Alexander Mamaev's return from the front line in Ukraine ended in tragedy. The 44-year-old got drunk at a party and stabbed and killed his wife in front of his children. He thought she was reaching for the money in his pocket.

People who knew Mamaev, who came from Zavolzhye in the Russian region of Nizhny Novgorod, told a court that before he went off to fight in the war he was a peaceful person, the kind that "wouldn't hurt a fly."

Sergeant Stanislav Ionkin decided to go partying while he was on leave last year. By his own account, he got into a drunken fight. Then he fired of a flare with his signal pistol, starting a fire that killed 13 people.

According to the Russian-language online media outlet Verstka, people who have participated in the war in Ukraine have committed 190 crimes back at home, including 55 murders. Most of the perpetrators were under the influence of alcohol. Later, they complained of uncontrollable outbursts of violence.

According to psychologists, these are signs of post-traumatic stress disorder (PTSD). The reports show that many of the crimes were committed by former mercenaries from the private military company, the Wagner Group.

Russian authorities have launched a program to treat military returning from the front who are suffering from PTSD. The need is so acute that not all those affected can be helped. In addition, many military personnel also refuse any offer of help.

'Over time, you realize that you've changed'

One of the most frequent problems that soldiers report on social media are nightmares and flashbacks — traumatic experiences that keep replaying in their mind.

Despite being far away from the battlefield, they might feel as if they're being shot at, particularly in places where there are many people or vehicles. Others react when fireworks are let off, or are too scared to go outside without a weapon.

"When you're at war, you think everything is fine with you. But then you return to civilian life and realize how different it is. Over time, you realize that you've changed inside," Andrei, a 23-year-old contract soldier who was given a fake name to protect his identity, told DW.

Over the past two years of war, he has changed a lot, according to his girlfriend Svetlana. She said he used to be talkative and cheerful, but now he is a withdrawn and aggressive man.

"A long time ago, when we spoke via video call, he said he was going crazy," said Svetlana. As a result, she spoke with Andrei less often on the phone, and his replies to text messages became shorter and shorter. Svetlana gave birth to their daughter earlier this year, but Andrei did not visit either of them during his last vacation.

"Once he wrote unkind things to me, also about our child. I thought our relationship was over. But the next day he apologized in a voice message and said he was just going crazy," Svetlana recalls. She hopes the thought of being a father will help Andrei to get back on his feet.

Few veterans able to receive treatment

In a study, the St. Petersburg Bekhterev Psychoneurological Research Institute found that between 3 and 11% of war veterans are at risk of developing PTSD. Last year, the institute sent out treatment instructions to various institutions, and Russian authorities announced the creation of corresponding rehabilitation centers.

According to the Russian Health Ministry, 11,000 Russian military personnel who had taken part in the war against Ukraine, as well as their family members, sought psychological help within a six-month period in 2023. Most of them were men who left the army for health reasons, or relatives of deceased soldiers.

But as Russian Health Minister Mikhail Murashko admitted, only 15% of those affected were able to receive treatment in 2023.

Some soldiers diagnosed with PTSD have even been forced to return to the front. This was the case for 25-year-old Alexander Strebkov, who was drafted during the first mobilization. Despite a doctors' diagnosis that he should not be given a weapon, he was sent back to the war zone.

PTSD can lead to alcohol, drug addiction

One Russian psychotherapist, speaking on condition of anonymity, said he thought that in such a major military conflict as in Ukraine, the number of psychological disorders among military personnel could be significantly higher than the Bekhterev Institute study suggested.

He cited figures from the US Department of Veterans Affairs, which has estimated the rate of PTSD among military personnel to be up to 29% across various conflicts.

The psychotherapist said he expected to see an increase in crimes attributed to PTSD among Russian soldiers. "You have to bear in mind that some participants in the war, like those in the Wagner Group, already had a criminal past. Their mental health may have suffered further as a result of combat," he said.

Untreated PTSD can also cause secondary disorders, he warned. "There is also addiction to alcohol or psychotropic substances, which causes problems in society." Families suffer the most, he said, with children's mental health frequently damaged.

Hero or human?

Treatment is based on reliving traumatic experiences, explained the therapist, who has worked with veterans of the wars in Chechyna and other places.

"Reliving something like this helps patients to work through it," he said. On average, recovery can take about 10 sessions over six months.

Some psychologists who treat soldiers with PTSD try to make the men's experiences seem heroic, the therapist explained. "On an emotional level it can be supportive during therapy, but on a moral level it can also normalize violence and aggression," he said.

Instead of deluding someone about their own heroism, he suggested therapists should help the person to understand the situation they are in and to work through feelings of guilt.

"The main task of therapy is to get a patient back to normality so they understand their mistakes and build a new life, which everyone has the right to do."

This article was originally written in Russian.