Article by Peter Maass

Serbia on the Couch

Talk  |  December 1999
Tijana Mandic was the therapist of choice for Belgrade’s cultural elite. Then a war-scarred veteran came under her care, and the horror of his battles in the Balkans began to haunt her dreams.

“Say out loud that you feel repelled looking into the eyes of a murderer,” Zoran whispered. “I saw the expression in your eyes when I first told you what happened.”

Tijana Mandic hesitated. After 25 years as a psychologist, Mandic thought she had heard it all, knew it all, and then Zoran-this is not his real name-walked into her office. He was a sniper who had killed many times, none of which he professed any guilt about, not until he killed when he knew he shouldn’t have killed, and now he felt a gnawing kind of guilt that was tormenting him to the edge of madness. For several months he had been lying on Mandic’s couch, three days a week, confessing and accusing and asking forgiveness. Mandic could take no more.

“I don’t think I’m qualified enough to help you,” she said.

“You’re not very good at lying,” Zoran replied. “When you look at me you only see a murderer, and you judge me. You are a hypocrite, a liar, and a coward. I don’t see why you should be spared all of this. You must listen to my nightmare and suffer the way I suffer. You can’t escape your job, your part of the responsibility. You are just as guilty as I am for what happened over there.”

Over there. The front line. Sarajevo. Pristina. Vukovar. The places where young men who used to be friends came to fight each other for reasons of patriotism or revenge or bloodlust or money or because they had the miserably bad luck to get drafted into a war they did not care for but could not avoid. And that’s where it happened. Mortars fired without regard to striking any particular target. Houses torched because “they” had torched yours. Women raped. Civilians shot because your civilians had been shot, or one of your buddies had been shot, and what were you to do but take an eye for an eye, a life for a life, or perhaps many lives for a single one? This is the way war tends to be practiced at the end of the 20th century, much as it was at the beginning of the century, with gut instincts and dumb bullets rather than Intel chips and smart bombs.

“I’m a pacifist by conviction,” Mandic said.

“Bullshit,” Zoran countered. “You have to help me. You owe me. I can’t tell my sister or my parents or my wife. No one would understand. They would be horrified, just the way you are horrified now. I’m trying to put the whole picture together for you. I have to explain to you what happened.”

War is a strange thing. You can live not far from it yet pretend it’s not there; the sound of a howitzer doesn’t travel an immense distance. When Yugoslavia imploded into warfare, Tijana Mandic was living a placid life in Belgrade, not much more than a hundred miles from what turned into the killing fields of Croatia and Bosnia. She opposed those wars and opposed Serbian leader Slobodan Milosevic, but there were other things in her life that were more important. The author of a best-selling book about the psychology of communication, she was the therapist of choice for journalists and actors. She appeared on television panels and in the pages of the best newspapers, and her students at the University of Belgrade, where she is a tenured professor, adored her. Life was good, or as good as it could be in a country whose soldiers were committing the worst atrocities in Europe since World War II.

Another strange thing about war is that no matter how far away you might be, you cannot, in the end, escape it. As surely as war creates violence, it creates soldiers who need to vent about what happened, and if you are a therapist in Belgrade, a soldier will wind up on your couch one day, drawing you into his tortured world. Whether it is a good war or a not-so-good war, things have been done and things have been seen that the human mind has difficulty processing. The clinical term is post-traumatic stress disorder (PTSD). Flashbacks, insomnia, nightmares, anger, substance abuse-these are the symptoms of a war’s psychological toll.

Mandic’s sessions with Zoran exposed her to a perilous unburdening of rage that she had not been trained to deal with. The anger of a traumatized veteran can wound as surely as a weapon, and Zoran, ever the sniper, hit his target with pinpoint accuracy. Why didn’t Mandic do more to stop a war in which innocents were slaughtered? It’s an accusation most civilians who mind their own business in wartime are fortunate enough to avoid confronting. But there’s more, terribly more. Unlike the delusions of a psychotic, the horrors recounted by veterans are not hallucinatory. They are real and gruesome and they force the listener to face unsettling questions about human nature. If you prefer to believe that men and women are innately pacific creatures, you should avoid sitting down with a combat-scarred veteran.

“When people talk about the most atrocious things that one person can do to another, in detail and up close and repeatedly, it’s psychologically toxic to listen to,” says Dr. Judith Herman, a professor of psychiatry at Harvard Medical School and author of Trauma and Recovery. “People who treat traumatized patients need to take care of their health. They can get vicarious traumatization, as a contagion.”

Serbia has been involved in four wars in the past decade-in Slovenia, Croatia, Bosnia, and Kosovo-so the caseload for the country’s therapists is rather high and rather bleak. They face a particularly heavy psychological burden, because their exposure to trauma is not confined to the hours of nine to five. The society in which they live is falling to pieces, politically and economically and morally. The best escape is emigration, the road many therapists have taken, but that has only worsened the plight for those who remain behind. Their support networks, which are vital for coping with the trauma of treating trauma, are thinning out as colleagues and friends flee to countries that are less insane than Yugoslavia. Several therapists I spoke with in Belgrade believe the rate of burnout and suicide in their field is going off the charts. These are the secondary casualties of war, and Mandic almost became one of them.

“I have to finish this with you,” Zoran said at one point, referring to an issue-forgiveness-that he frequently raised. “Do you understand me at all?”

“No, I don’t,” Mandic replied. “What do you mean by saying ‘to finish’ with me?”

“Don’t be afraid. You don’t think I’m going to murder you?”

And then he laughed.

Tijana Mandic is on the phone, but the connection is poor and she is speaking fast, in staccato bursts. I can barely understand her. “There was an explosion,” she says. “My car is a mess…. I don’t know how…. We can’t meet today.” On the following day, when we meet for lunch in calmer circumstances, I learn that a can of soda she had left on the dashboard, in the sun, had managed to self-detonate; her car smells like a soft drink. This, I am learning, is her kinetic world. It revolves at warp speed and has a soundtrack-the ringing of her cell phone. One day, when we happened to meet a student of hers in the street, she hugged him and introduced me but neglected to tell me his name. When I later asked, she blushed and said she had forgotten it. “I see 500 people a week,” she explained.

Mandic was born into her country’s cultural elite. Her father was a diplomat stationed, when she was a child, in Geneva, and she attended a boarding school in France. She speaks English fluently, with just a slight accent, and she has been a frequent visitor to America for conferences and seminars. She did most of her doctoral work in London, focusing on group therapy for psychotics.

Mandic, who is 48 but looks younger, is divorced and has a teenage son, with whom she lives in the fashionable Belgrade suburb of Dedinje, home to diplomats, businessmen-and Slobodan Milosevic, recently indicted for war crimes. She is a stylish woman, in a low-key, tasteful way. Her defining features are her eyes: large and curious and childlike in their intensity and openness. Everything else is small-the rest of her face, her thin physique, her light hair, even her voice, which is hesitant, girlish. Her persona is the opposite of authoritative, and this is the key to her success. She is understanding itself; she doesn’t sit in judgment, she listens and confides, and this is why even her students call her Tijana. Everyone responds to her: psychotics, journalists, politicians, children, soldiers.

“If you’re in the presence of this lady, something changes in the room,” said Jonathan Rider, director of the International High School of Belgrade, which Mandic helped create several years ago. “She carries around her own little cosmos. It’s a profound thing to work with her.”

In 1991 Mandic went to New Jersey on sabbatical to finish a book on treating psychotics; the working title was Connoisseurs of Chaos. Although the world of psychotics was just about as far from reality as one can get or seek to get, the war in the Balkans, thousands of miles away, nipped at her heels. Mandic began receiving phone calls from refugees who wanted her help. She was only mildly aware of the psychological impact of war, so she went to a Barnes & Noble bookstore in Manhattan and purchased a few volumes on the subject.

Soon after she returned from America, the war seized her by the throat. A man whose sister she had once treated said he was having trouble sleeping. She agreed to help him. The man fit the profile of her typical patient: well-educated, articulate, connected, moneyed. Perhaps, like other patients, he was having marital problems, or maybe he fiddled with his taxes and felt guilty about it. He loved classical music, opera, theater. She had no idea a sniper had just walked into her life, though that became clear, brutally, rather quickly.

“In the beginning his whole image was very frightening,” Mandic recalled as we talked one day at a youth center where she spends part of her time. “He is a tall person, a strong person, athletic. At one point he said, ‘Are you afraid I am going to hit you?’ I was. Before that I worked with [psychotic] people who believed in devils and had paranoid delusions. But the threats before always had something irrational-that I was the devil, you know. There was something frightening about him that was not irrational. He is a warrior.”

The therapy would last for four months in 1992. They met three times a week, but there were many phone calls, too, especially when he turned suicidal. Mandic’s knack for listening and empathizing became her curse, because she absorbed the toxins of Zoran’s trauma. Her descent into his hell of guilt is documented in transcripts of the sessions, which Zoran agreed to have taped and, if Mandic chose, published at a later date, so long as his identity was not disclosed. She gave me a transcript of their final session, which touched on every key issue in their therapeutic relationship.

At the outset, he insisted on telling and retelling the nightmare that was jolting him from his sleep every night. It revolved around a killing that had occurred while he was stationed in Vukovar, a once-lovely Croatian town that in 1991 was shelled into submission by the Yugoslav National Army and cleansed of its Croatian inhabitants. Zoran was a sniper who also led a platoon in house-to-house fighting. One day two of his men were killed. He saw this too many times-raw recruits sent to the front and chewed up like so much hamburger meat. The squad quickly stormed an enemy house and cleaned it out, one soldier checking upstairs, another the ground floor.

Zoran had the job of checking the basement. He tiptoed into the dark cellar, soft step by soft step. He could hardly see a thing, but he could hear, and that was the sense he followed most closely. Left, right, straight ahead, he listened, looked, smelled; he had done this before, often. He heard a movement in the back of the basement. The enemy was there, now, waiting in ambush, probably pulling the trigger at that instant. He didn’t need to think; he fired his AK-47. The rustling stopped. He found, in a corner, a baby he had just shot dead.

That’s what he relived in his unremitting nightmares. Sometimes he was killing the baby, sometimes he was an observer watching it happen, but the result was the same: him waking up screaming, his wife holding on to him, telling him it was okay, be calm, be calm, you’re home now.

“Am I, in your opinion, a psychopath?” he asked Mandic. “Yes, I was killing. They would have killed me if they could. I told you, it’s the reality of war. Do you want me to spell it out for you? In war people kill each other. I only feel sorry about the baby. It happened in a split second, and those blue eyes haunt me.”

Just as Zoran learned new rules of engagement on the front line, Mandic was learning new rules of engagement in her office, a quiet, softly lit corner of her living room lined with family pictures and leather-bound editions of Freud and Jung. It is not unusual for veterans with severe PTSD to attempt to intimidate therapists. Much of their postwar anger is directed at civilians who sat on the sidelines, uninvolved, unknowing, uncaring. The threats, according to experts in the field, are designed to test the therapist, to figure out whether the therapist is just another pathetic civilian or, perhaps, is understanding enough and tough enough to deal with the truth and ugliness of what happened in combat.

“I don’t know what to tell you,” Mandic said.

“That I am a murderer and you are a phony,” Zoran shot back from the couch, his voice a whisper that belied his athletic frame, his expertise in martial arts, and his threats to harm Mandic, who sat a few feet away in an armchair.

His offensives were successful. Mandic occasionally broke into tears. She does not pretend to be an all-knowing observer of her patients’ lives; she is willing to bare her emotions because she believes a therapist is nearly as much of a participant in the therapy as the patient. If the patient will benefit from displays of her feelings, whether they be fear, sadness, or anger, she will let it all hang out. The book she is now completing, which consists largely of extracts from sessions with patients, including Zoran, is called The Human Mirror. It catalogs her words and thoughts as much as her patients’; it is a look into the mind of a Balkan therapist.

“Therapists usually are, in a way, mirrors,” she told me. “But I am a very active mirror.”

In general, that approach can work well with veterans, but it’s perilous for the therapist. Dr. Jonathan Shay, author of Achilles in Vietnam: Combat Trauma and the Undoing of Character, described PTSD therapy to me as “a creative act of two people struggling with each other…. You have to go naked.” The worst approach, he believes, is to maintain a neutral or aloof attitude.

“The veteran most of all wants to know that you are actually hearing him and feeling something,” Shay told me. “To retreat behind professional neutrality gets them to redouble their effort to penetrate this armor, and the attacks escalate. They saw people die or come close to death because someone in authority was following the book rather than their own personal vision or integrity. For many of the veterans I’ve worked with, that sort of behavior-from a therapist-is a traumatic trigger. It triggers a sense of, ‘Oh my God, I’m back in that same situation.’”

But going naked can let the toxins seep in. Mandic began having trouble sleeping; she took Valium. She lost weight, and friends at the time said she looked miserable. She began having nightmares-Zoran’s nightmares, the ones of the baby being killed. She saw the basement, she saw herself in the basement, she saw the baby being shot dead. It was getting to be too much. One of her longtime friends recalls that during those months Mandic was nervous and jittery, and during visits to the friend’s home, Mandic would disappear into a spare room to talk to Zoran on the phone; sometimes she would emerge from the room in tears. At one point Mandic asked the friend, “Is it only me who is crazy? What the hell is happening?”

Mandic was flirting with psychological disaster. Showing your emotions to a PTSD patient can be useful, if only to establish that you are listening and feeling, but it is something else to be overcome by those emotions or let them get in the way of making a hardheaded analysis of the patient’s needs. Just as the human mind can have trouble processing trauma, it can have trouble processing tales of trauma. Reaching out is the only answer, and this is what Mandic did, seeking advice from colleagues and friends. In Belgrade groups of therapists who treat refugees and soldiers assemble at regular intervals-weekly or monthly-to vent to each other. One of the therapists who leads these gatherings described them to me as deeply emotional. “We scream,” she said with a smile.

One of Mandic’s longtime colleagues flatly advised her to stop treating Zoran-partly, the colleague believed, because he was evil. Vesna (not her real name), who is a psychologist, nearly became physically ill as she listened to Mandic, suspecting that Zoran had committed many worse acts than he was admitting; she thought he fit the description of a psychopath or sociopath.

“He doesn’t deserve to work with any psychologist in the world, and I wouldn’t work with him in a million years,” Vesna recalls saying as they drove home one night from a seminar outside Belgrade.

“But he wants to commit suicide,” Mandic replied.

“So what?” Vesna said. “He killed people. He killed a baby.”

Mandic still wasn’t convinced.

“Okay,” she finally said. “But maybe it’s punishment for him to live.”

Should a therapist help a soldier who might be a war criminal? Though most veterans, whether in America or Serbia, did not commit or abet atrocities, some did. They were perpetrators of evil, not just victims of it. To help or not to help? Therapists have been wrestling with that question for as long as war and therapy have existed; the answer, though not an easy one for the righteous, is fairly clear. “That’s one of the dilemmas you have to manage when you deal with war-related PTSD,” said Dr. Terence Keane of the Veteran Administration’s National Center for Post-Traumatic Stress Disorder. “Would we work with someone who was at My Lai? I think it’s my responsibility and duty to help people who may have made a mistake.”

Mandic came to the same conclusion. She stuck with Zoran. He wasn’t just threatening to kill himself, he was threatening others, too.

“I’ve been thinking about two possibilities for making up for the mistake,” Zoran said. “First is to kill my wife, my children, and myself during the night. That would make up for the baby. The other one is to go to war again and get killed, although I have tried it already. I ran toward danger wherever I could, but there wasn’t a bullet with my name on it. My buddies thought I had gone crazy. I used to take off my helmet and run to save every wounded soldier, especially to protect the youngest boys. They thought I was courageous and they loved me, those young boys, but all I wanted was to get killed. It just didn’t happen.”

“Excuse me,” Mandic interrupted. “I can hardly hear you now. You’re speaking softly.”

“And you think murderers shout?”

“I’m trying to hear your solutions,” she responded. “Where’s the repentance? Where is the mending?”

“What would you like me to do?” Zoran asked. “Build a church or an orphanage? Then everything would be forgiven?”

“Do you feel guilty?”

“Yes, but only for the baby,” he replied. “It wasn’t guilty. It wasn’t a fighter. I made a mistake. The rest of it was war. War is war. People kill each other. Either you kill them or they kill you.”

The one thing Zoran explicitly asked for-forgiveness-she refused to provide. Should the unintentional killing of a baby be forgiven? Perhaps. But what about the other people he killed? What really happened on the battlefield? Was he telling her the entire truth? Even if he deserved forgiveness, should a therapist dispense it? Zoran had little patience for Mandic’s hesitations, and when she began crying at one point, he lashed out at her.

“Why are you whining now?” he snapped. “Just listen to me. You have to forgive me.”

“I’m neither a priest nor a judge nor a court witness,” she replied. “I’m only a confused woman. I can’t forgive you. I don’t have that power. Go to church. Go…”

Mandic repeated to me many times that she is a pacifist. She is religious, too, and wears a pendant of her family saint, Saint Nicholas, around her neck. She had once more run into one of the dilemmas of treating PTSD: guilt. These issues surface in other trauma cases-for example, a truck driver who accidentally kills someone in a road mishap, or a husband who kills his wife in a fit of rage. Should they be forgiven by a therapist? The answer most therapists give is that they are not the appropriate ones to offer forgiveness, and even if they did offer it the effect wouldn’t be lasting. Guilt is not washed away by a few words from a shrink. Restoration comes, if ever, from some sort of deeper resolution, such as seeking forgiveness from the victims or relatives of the victim.

Zoran did not receive the absolution he was seeking. Abruptly he brought the therapy to a close. At the conclusion of what turned out to be the final session he said, in a voice that Mandic recalls as soft and threatening, “Your time is up, doctor. This conversation is finished. Goodbye and have a bit more soul.” He got up and left.

Ultimately Zoran played a key role in altering Mandic’s life, and he did it by making what seemed an outlandish suggestion: that she was responsible for his sins. He may have been intending to wound her or shake off his own guilt, but his accusation is a common one among veterans, not just in Serbia or Croatia or Bosnia but in America and any country that sends soldiers into unclean wars that defy polite behavior.

“It’s your turn for once to face reality and not simply escape from it,” Zoran said. “Your escapism is worse of a sin than mine. Once upon a time I also used to be like you-ordinary. I have a university degree; I also like to read, go to the theater. I also have a family and children that I adore. And then I found myself in a war, and I no longer have my life-I am scarred. I am not the same anymore. You destroyed me-you and the neutral people who didn’t take sides, who didn’t get dirty. The pure and righteous ones who pretended as though the war did not exist at all.”

At the time Mandic had no response and changed the subject. Later she decided there was much in what Zoran had said that made sense. Weren’t soldiers like Zoran victims of a society that let madmen take control and fill the airwaves with hatred and, ultimately, send ordinary men into battles in which atrocities were nearly inevitable? Did people like Mandic, who confined their objections to the voting booth or, on occasion, polite demonstrations, bear some responsibility for not doing more in the face of evil?

Most therapists involved with war-related PTSD confront these issues, and that’s what sets their line of work apart from other fields of therapy. The root problems are not immutable matters of human biology but problems of power and the abuse of power. War is not a disease but a political outcome. There’s not much a society can do to prevent schizophrenia, but wars can be prevented, or, once they start, steps can be taken to ensure they are fought in ethical ways.

Shortly after she stopped treating Zoran, Mandic agreed to become the director of an alternative education program (underwritten by George Soros’s Open Society Institute) that sponsors debate clubs in which youths learn how to discuss and resolve disagreements peacefully and rationally. The aim is to help them see through the sort of incendiary rhetoric that has fueled warfare in the Balkans for the past decade. She has many fewer private patients than before-she doesn’t have enough time.

Mandic heard that Zoran later divorced his wife and married a widow whose husband was killed in the war in Bosnia. He adopted the widow’s children. Mandic suspects this was his form of repentance, to make whole a life shattered by war. She has wondered, though, whether he has sought or found redemption through good works, or whether he returned to fight in Bosnia or Kosovo. She also wonders whether he was a victim or, as Vesna suspects, a psychopath. Mandic has contacted him again and hopes to meet him face-to-face one day soon.

For now, she is left with the strange memory of the last time she saw him. She was at the theater in Belgrade a few years ago and spotted him in the crowd. He likes the theater, so she was not altogether surprised. He noticed her, too. He glared at her for a moment but then moved on without saying a word, disappearing into the crowd, which covered his retreat.