This is the second article from a number of mental health publications. Anastasia is a civil activist who was forced to leave Kyiv for Berlin because of the war. There she faced addiction and deteriorating mental health, which landed her in the hospital. “Not Today, Not Yesterday, Not Tomorrow” talked to Anastasia about borderline personality disorder and treatment in Germany.

I was born and lived in Moldova, but moved to Ukraine in 2020. Six months before the invasion started, everyone started discussing this topic, but in my surroundings it was more of a joke. I also thought that it would be more of an information war, but not with tanks and missiles… So there were no plans to leave.

On the first day, when the shelling started in Kyiv, it “flew” very close to my house.. I was in such a state that I did not understand what was happening. I somehow reached the subway, to my friends. At the railway station I heard that there were evacuation trains for women and children. I managed to get put on it, but I didn’t know where it was going. In the end I got to Poland and went to Germany for a lot of money. All this I did without stopping, I didn’t sleep, I didn’t eat.

A week before the war started, my friends from Berlin wrote to me, “If anything, come.” That’s how I ended up here. I’ve been in this city about fifteen times, I know it well, I know the language. A lot of friends from my party moved from Kyiv to Berlin, so I felt comfortable here.

In Berlin, I started volunteering, helping refugees from Ukraine. I redirected them, found out where they were coming from and  for help there. Of course this worsened my psychological state. How to be okay when you meet women, and sometimes girls, who have been raped by the Russian military?

After the evacuation, burnout and depression were added to my mental diagnosis. On top of that, I developed an addiction to hard drugs, including physical addiction. And so it happened that at one point I lost my home, my job and my partner. I tried to kill myself and ended up in hospital.

I have been in Germany’s hospitals twice and both times I left there early… I was always afraid to go to such institutions in the post-Soviet space, because they are brutal. I thought it would be better in Germany, but it turned out that it was a prison for me. The schedule was as such: at half past seven you get up, they wake you up to drink medication, at seven – breakfast, and the rest of the time – therapy and medication. They bring them in a plastic cup, in liquid form, because we all know how to hide the pills, but you can’t do that here. I only went to art therapy, although there was also music therapy: it’s when a sick head patient, like me, takes an instrument and starts playing randomly. And I think it didn’t help at all.

At first I was in the bipolar ward, because my certificate says bipolar disorder, and it was more or less the same. Then they determined that it wasn’t BPAD, but BPD, and I was transferred to the Borderline Disorder ward. It was a total… My condition got even worse. There’s almost no medication because you’re addicted. The psychologist doesn’t want to work with you because you’re a “drug addict”. And the environment and attitude is not exactly what I imagined in Germany. In the bipolar ward at least I was given medication and the staff was kinder. The border guards turned out to be stricter, more restrictive. I was given nasal drops in doses, four doses a day, even though I have maxillary sinusitis and I can’t breathe without them. It’s also an addiction and they’ve tried to get rid of it too. The bipolar ward has three and a half hours for a visit, and we only had an hour. Those are the rules. My diagnosis is treated with three types of medication and two types of therapy – none of that was presented. We don’t do that and it’s all “bull shit” – that’s what the head doctor told me. There I was given diazepam to relieve withdrawal and sometimes a neuroleptic when I couldn’t sleep …

Mostly you just lie there all the time. You also have to go to group therapy, but I don’t see the point of it. I find this method annoying. I understand that it works for some people and that they need support, but I don’t like to ask for help. That’s why I gave up this therapy too.

Nothing else happened, you get a schedule and you live by it. If you have a deterioration, you call a nurse, press a button: she comes, looks at you and does nothing. You could take your technology with you, I had a phone and a laptop. Laces are left behind, they only took away razors, herbal-based sleeping pills. But there was an incident once – I stole a fork to stick in the nurse’s hand later, which angered me during an attack. So if you want to find something, you’ll figure it out.

I suspected I had borderline personality disorder before – there were more signs and it was a mistake to ignore them for so many years. But I was diagnosed with bipolar disorder at the time. The problems started as early as age 8: I started cutting myself and not going to school for weeks at a time. Then I was taken to neurologists, trying to figure out what was wrong. I was diagnosed with bipolar disorder at 21, in Moldova, and for six years I was treated for the wrong thing. It wasn’t until I was 27 that I was diagnosed with BPD.

People with BPD are defined by self-harm and a tendency to addiction – which is exactly what I had. Emotional instability and lability are also characteristic. BPD is sometimes confused with bipolar disorder, as was my case. With BPD, you can also be on a high and do everything, fly, and then snap back, depressed… and hopeless, as with BPAD. But they are treated differently: in BPD you need therapy (cognitive-behavioural therapy, for example), medication only relieves the attacks. And bipolar disorder is treated with pills: antidepressants, neuroleptics and something from mood stabilisers. This is the typical treatment for BPAD.

This is the fifth suicide attempt in my lifetime. My diagnosis manifests itself in the fact that I sometimes say or do things impulsively. And I don’t remember it. I can also hurt myself or others around me. I can unknowingly do something, but am only able to realise it all after it has happened. All the times I’ve tried to kill myself, I’ve been in a coma or in intensive care for a long time… This time I jumped off a bridge and had a lot of pills and butyrate in me. I fell in the mud instead of the tarmac…. naturally, because I am “immortal”. I refused hospitalisation and then came to the hospital only after a week. I realised that I couldn’t cope on my own.

And I’m not really coping right now. If I have a suicidal risk, I don’t call anyone, I don’t talk about it, I just do it. But I have an agreement with my parents: not to pay attention if I go into an aggressive state. They recognise that it’s not really me, but my disorder and don’t touch me. We have a generation of women doctors in our family, they understand everything.

It is difficult to find a good specialist in Moldova or Ukraine who works with borderline personality disorder and can recognize this diagnosis. I went to a regular therapist who then became my supervisor when I started working. Yes, I myself am a colleague of theirs in the specialty and to be in the patient’s place, on the other hand, it was… interesting. I’m a clinical psychotherapist, I’ve been in practice for four years. But I can’t do counselling right now, it would be unethical, being in such an acute state.

In Ukraine, I had two girl neighbours, also with diagnoses. When we moved in, they didn’t know about it. You could make a TV series about life in that apartment. We didn’t have an agreement on how to behave in such cases. If there was an aggravation, I was the one who dealt with the situation, as I was older and had a degree  in this field.

I have an addiction, but only now have I started to realise that it is ruining my life. As much as I have tried to stop, I just think about it. There comes a point where you don’t have any acquaintances or friends around you, you lose your job, you don’t have any goals and then you just want to get high. And underneath it all you think: “Here, I can do anything.” And then you realise it’s a swing. Neither your brain, nor your body, wants anything else except to get your serotonin up and not think that everything is going to be easy and simple right now. And when you get sober, it’s twice as hard to realise how bad it is. You just want to get that feeling back so you can turn on that TV.

Treatment in Germany is free, it’s included in the insurance. Only there are some prescription drugs that cost 5 EUR at the pharmacy. But that’s how you get medication for free. Therapy is another matter, if the doctor is private, you have to pay.

There are two therapies in Berlin where they help those who came from Ukraine. Lots of support from the LGBTQ+ community. There is also treatment for people with HIV and addicts. There are groups for the latter, but as I said above, I don’t like them. I understand perfectly well why I do it (psychoactive substance use) and I don’t want to justify myself to others.

Nevertheless, in Berlin it is easier to exist with a diagnosis and addiction. Not everywhere, of course, it all depends on your field of work, but there is much less prejudice. But this is incomparable to the post-Soviet world and the way these problems are perceived there.