IHOR KHOLODILO should probably not have survived to tell his tale. The military psychologist and medic was evacuating comrades in early 2023 when his jeep was hit by a Russian tank shell. He suffered injuries to his eyes and heart, and was left barely able to communicate. Operations saved his heart and vision. But doctors were unable to correct his slur and stammer. He tried all kinds of radical therapies, but nothing helped. Then came a chance meeting with Vladislav Matrenitsky, a pioneer of psychedelic-assisted psychotherapy, who posed an unexpected question. Would he try ketamine?

Mr Kholodilo decided to give it a go, not expecting much. But the results were astonishing. After one session under the sedative his stammer all but disappeared. Another five and he was almost back to normal. Gone were the introversion, the nightmares and the fears about daily life. Ketamine therapy was not comfortable or easy, he says, but it allowed him to resolve the trauma that caused his symptoms: “I returned to what you could call life…I felt light, just blessed.”

Ketamine has been legal in Ukraine as a treatment for mental illness since 2017. The use of psychedelics to treat anxiety and depression has a much longer history, and was explored in America in the 1950s-60s. After the hippie movement the treatment fell out of political favour. For a while, psychedelics were equated with serious narcotics like heroin. But in many countries, in the past decade or so they have experienced a renaissance.

Now the biggest European war in decades is putting Ukraine in the forefront of the treatment. Dr Matrenitsky, who runs the only clinic in the country offering ketamine therapy, says he has handled nearly 300 patients suffering from treatment-resistant depression, post-traumatic stress disorder (PTSD) or anxiety. A growing share are soldiers, who seek the treatment in a private capacity.

A 40-minute session at Dr Matrenitsky’s clinic, on the top floor of a drab children’s hospital in north Kyiv, costs just 4,000 hryvnia ($105), although the clinic provides some soldiers with treatment for free. A typical course runs between two and six sessions. The ketamine dose—0.5 mg per kilo of body weight—is administered by drip.

A psychotherapist then leads the patient through their trip. The aim, says Dr Matrenitsky, is to access subconscious traumas: “What we are doing is turning the memories into a metaphoric journey, and that can discharge their emotional pressure.” He says about a third of his patients receiving ketamine enjoy “extremely good” results, and another third achieve “reasonably good” outcomes. Bad reactions are rare, usually manifesting as panic attacks. That is the signal to stop the drip.

The doctor says most soldiers on the front lines have accumulated so much stress that they would benefit from his treatment. He blames stigma and a “Soviet” approach to military medicine for slowing access to ketamine therapy, and is lobbying to make it more common. Another goal is to expand the treatment beyond ketamine, which is legal because of its use in anaesthesia, to include prohibited substances like MDMA and psilocybin (the active molecule in magic mushrooms).

MPs and officials in the Health Ministry are largely sympathetic. Kseniya Voznіtsyna, director of Forest Glade, a government military-rehabilitation centre, thinks a pilot project using MDMA and psilocybin could get the go-ahead within six months. In May her centre sponsored a conference on psychedelics in psychotherapy, helping build consensus. A select committee raised a few objections. But Ms Voznіtsyna thinks psychedelics should be used sparingly, and never for active soldiers. “This is a therapy for difficult situations, medication-resistant PTSD, when the usual methods don’t work.”

Others disagree. Mr Kholodilo says Ukraine should be using psychedelics to improve battle performance. He sees two uses. The first he calls “decompression”, to prevent depression from developing in front-line fighters in the first place. The second would be a ritual to prepare soldiers for the possibility of death. “It’s foremost in the mind of any soldier heading to the front lines. It paralyses some of them.” A soldier who accepts the risk of death is a much more effective warrior, he says—and has a greater chance of surviving.

The notion of using psychoactive drugs to help soldiers fight raises troubling moral issues. The army is still far from formally embracing ketamine therapy, let alone giving it to serving soldiers. But Ukraine’s armed forces are highly decentralised, and some units are apparently experimenting.

Mr Kholodilo says he has already referred one elite special-forces unit for the treatment, and is thinking about applying it with a second. He says ketamine could keep Ukrainians fighting more effectively and for longer. “The soldiers were surprised at being able to return to the front lines so quickly,” he says. “They simply didn’t think it was possible.”■