Jan Verhaegh
Not on the Agenda
Clients and psychiatry in
Central Europe
Introduction
As a result of happy
circumstances my son Stefan and I had the opportunity of making a study trip
through Eastern Europe. This study trip could not have taken place without the
great hospitality of members of the board of the European Network Users Survivors
Psychiatry. My son and I were guests of Peter Lehman (Berlin), Gabor Gombos and his wife Kathy (Budapest), Piotr Iwanejko
(Krakow) and Vahid Dulovic
(Tuzla).
This hospitality,
the kindness, the music, the quality of food, the life-power, the cheerfulness
of these people, their families and their friends turned our journey into an
unforgettable, special and impressive experience. At the same time being
ignorant and naive people from Western Europe we were touched by great
sufferance and shocked by the depth of the suffering in these countries.
At several moments
during our trip we experienced a deep feeling of powerlessness when confronted
with the misery and awful circumstances under which not only psychiatric
patients were living, but whole groups of people. This is the reason that we
find it a moral duty to tell about the things we have seen, so that as many
people as possible are informed about the situation of our Eastern Europe
neighbors. Also, our friends over there specifically urged us to tell their
stories.
Clients are active everywhere
Throughout Europe persons with
psychosocial disabilities (clients), under difficult circumstances and with no
or very few means, are helping each other to be independent, to have a vision
and to fight for their rights. These organizations of patients have the very
important task to democratize psychiatry and society and most of all to fight
for their human rights.
In Central Europe
the Hamlet Trust has carried out extremely important projects. Nowadays
there is a new organization: Mental Health International
Development that continues the mission of Hamlet Trust. (See: http://www.mhid.uk.net/about_us.shtml).
In addition to these efforts, there patients who draw and paint, proudly
exhibit their work. In effort to make these works available for viewing to
other people in Europe and to give other patients the opportunity to do the same,
we have set up a website on the European Network, where we have built an Art Gallery.
See for further details: http://www.enusp.org/documents/art.htm.
Mutual solidarity
We not only experienced
impressive activities of clients, but also of managers, psychiatrists, nurses
and social workers. In Hungary for instance we were taken on an enthusiastic
excursion by the manager of a social pension. This man has reached rare but very
important results: he turned a large scaled institution into small parts.
Striking was the
pride with which all people spoke about their work, results achieved and the
results logged by their clients as well. In cases where both clients and
professionals had very little to work with, it seemed that sometimes this
shared poverty created mutual solidarity between professionals and clients.
This solidarity we are often missing in the Netherlands, I feel.
As most people are
dependent on their family, due to the lack of welfare, the extent of
hospitalization was overwhelming. It was so overwhelming in fact that we were
surprised and impressed by it. At the same time there corruption is rampant.
Where there are few social services and the social security network is failing,
where everyone depends on the support of friends and family in times of
difficulties, everyone tries to obtain money via of corruption. In relation to
this we were impressed by the plans of the self help organization Fenix in Tuzla to earn money from
home made souvenirs, furniture and organically farmed plants and herbs to be financial
independent.
Genocide
Genocide is a fundamental
European problem for which there is no answer. One of the most shocking things
to realize during our journey is although an end has come to Auschwitz - Birkenau, genocide still exists in Europe. We were in
Auschwitz and were deeply touched by the enormous desolate and extendedness of Birkenau. And the extermination of the Jewish people was
only the beginning, after that it was the turn of the Slavic people to be
exterminated.
Genocide is much
older than Auschwitz. We had the chance to talk to an Irishman in Auschwitz. He
said that British people in the 19th century set out to starve the Irish.
Several millions died.
We know that in
Turkey during World War I genocide was being committed on the Armenian people.
We also know about the role Belgium played in Rwanda. We know that President
Bush does not have any problem with wearing a cowboy uniform. (How many Indians
were killed by cowboys?) And In Bosnia we saw with our own eyes the results of
genocide in Srebenica, exactly ten years ago this
coming September 2005. In relation to psychiatry we heard stories about a
clinic in Bosnia where the Serb management killed two or three hundred patients
who were not Serb (Sokolac).
The stories about Srebenica and Sokolac helped us
to realize that in Europe genocide is still being carried out. Therefore, we
propose to change the slogan: “Never again Auschwitz” into “When shall we put
an end to practices like Auschwitz?”
We are not the only
ones who have made this comparison. There are reports about Dutch soldiers who
were rightwing-extremists, brining Hitler greetings and becoming enthusiastic
about the Nazis and what they did.
They also
voluntarily helped kill Muslims. There are even rumors (unbelievable, but
strong) that Dutch soldiers gave sweets to Muslim children with the purpose to
kill them.
Nazi Euthanasia
Commitment to genocide is a black
page to the history of psychiatry and medical sciences. The idea of
systematically killing Jews was given to the German Nazi’s by doctors and
psychiatrists and started with the mass murder of patients and people with
learning difficulties and physical disabilities.
The
biological-medical model was combined with a social-Darwinist politics and concepts
on cost savings. This combination greatly contributed to the catastrophe and we
should be aware of the fact that elements of these ideologies are still alive
today.
Rather than
repressing and/or trying to forget one should strive to process these
histories. We should all realize that genocide and Auschwitz can happen again
tomorrow, seeing as how the factors causing the rise of these things still
exist. A fine example of the way to deal with history and traumatic experiences
is the monument on the grounds of the psychiatric hospital in Krakow. It was
given to the hospital by the Germans. The names of all the murdered psychiatric
patients and the psychiatrists, who stood by the patients, are listed on the
monument. Patients have a memorial service each year. As Wiedergutmachung
the Germans also built a house for the rehabilitation of patients, allowing
them to reintegrate into society. The dorms do not contain the usual twenty
beds but are designed for two or three patients and some rooms even facilitate
a computer.
Neo-liberal
misery—social euthanasia?
The Social Darwinist way of
thinking belongs to the family of neo-liberal way thinking. This way of
thinking, in combination with the refusal of giving enough money, peaks in a
worldwide social euthanasia. In Eastern Europe clinics do not have enough money
to provide help in an adequate way. We have heard stories about a high
mortality rate, as high as fifty percent, during the first year of
hospitalization as result of cold and unhygienic circumstances, lack of food,
poverty and a shortage of medicine. New medicines are too expensive and
sometimes not even the old ones are available.
In Hungary there
are thousands of psychiatric patients housed in social pensions. These people
do not have enough money to live outside these social pensions. Even in rich
countries, such as in the Netherlands, there is not enough money spent allowing
for chronically disabled psychiatric patients in hospital to have a normal
quality of life. (See Report “a long chain of empty Sundays”). Ray Rowden, former director of Hamlet Trust, speaks about
psychiatric hospitals in Eastern Europe as “Death camps, where people are
killed...” Also, Clemens Huitink, spokesman of the
Organization for Mental Health Care Institutions in the Netherlands, describes
a sad situation. At www.poianamare.org
one can see photos about the situation of a psychiatric hospital, while at www.mdri.org you can see the situation in
Paraguay. It is even worse still.
Stalinism
Under Stalinism psychiatry was
a part of the ruling system. The biological-medical model was dominant.
Psychotherapy and psychoanalysis played a stigmatizing role as western
bourgeois inventions and were forbidden, because it was dangerous to talk to
other people. It was quickly seen as subversion. As a result people could stay
in hospitals for years and being exposed to series of electroshocks without
having any possibility to speak out. We know a lady who experienced this for
two years. A man, who was forced to take anti-depressive medicine, responded
that he would do so, if he also received some kind of psychotherapy. He was
sent to a body movement therapy. He was allowed to speak two minutes about his
problems and then the therapist started to talk about the problems in her own
marriage. After two months he refused to take his medicine because he had been
denied psychotherapy and spoke of the situation he was in. When he came back to
the physiotherapist, she cried and said that she did not know anything about psychotherapy,
but was ordered to give him therapy.
Collective trauma
Everywhere in the streets, at
bus stops, on buses, in cafes, in museums, people told us stories about the
situation under Stalinism. People, who were in prison, people who with
destroyed bodies. We also saw the museum of Staatssicherheitspolizei
in Berlin.
One of the results of recent
history is that culture is still repressive and built upon authoritarian
relationships.
The rise of
psychotherapy seems to have problems, because there is no tradition of talking
about problems with each other. Also patients experience problems in self help
groups of not being able to talk to each other. Sometimes they are scared to do
so, and that is the reason why they prefer to work with each other instead.
Especially in Tuzla, where there was war, they told
us so. There people experienced how quickly friends or family turned into
enemies and killed each other.
Authoritarian systems
The more authoritarian the system is, the more human rights are violated, the more psychological and physical maltreatment, and sexual abuse there are. As a result of what we have seen and heard, we expect this to be the case in Central and Eastern Europe (but also in Western Europe on a large scale in authoritarian psychiatric hospitals). We expect that violations will continue to exist on a large scale and much more so than we realize. Psychiatric hospitals were a place where political dissidents were sent and psychiatrists even invented the diagnosis of sluggish schizophrenia...As an example of sexual abuse we advise you to have a look at www.mdri.org/pdf/KosovoReport.pdf. A report can be downloaded from here, titled: “Not on the agenda...” about the special institute Shtime in Kosovo, where a lot of sexual abuse was being committed among several other unacceptable things. Based on this report the government of the Netherlands sent 2 Million € for improvement. This funding was shamefully spent on cosmetic surgery. The management has had marble staircases and Italian bathrooms built and nothing changed concerning the problems themselves… The general manager was a Dutchman. He has since left. However, there is no improvement and the international community has lost chances to invent important new activities. The international community barely interested in psychiatry anymore.
Lack of privacy
In most places there are large
bedrooms, the small ones are for six persons. We saw no possibilities for
enjoying privacy. There is not a chance to be alone, only in the toilet or in
the bathroom. Sometimes psychiatric hospitals use bed-cages to keep people
locked up even nowadays.
No work, no money, no future
Although there is more freedom
in contemporary Central Europe there are huge social and economic problems.
Capitalism with the accompanying ideology of neo-liberalism does not offer any
solution for the problems of Central Europe. There used to be work, homes and
health care. Nowadays this is not longer the case. People are, in a cynical
way, joking about this situation. They say: “In earlier times we were not
allowed to travel, but we had money. Now we have the freedom to do so, but we
have no money.”
What is the worth
of freedom if you do not have money to spend? The majority of people are
unemployed. They have no income or hardly any money. People, who used to be
psychiatric patients, doubly suffer from these problems. They are more often
stigmatized, poor, unemployed and have unsolvable difficulties in finding a
job. They are very much excluded.
As a result of the
social-economic problems a lot of people suffer from psychological or
psychiatric problems, they are depressed and, or addicted. Many of them
(alarmingly many young people) use drugs or alcohol, as self-medication.
Hungary makes a melancholic impression and in Poland we have heard and have
seen a lot of people using drugs or alcohol.
Dangerous religion
With respect to the positive
effects of good religion (as in Buddhism) we are no longer accustomed to
the ways of the religion we saw. Young people kneel on the floor of the church.
This is something that cannot be seen in the Netherlands. In Bosnia religion
plays a dangerous role. Sometimes as in Poland, but also in Bosnia, religion
has nationalist references.
Warlike Europe
War is also a European
phenomenon, of which we are not free at this moment and will not be even for a
long time to come. In Bosnia we saw an organization of ex-soldiers who suffer
from post-traumatic stress disorder. We have seen that in an impressive way
clients are actively dealing with their problems. In the barracks of Bosnia
there are six thousand soldiers of whom three thousand suffer from a
posttraumatic stress disorder. Nowadays the government sends these soldiers as
invalids to the streets, where they join the army of unemployed people.
The results of the
war are disastrous. We have seen not only a lot of packing material for
medicine (narcoleptics, benzodiazepine, anti-depressive) in dustbins, but we
have also met people who were greatly traumatized. Almost everybody has lost a
family member, a father, brother, husband or child in the war. People die daily
by exploding mines. Srebenica is very, very poor. The
whole city still caries traces of its destruction. Forty percent of the
population is unemployed and poor. The Netherlands has done nothing, or was
unable to do anything. We have heard from the United Nations spokesman there
that there are plans coming from the Netherlands to withdraw their help,
because Srebenica is no longer a current topic and a
sexy case…
Especially young
people in Bosnia are the victims of the war, they are traumatized or demoralized.
They deserve our complete support. It makes us sad to realize that the fragment
out of the song: “Over de Muur” of Het Klein Orkest
from 1984 is still true.
“But what is
freedom without a house, without a job
So many Turkish
people in Kreuzberg, who can scarcely exist
Good, you are
allowed to demonstrate, but with your back against the wall
and only when you have money, freedom is not expensive..”
When client organizations
mobilize or succeed in mobilizing other organizations, we stand stronger. It is
important that Amnesty International fights for the human rights of psychiatric
patients. It would be relevant to put our problems on the agenda of groups of
activists. Unfortunately, the official international community is not
interested in the problems of psychiatry and psychiatric patients. Groups
fighting for another or a better world should be much more aware of these
problems. So it would be a sensible suggestion to attend the World and Regional
Social forum to raise awareness about these issues.
But perhaps there
are more positive changes than we have expected. After our voyage we received
the March 2005 issue of the journal Epidemiologia
Psychiatria Sociale. In
this Italian magazine we have found a bit more positive article of Benedetto Saraceno
and Shekhar Saxena
on mental health services in Central Europe and Eastern Europe.
Before we started
our journey my son, and I were not informed about the
situation I have described here. These problems are not enough discussed. How
can we raise awareness? Concrete and huge problems such as genocide, war,
poverty, exclusion and refugees are perhaps neglected by the client movement as
well. Psychiatrists tell us that clients should not deal with such serious
problems because they already have so much to deal with. It is better for them
to do nice things and not to think about the world.
I keep thinking of
the Dutch soldiers who gave Muslim children sweets with the purpose to kill
them. Perhaps as clients we miss the chance to see and hear the reality and
suffer from it. Do people living with schizophrenia suffer from reality or from
truth?