of Law and Psychiatry, 49, 205–213;
Bennett, D.C., Morris, D.H., Sexton, M.B., Bonar, E.E., & Chermack, S. T. (2018). Associations
between posttraumatic stress and legal charges among substance using veterans. Law and Human
Behavior, 42(2), 135–144. https://doi.org/10.1037/lhb0000268; Black, D.W., Carney, C.P.,
Peloso, P. M., Woolson, R. F., Letuchy, E., & Doebbeling, B. N. (2005). Incarceration and
veterans of the first gulf war. Military Medicine, 170(7), 612–618; Bray, I., O'Malley, P.,
Ashcroft, S., Adedeji, L., & Spriggs, A. (2013). Ex-military personnel in the criminal justice
system: A cross-sectional study. Howard Journal of Criminal Justice, 52(5), 516–526; Bronson,
J., Carson, E. A., Noonan, M., & Berzofsky, M. (2015). Veterans in prison and jail, 2011–12
(NCJ 249144). Retrieved from Bureau of Justice
Statistics: https://www.bjs.gov/content/pub/pdf/vpj1112.pdf; Brown, W.B. (2011). From war
zones to jail: Veteran reintegration problems. Justice Policy Journal, 8, 1–48; Cantrell, B.C.
(1999). Social support as a function of posttraumatic stress disorder (PTSD) within Washington
state Vietnam veteran populations. Dissertation Abstracts International: Section B: The Sciences
and Engineering, 60(8), 4207; MacManus, D., Dean, K., Jones, M., Rona, R. J., Greenberg, N.,
Hull, L., et al. (2013). Violent offending by UK military personnel deployed to Iraq and
Afghanistan: A data linkage cohort study. Lancet, 381(9870), 907–917 та ін.

39. його початок зафіксовано більше ніж через 6 місяців після події. Якщо
симптоми зберігаються від 2 днів до 4 тижнів, то діагноз – гострий
стресовий розлад; якщо симптоми тривають більше 1 місяця, то діагноз
– ПТСР12
. Однак, на думку деяких дослідників, симптоми ПТСР зазвичай
починаються невдовзі після бойового стресу, навіть в той же день13
.
Симптоми, які характеризують ПТСР, виникають після такого
емоційного травматичного впливу і включають повторне переживання
травматичної події через спогади та кошмари, уникнення речей,
пов’язаних з травмою, і гіперзбудження (перебільшений страх і труднощі
зі сном і концентрацією)14
.
Отже, ПТСР виникає у учасника бойових дій не під час його участі
у військових діях (подія, що викликає гостру стресову реакцію), а після
закінчення латентного періоду, який зазвичай становить від 2 до 6
місяців з моменту отримання психологічної травми, коли психіка людини
змогла вийти зі стану гострого стресу.
ПТСР сприяє формуванню у учасника бойових дій специфічного
ставлення до інших людей, ускладнює його адаптацію до умов мирного
часу та впливає на все його подальше життя15
.
15
Tull, M., The Rates of PTSD in Military Veterans, VERYWELLMIND, (Sept. 30,
2020, 3:00 PM) https://www.verywellmind.com/rates-of-ptsd-in-veterans2797430#citation-1;
Блінов О.А. (2013). Прояви посттравматичних стресових розладів. Актуальні проблеми
психології. Т. 7. Вип. 32. С. 15–20. URL: http://appsychology.org.ua/data/jrn/v7/i32/4.pdf;
Гуменюк Л.Й., Федчук О.В. Дослідження посттравматичного стресового розладу і
напрямків психореабілітації постраждалих від воєнних психотравм. Науковий віник
14
IOM (Institute of Medicine). Posttraumatic Stress Disorder: Diagnosis and
Assessment. Washington, DC: The National Academies Press; 2006.
13
North C.S., Nixon S.J., Shariat S., Mallonee S., McMillen JC, Spitznagel E.L., Smith
E.M. Journal of the American Medical Association. 8. Vol. 282. 1999. Psychiatric disorders
among survivors of the Oklahoma City bombing; pp. 755–762.
12
American Psychiatric Association. Diagnostic and statistical manual of mental
disorders (DSM-5®). Fifth ed. Arlington, VA: American Psychiatric Association; 2013.

40. Через пережиті стреси на війні у учасників бойових дій вже за умов
мирного часу втрачається інтерес до сімейного, суспільного життя,
загострюється почуття справедливості, тривожності, підозрілості, що
може призводити до непередбачуваних вибухових реакцій навіть на
незначні подразники психіки.
З ПТСР пов’язані численні психосоціальні стани, наприклад,
насильство та агресія, проблеми у стосунках, зниження якості життя,
проблеми з законом та бездомність. Дослідження показують, що ПТСР
може викликати значний дистрес і функціональні порушення. Різні
взаємозв’язки ПТСР з іншими фізичними, психічними та соціальними
наслідками можуть перешкоджати пристосуванню ветерана до мирного
життя.
У численних наукових дослідженнях проблематики ПТСР щодо
ветеранів16
встановлено зв’язок між ПТСР, одержаним комбатантами у
зв’язку із бойовими діями, і зростанням насильства з боку ветерана до
свого партнера та інших членів сім’ї. Насильство у сім’ї значно
підвищується у сім’ях ветеранів, які мають ПТСР. У зв’язку із
зловживанням алкоголем тощо, поведінка ветеранів, які отримали
16
Jordan B.K., Marmar C.R., Fairbank J.A., Schlenger W.E., Kulka R.A., Hough R.L.,
Weiss D.S. Problems in families of male Vietnam veterans with posttraumatic stress disorder;
Journal of Consulting and Clinical Psychology. 6. Vol. 60. 1992. pp. 916–926; Glenn D.M.,
Beckham J.C., Feldman M.E., Kirby A.C., Hertzberg M.A., Moore S.D. Violence and hostility
among families of Vietnam veterans with combat-related posttraumatic stress disorder; Violence
and Victims. 4. Vol. 17. 2002. pp. 473–489.
Львівського державного університету внутрішніх справ. 2016. № 1. С. 228–240.
http://www2.lvduvs.edu.ua/documents_pdf/visnyky/nvsp/01_2016/16glivvp.pdf; Ковальчук
В.М. Посттравматичний стресовий розлад, як наслідок дизадаптивного прояву
стресогенного впливу. Вісник Національного університету оборони України. 2011. Вип. 4
(23). С. 152–155.

41. ПТСР, харатеризується значно більшим гнівом, ворожістю та агресію,
ніж у ветеранів, у яких не було виявлено ПТСР17
.
Перебіг симптомів ПТСР дуже різниться у залежності від ситуації
та особистості. Деякі постраждалі від військової травми навіть можуть
досягти повного одужання, тоді як у інших може розвинутися стійкий
психічний розлад, що призводить до непрацездатності людини18
.
Дослідження показників ПТСР серед ветеранів різних війн
свідчать, що кожен п’ятий учасник бойових дій за відсутності будь-яких
фізичних ушкоджень страждає нервово-психічними розладами, а серед
ветеранів, які зазнали фізичних ушкоджень та каліцтв – кожен третій19
.
За даними досліджень, проведених стосовно американських
ветеранів в’єтнамської війни у 15,2% ветеранів спостерігалися виражені
ПТСР, а ще у 11,1% відзначалися окремі симптоми таких розладів. За
іншими даними, приблизно у 25% американських ветеранів В’єтнаму
відзначається розвиток несприятливих особистісних змін після
отриманої психотравми. До початку 1990-х рр. близько 100 000 ветеранів
цієї війни покінчили життя самогубством, 40000 ведуть замкнутий, майже
19
Лікування та реабілітація комбатантів – миротворців iз посттравматичним
стресовим розладом / О.Г. Сироп’ятов, О.К. Напреєнко, Н.О. Дзеружинська та ін. К.: О.Т.
Ростунов, 2012. 76 с.
18
Friedman M.J., Schnurr P.P., McDonagh-Coyle A. Post-traumatic stress disorder in the
military veteran. Psychiatr Clin North Am. 1994 Jun;17(2):265-77.
17
Jakupcak M., Hoerster K.D., Varra A., Vannoy S., Felker B., Hunt S. Hopelessness and
suicidal ideation in Iraq and Afghanistan war veterans reporting subthreshold and threshold
posttraumatic stress disorder; Journal of Nervous and Mental Disease. 4. Vol. 199. 2011. pp.
272–275; Widome R., Kehle S.M., Carlson K.F., Laska M.N., Gulden A., Lust K. Post-traumatic
stress disorder and health risk behaviors among Afghanistan and Iraq war veterans attending
college. American Journal of Health Behavior. 4. Vol. 35. 2011; pp. 387–392.

42. аутичний спосіб життя20
. Висновки щодо смертності неоднозначні, але
загалом показують, що ПТСР пов’язаний із збільшенням загальної
смертності та смертності внаслідок випадкових причин21
.
ПТСР є одним із психічних захворювань, які найчастіше
діагностують у бойових військах США після їх розгортання в Афганістані
(«Неперевершена свобода» (OEF)) та Іраку (операція «Іракська свобода»
(OIF)22
. За оцінками Комісії з оцінки потреб у адаптації
військовослужбовців, ветеранів та членів їх сімей, Ради з питань
здоров’я окремих груп населення та Інституту медицини США,
поширеність ПТСР у військовослужбовців, залучених до спецоперацій в
Афганістані та Іраку, коливається від 5% до 20%23
.
23
Committee on the Assessment of the Readjustment Needs of Military Personnel,
Veterans, and Their Families; Board on the Health of Select Populations; Institute of Medicine.
22
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. New England
Journal of Medicine. 1. Vol. 351. 2004a. Combat duty in Iraq and Afghanistan, mental health
problems, and barriers to care; pp. 13–22; Hoge CW, Wright K, Bliese P, Adler A, Thomas
J. Prevalence and Screening of Mental Health Problems Among US Combat Soldiers Pre- and
Post- Deployment. Silver Spring, MD: Walter Reed Army Institute of Research; 2004b; Hoge
CW, Auchterlonie JL, Milliken CS. Journal of the American Medical Association. 9. Vol. 295.
2006. Mental health problems, use of mental health services, and attrition from military service
after returning from deployment to Iraq or Afghanistan; pp. 1023–1032; Hoge CW, Terhakopian
A, Castro CA, Messer SC, Engel CC. American Journal of Psychiatry. 1. Vol. 164. 2007.
Association of posttraumatic stress disorder with somatic symptoms, health care visits, and
absenteeism among Iraq war veterans; pp. 150–153; Hoge CW, McGurk D, Thomas J, Cox AL,
Engel CC, Castro CA. New England Journal of Medicine. 5. Vol. 358. 2008. Mild traumatic
brain injury in US soldiers returning from Iraq; pp. 453–463; Smith TC, Ryan MA, Wingard DL,
Slymen DJ, Sallis JF, Kritz-Silverstein D. British Medical Journal. 7640. Vol. 336. 2008. New
onset and persistent symptoms of posttraumatic stress disorder self reported after deployment
and combat exposures: Prospective population based US military cohort study; pp. 366–371;
DOD (Department of Defense). DOD/VA Code Proposal Final. 2009a. [October 29,
2012]. http://www​
.cdc.gov/nchs​
/data/icd9/Sep08TBI.pdf.
21
VA/DoD clinical practice guideline for management of post-traumatic stress // The
Department of Veterans Affairs (VA) and The Department of Defense (DoD), Version 3.0. –
2017. – pp.5-16.
20
Блінов О.А. (2013). Прояви посттравматичних стресових розладів. Актуальні
проблеми психології. Т. 7. Вип. 32. С. 15–20. URL:
http://appsychology.org.ua/data/jrn/v7/i32/4.pdf

43. Деякі фактори ризику ПТСР у ветеранів – це низький вік
військовослужбовців (резервісти мають більший вік); бойовий вплив;
їхня самотність або розлучення; попередній травматичний вплив
(особливо фізичне насильство у дитинстві та інші несприятливі
переживання). ПТСР часто супроводжується декількома іншими
станами психічного здоров’я, такими як депресія, тривожні розлади та
зловживання алкоголем чи наркотичними засобами.24
Хоча точна оцінка поширеності ПТСР серед нинішньої популяції
ветеранів США загалом ще не встановлена, але діагностується
збільшення ризику ПТСР в 1,5-3,5 рази у зв’язку із залученням
комбатантів до активних військових ді, незалежно від епохи війни25
.
25
Magruder K.M., Frueh B.C., Knapp R.G., Johnson M.R., Vaughan Iii J.A., Carson T.C.,
Powell D.A., Hebert R.,(2004) PTSD symptoms, demographic characteristics, and functional
status among veterans treated in VA primary care clinics; Journal of Traumatic Stress. 4. Vol. 17.
pp. 293–301.
24
Committee on the Assessment of the Readjustment Needs of Military Personnel,
Veterans, and Their Families; Board on the Health of Select Populations; Institute of Medicine.
Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans,
Service Members, and Their Families. Washington (DC): National Academies Press (US); 2013
Mar 12. 4, LONG-TERM OUTCOMES. https://www.ncbi.nlm.nih.gov/books/NBK206865/#;
Monson C.M., Taft C.T., Fredman S.J. Military-related PTSD and intimate relationships: From
description to theory-driven research and intervention development; Clinical Psychology
Review. 8. Vol. 29. 2009. pp. 707–714; Jakupcak M., Conybeare D., Phelps L., Hunt S., Holmes
H.A., Felker B., Klevens M., McFall M.E. Anger, hostility, and aggression among Iraq and
Afghanistan war veterans reporting PTSD and subthreshold PTSD; Journal of Traumatic
Stress. 6. Vol. 20. 2007. pp. 945–954; Richardson L.K., Frueh B.C., Acierno R. Prevalence
estimates of combat-related posttraumatic stress disorder: Critical review; Australian and New
Zealand Journal of Psychiatry. 1. Vol. 44. 2010. pp. 4–19.
Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans,
Service Members, and Their Families. Washington (DC): National Academies Press (US); 2013
Mar 12. 4, LONG-TERM OUTCOMES. https://www.ncbi.nlm.nih.gov/books/NBK206865/#

44. Поширеність ПТСР, пов’язаного з зоною війни, становила 17,0% у
чоловіків і 15,2% у жінок26
. Незалежно від конкретної оцінки, дослідження
свідчать, що деякі ветерани продовжують відчувати посттравматичні
стресові розлади до старості27
.
У численних дослідженнях, проведених стосовно ветеранів США,
було встановлено, що ПТСР у ветеранів війни може бути причиною їх
численних проблем із законом. Зокрема, у дослідженні, проведеному Р.
Хайфил-Макрой та ін. (2010), стосовно проблем поведінки морських
піхотинців з ПТСР, які перебувають на військовій службі та були задіяні
до операцій в Іраку, Афганістані чи Кувейті, було встановлено, що в
морські піхотинці з ПТСР у 11 разів частіше, ніж їхні колеги, які не мали
психіатричного діагнозу, вчинили серйозні злочини, які призвели до
звільнень та кримінального покарання28
.
За результатами дослідження Кулька та ін. (1990) стосовно
ветеранів В’єтнаму було виявлено безпосередній зв’язок діагнозу ПТСР
з їх арештом та ув’язненням. Зокрема, 45,7% ветеранів В’єтнаму, які
мають ПТСР, були заарештовані або ув’язнені більше одного разу у
житті порівняно із 11,6% ветеранів, які не мали ПТСР; 11,5% ветеранів з
ПТСР були засуджені за тяжкий злочин29
.
29
Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss
DS, Grady DA. Trauma and the Vietnam War Generation: Report of Findings from the National
Vietnam Veterans Readjustment Study. New York: Routledge; 1990.
28
Highfill-McRoy RM, Larson GE, Booth-Kewley S, Garland CF. BMC Psychiatry. Vol.
10. 2010. Psychiatric diagnoses and punishment for misconduct: The effects of PTSD in
combat-deployed marines; p. 88.
27
VA/DoDClinical Practice Guideline for theManagement of Posttravmatic Stres
Disorder and Acute Stres Disorder June 2017
26
Marmar C.R., Schlenger W., Henn-Haase C., et al. Course of posttraumatic stress
disorder 40 years after the Vietnam war: Findings from the national Vietnam Veterans
longitudinal study. JAMA Psychiatry. Sep 2015;72(9):875-881.