Since the collapse of communism in Central and Eastern Europe and the former Soviet Union, there has been a great deal of reporting on the political turmoil, economic chaos and the region’s severe environmental problems. But much less has been said about the psychological damage caused by half a century of totalitarian rule. There are increasing rates of suicide, alcoholism, domestic violence and mental illness. The Geneva Initiative on Psychiatry, an organisation set up in the early 1980’s to combat the abuse of psychiatry in the former East Bloc, is now working to help reform mental health care in the region.
Broadcast: March 8, 1998
Since the collapse of communism in Central and Eastern Europe and the former Soviet Union, there’s been a great deal of reporting on the political turmoil, the economic chaos, and the region’s severe environmental problems. But much less has been said about the psychological damage caused by half a century of totalitarian rule. The consequences of 50 years of repression are only now beginning to emerge: rising suicide rates, alcoholism, domestic violence, mental illness. The stress of extreme poverty and social problems is taking its toll on the family itself and on the fabric of societies in the former East Bloc. My colleague, Eric Beauchemin, who recently spent several weeks traveling in Eastern Europe, was struck by the enormous damage which the past half century of authoritarian rule has had on people’s mind and psyche. When he got back, he went to speak to Robert van Voren, the General Secretary of the Geneva Initiative on Psychiatry, an organization set up in the early 1980’s to combat the abuse of psychiatry in the former East Bloc and now working to help reform mental health care in the region. The communist system, he said, forced most people to lead schizophrenic lives.
I think the Soviet system can be characterised as a very sophisticated, totalitarian system, which meant that it was all pervasive. There was not one sector of society that was able to keep out of this and to avoid influence by the communist party and the ideology. It was also a system which forced the people to become almost a split personality. You had your personality in a homily setting, among your friends, with your relatives, where you could voice your opinions and think what you really thought. And as soon as you left the apartment, you would have to put up your – what you could say – Soviet mask and participate in the ordinary, daily life of a communist system. People, they were taught to do this almost from the day they were born. So it became almost natural, part of their genes to behave in such a manner. Then of course when the system changes, and for them it almost changed over night – it’s very hard to adapt to a new situation. It’s incredibly confusion. In a sense, you could say that the whole population of these countries is suffering from a kind of collective post traumatic stress disorder. EB: You said that people in the family were safe but for example in Romania, even in the family, it was difficult to speak openly. I spoke to one person who said that OK, in my family I could speak, but I know that in other families it was impossible to speak, and I certainly would never have dared to speak to my friends even good friends, because you simply didn’t know who you could trust and they didn’t know if they could trust me. Well, yes, but Romania I think to a certain degree is an exception. In the sense that Ceaușescu managed to build a system that was very similar to the hard-core Stalinism that the Soviet Union knew under Stalin. And of course, under Stalin, parents wouldn’t tell anything to their kids, and kids wouldn’t tell anything to their parents because they were taught day-in-day-out that they had to denounce even if it was a brother, sister, father or mother. To a certain degree, that continued in Romania and even increased under the rule of Ceaușescu. There’s another difference between Romania and the Soviet Union, and that is that in Romania you still had a sector of society that had been educated and lived before the communists took power. So they knew the old Romania, which was not a democratic state but was a fairly civilized state. For them, it was much harsher to see Romania develop in the way it developed. Whereas if you go to the Soviet Union, there is virtually none who lived and had known what Russia had been before the communists took power. So everyone was Soviet: 290 million people walked along and participated in the same system and that makes it much easier to deal with. I think that’s also one of the reasons why the situation in Romania is so complex, and it’s so hard to build an open and honest relationship with someone in that society because this conspiracy syndrome is so much part of their thinking and their behavior and their genes. It’s almost impossible to overcome.
EB: You spoke about putting on a Soviet mask when you went outside the home, and you talked about people living with a type of schizophrenia.. What are the consequences of that for people, for a person’s psyche? Was it that people switched off their minds when they went outside, they simply followed instructions, obeyed orders and did what they were told and didn’t think, and then when they went back into the home, they had some freedom, or was it completely different? Well I think this accounts for the majority of the people. Plus you have to realize that because it was so common, because everybody participated, because they didn’t know that there could be another type of life, many didn’t even realize what was going on, didn’t realise that they were living a split life. A couple of years ago, I had a long talk with a psychiatrist from one of the provincial towns in Ukraine, who had been in medical school with one of the dissidents in the Soviet Union who served 10 years of camp for his opposition to the political use of psychiatry. He had been not a very good student. She had been a very good student, so she became a member of the party and eventually grew up to become the party boss in this provincial town. She said that well, when Gorbachev assumed power and they had the first party plenum and she received the papers on her desk, she was shocked. She just couldn’t sleep because it was so different than what she had expected and what she had known before that she was convinced that something was wrong with Gorbachev. There must be something wrong with this guy because this is not the way we think. And she continued to believe that until 1991 when the Soviet Union collapsed and Ukraine became an independent state. And only now she is starting to be able to look back and see where things went wrong and what kind of life she led. And she has the courage to do so because many of the people are afraid to do so because it would mean that it many respects they’d throw out their lives. Their lives had been in vain. In The Netherlands, I think about 20 years ago, a film was on TV called The Bridge, and it was a series of interviews with old communists who had been very active in the communist movement in the 20’s, 30’s, and 40’s here in the Netherlands and going out to the Soviet Union to help build a Soviet state. And some of them broke down in tears during the interviews and acknowledged that they had just been a participant in the construction of a dictatorial regime. But others you could see from the way they reacted that they understood that that was the case, but they just didn’t want to acknowledge it because that meant that 50 years of their lives would just flow out of the window. So they had to continue to believe in what they did because otherwise it would have all been in vain. And I think this accounts for a large part of societies over there. But again if you look to the Soviet Union, apart from this very small circle of dissidents, they all participated. So there is nobody next to you who can say “well, you were worse than I was, because they were all parts of the same system”. In a sense it makes it easier. You don’t have this terrible division between the good and the bad, the black and white.
EB: You talked about the government and government control. How much of a role did the secret police play, perhaps not only in Romania but throughout the former East Bloc? Well, Romania is one of the countries where the secret police was all pervasive. There are estimates that 1 out of 10 was working for the Securitate. It probably was worse in Romania than in a country like Bulgaria or in Czechoslovakia and maybe even than in the Soviet Union. But it’s not even interesting actually how effective and how strong the secret police was because the major job that the secret police had to carry out was already carried out by the population because they thought it was a duty as a Soviet citizen. It was a natural thing. You go somewhere, you write a report. You go abroad, you denounce your fellow travelers. You never travel alone. You’re always in groups of three and one of them is a secret agent. And they just went along. They accepted it. It was part of reality and it was the only reality they knew and they had no idea of how life could be different. It’s absolutely closed societies with a very small nomenklatura having contact with the outside world and knowing that it was all just a farce and a totalitarian state. But hey, they lived on it. It gave them power. It gave them a good position. It gave them a good life, so they went along and they participated. EB: But if the entire society was closed in this fashion, was there any type of fear? Because if everyone was taking part in this system, willingly or unwillingly, then there wasn’t any fear, even of the secret police. Well there was fear. To start with, because under Stalin, dozens of millions of Soviet citizens had been exiled to Siberia and killed. So there was not one family in the Soviet Union that didn’t lose one or more relatives because of this terror. The terror was so sophisticated, so all-pervasive and so endless that fear became just an ordinary part of life, an extra sense, something that people never lost. It was there day-in-day-out in the morning, in the afternoon, in the evening and at night. In the 60’s and 70’s and 80’s, it diminished somewhat, but very little was necessary to call a Soviet citizen to detention and say, “well hey, watch it. Don’t go any further because then something will happen.” We still get every now and then access to documents from either the Central Committee of the Communist Party of the Soviet Union or from the archives of the KGB. I mean there are librarians who also want to earn some dollars, so they sell KGB documents. Some of them are really very interesting because there are reports by for instance Andropov to the Politburo or the Central Committee of the Communist Party dealing with anti-Soviet activity. To what extent it had grown during that year, and what kind of categories, what they had done with the people, measures they had proposed like we are now having a wave of anti-Soviet activity and we propose to send that and that percentage to psychiatric hospitals, I mean that was all very nicely planned. And then they found out that the number of psychiatric hospitals in the Soviet Union was too small to cope with all the political prisoners, so they started a building program to have more psychiatric hospitals. But it also indicates that 80-90% of people who complained were warned and one warning was enough. Of the others, 2 or 3 weeks in a psychiatric hospital and treatment with neuroleptics would carry them off for the rest of their lives. So if fear would diminish, the authorities were very capable of putting the fear back into the genes of these people.
EB: What type of effect does it have on people to have to live with this fear constantly, to have this fear almost ingrained in them? If you looked at these societies after the collapse of the Soviet system and the political changes in ’89, ’91, one of the first things that was clear was that people had no opinion because they were taught never to have an opinion. And they had no initiative because they were never taught to have an initiative. To the contrary, any initiative was immediately punished by the authorities. So only now, you see that people slowly are developing their own views and their opinions, and taking initiative. But again, very little has to happen and they are scared again. And they stop all activity because they don’t know whether they are doing something wrong, as if there always has to be some outside force that tells you you can go ahead because “it’s OK or no, stop because it’s not OK”. And I think basically the current generation in that respect is lost. Lots of the people that we work with in these countries who are in their 40s, 50s, 60s, say “well, we are the lost generation. We are too Soviet. You can’t change us. You can change the outer layer but you can’t change our way of thinking or our way of reacting. You can’t change our genes. Try to the next generation.” Then, you have to realize that in a certain sense the next generation in a certain sense is lost as well because they have been brought up by their parents so they have also been infected by Sovietism, plus as a reaction against what happened with their parents and reaction against the old regime, they have become incredibly materialistic. Not interested in any values or norms or morality whatsoever. So probably only their children will become a generation which is able to develop a society more along the lines that you would like a society to develop. It’s a lack of feeling of responsibility, and it’s an inertia which is sometimes almost frightening. I think it’s caused by one in the same cause which is the old system didn’t want people to feel responsible because the authorities were responsible. So leave it to us, we’ll solve your problems and we’ll deal with everything. You just walk along and produce. At the same time, the system was such that if you just sat behind your desk and you shifted papers from one pile to the next and did that for 30 years, nobody would even care. Everybody worked like that. So now suddenly they have to produce something and they are so unused to this that it’s very difficult to overcome this old way of behavior and old way of thinking, not knowing what to believe in, how to keep themselves afloat and how to survive. So yes, they become incredibly aggressive and they have no way to deal with this. There is no outlet. So it’s a very harsh, ruthless society.
EB: Is that also why people are becoming very selfish because you find even the family is breaking down in some cases, and it’s because individuals are only thinking about themselves. I’m not interesting in my parents or my brothers and sisters. It’s only me. I’m the one who counts. Yeah, yeah, yeah. It’s a natural reaction. You have to survive. It’s an instinct. So everything else becomes less important. Plus with your parents…your parents participated in this system which is the cause of all this trouble, so in a sense you blame your parents for having allowed this. I know a lot of people who lost contact with their children because of this because they’re blamed for what went on. Of course, they participated because everybody did. They had no choice. They were not dissidents. Their characters were not such that they would be able to resist an interrogation by KGB or any other secret service. But hey, everybody participated, not just they themselves. But of course the kids need to find a scapegoat, so it’s the parents. EB: Does the fact that the type of economy which is now being introduced in these countries also makes any type of improvement more difficult. The type of capitalism which you have in these countries is certainly not some type of civilized capitalism. You have to try to get as much as you can out of it, and there are some people who are going to make some money, but there are a lot of people who are going to make some money, and there are a lot of people who are going to be left down at the bottom. It’s bandit…as they call it themselves, bandit capitalism. It’s not an economic system that they are introducing. They’re introducing capitalism but because of the collapse of the old system and all the effects that it had, it has become bandit capitalism. I’m afraid that it will be like this for some time to come. Unfortunately, I think it’s a period they will have to go through. It’s still an evolution. Mind you, what it would have been a revolution? The problems they face now would have been minimal in comparison to what would have happened then: civil wars with millions of people being killed on both sides. So in a sense, I think we have to be lucky and happy that it went the way it went. But of course, if you live in such a society and you have known the life before, it’s very difficult to accept the fact that you are now allowed to open your mouth and say what you think means that you don’t have meat to eat and you can just afford bread and you’re bankrupt. I think there’s only a small portion of the population that now sees that they might have reached the bottom of the pit. That doesn’t mean that there is a big light at the end of the tunnel and that the tunnel is short, but at least they start to get the feeling that it can’t go further down or much further down, which in a sense is also a comfort. You know how bad it can get. So in a sense it can only get better. But still there are no guarantees and that’s a thing which also makes it very difficult for them. There are no guarantees; the old system guaranteed everything. The new system doesn’t guarantee anything: you have to do it yourself, with your own hands.
When we started in Ukraine with training courses for psychiatric nurses, after 2 years we realized that although we were getting the message across as to what kind of skills they should have, it was virtually impossible for them to put it into practice. The reason why was that we taught them to deal with their mental patients as human beings with their own value. Now, because these nurses don’t value themselves, don’t even see themselves as human beings who have a value, who have a human dignity, because they were Soviet citizens. You’re just expendable, you can be killed overnight and nobody cares. How can you expect from a person like that to look at the patient in another way? Patients are stigmatized and then still they should consider the patients better than themselves? We started introducing an extra thing to the curriculum which was building the individual person, building of the individuality of the psychiatric nurse, helping them to start to value themselves, to have human dignity. Once we did that, then the skills and dealing with the patient, etc. etc. was fairly easy. But this first barrier was essential and the first barrier took about a year for a small group of 20 nurses to go through this process. Interestingly, it is Bulgarians who are carrying out these courses, mainly because they realized this 10 15 years ago, a group of psychiatrists and psychologists and have been working first on themselves and then on their students, and they build a kind of community which can work with these types of groups so they are now going out to the former Soviet Union to help us to rebuild mental health care and thus also rebuild society.
EB: You said at the very beginning that there is a type of collective post traumatic stress disorder in these countries, yet mental health doesn’t seem to be an issue in these countries. Most people don’t even know about it, and they could care less. They don’t see it as an essential thing. Doesn’t that make it difficult to get over these mental health problems? Oh absolutely. Absolutely, absolutely. But I think there are two sides to this. One is, I mean if you look here at the Western world and you look for instance at fund-raising for medical issues, you will see that for mental health, very little is being given. Very few people actually donate money to mental health-related organizations because it’s considered a luxury. They think it concerns only a small portion of the population, and in a sense it’s scary. Of course, it’s not contagious, but still people are scared to become mentally ill or to have to deal with the mentally ill. So they’d rather not think about it. The same counts for these societies. In addition, part of Soviet ideology was that a human being with value, with dignity was a whole human being, both physically and mentally who could be productive and help build a Soviet state. So physically handicapped, mentally handicapped, mentally ill were just ostracized from society, and they were really banned out of the cities. You will still see in all of the Soviet towns that chronically mentally ill and mentally retarded, all the institutions are outside the city, almost inaccessible, and they’re just locked away and these are huge coffins. People are just sent there to die. EB: But governments and Western donors say this isn’t a priority. The first thing we need to do is go build the economy. Yes, but then we get to the first point I made, which is that is a problem that we have in the West. Psychiatric associations here have a duty to go to the authorities and say well 1 out of 10 will become depressive at some stage in his life. So many out of that populace will die demented. So we are talking about a large portion of the society actually. If you look at the number of years that are lost because of disease, over 11 percent of the years lost in a society because of disease is because of mental illness and mental illness-related problems. I mean it’s one of the biggest problems in society. It’s the task of the professionals to go to the authorities and tell them. EB: Are these figures for western Europe or eastern Europe? No, these are worldwide figures. It’s a report that was published I think last year by Harvard Medical School: the Global Burden of Disease. It’s a 10-centimetre thick book, but it’s based on statistics worldwide and probably in the Soviet Union, the problem is higher. We know from for instance from the Baltic countries where they’re now trying to get statistics that the suicide rates are exceptionally high. The alcoholism rates are exceptionally high and it’s all because of total…well, societies gone out of control and people not knowing where to go and what to do and what systems to believe and what ideology to believe, what values etc. etc. So they start drinking or they jump from a building.
EB: You touched on the family. How has the family been affected by all these changes?
In the old days, when the Soviet Union was still the Soviet Union, family was essential because it was the small circle where you could be yourself and not be part of this system marching along. So contacts with your relatives, with your parents, etc. etc. were very important, plus there was always a problem lack of housing as a result of which you often had to live with your parents, whether you were married or not or whether you had children or not. Just in very small crowded areas. Now with the new situation, these contacts with the relatives are less important, plus you get quite an increase in situations where parents are valued as to what they’re worth on the market, as it were. To give you an example, we know of quite a few examples in one psychiatric hospital in Kiev where people would come to bribe a psychiatrist and have mother or father declared mentally ill because mother or father owned an apartment in their city of Kiev and hey, they go for 90,000 or 100,000. So if Dad is hospitalized in a psychiatric hospital, they can sell the apartment. So $300, psychiatrist says yes and problem solved. So they have a market value. And they don’t care less what happens to their father. In general, mental health care is a difficult sector of society, but at the same time it’s very much a mirror of what is going on in society and the fact in most of the hospitals, 90-95% of the patients have no contact with their relatives whatsoever, are never visited again, says something what the value of the family is at the moment in these countries. EB: But if you’re talking for example about an increase in alcoholism, increase in suicide, I’m sure, because of the strains and the stress of daily life, that wives are being battered more frequently than they used to be, that children are being battered. There must be a lot of domestic violence. Is this actually happening quite a bit? Yes it is happening, and it was happening in the old days. But no figures. No figures because there are no statistics, and there is nobody who is actually interested in this. I mean issues like battered women, domestic violence, sexual exploitation, etc., they were considered absolutely luxuries in these societies. So nobody deals with it. The only ones who deal with it – and that is something that is sometimes very frustrating – are quite often people within the ministries or the nomenklatura who understand that if they have a project for sexual exploitation or for domestic violence, they run a high chance of having it funded by a budget line in Brussels. So they write up such a project, get the funding, and pocket the money. That’s it. There have been projects like this that we’ve seen coming from the Ministry of Health of Ukraine. It’s sickening if you think that this is actually something that’s going to be funded. EB: But this actually happens quite a bit with all non-governmental organizations. One person told me “not only did we lose the Cold War, we’ve also lost the post-Cold War”. The people who should have been punished, the nomenklatura and the former leaders and their children, are the people who are now running the economy and the government, in charge of everything, and they’re the ones who are rich again. Yes, because they in contrary to the rest of the population were taught to act and to organize and to set things straight and make sure than an organization would run. So with the new opportunities, they were the first in line and they were the ones who were able to grab everything and get rich. Yes, it’s incredibly frustrating. EB: It must be extremely frustrating for the people there who see these things. Yes, yes. It’s frustrating. It’s discouraging. It’s sickening. I think a very normal reaction is to grab a bottle of vodka and empty it, just not to be conscious of all this. That makes alcoholism so much part of these societies.
EB: Looking forward, it sounds like the picture is pretty bleak. You said that it’s probably going to take at least one or two generations for things to really start to change. Do you think that they WILL start changing or do you think that it can get worse than it is at the moment? No, I think that they will change. And I see them change. I’m from the generation that fought the KGB to get political prisoners released from camps and psychiatric hospitals. Even if we would fight for five years, the person would usually still be in the same place and usually worse off because the system slowly deteriorated. So we were taught patience. Now we see things develop and improve and slowly move forward. But for us it is quite a high pace. We really had to get used to the developments. No, there are changes and there is an increasing number of people who are slowly getting their act together and understand in which direction they have to move. In one society, it goes quicker than in the other. Baltic countries, the changes are momentous. Bulgaria: quite exceptional in the field in which we work at least. But there are also countries where you just return to the Soviet Union as if absolutely nothing changed. We had a conference in Moldova the other day. It’s 75 years of Soviet life and then 7 years of quarantine. Absolutely the same the way it was left when the Soviets lost power. And in a sense, they didn’t lose power because they are still there. So there are changes, but you really have to take a very long, deep breath and try to persevere. There is no other option, whether you like it or not. EB: That’s at the level of mental health care. What about at the level of society’s psyche? Do you see improvements there? Yes, yes. I mean, these things can’t be separated. When we started with our mental health-related projects, we very quickly realized that you can build a nice mental health care system, but if you don’t change society, there is no chance that you will ever have a solid footing for your programs. So we’re doing a lot in the sphere of trying to change the mentality of the population. Of course in particular towards the mentally ill, so destigmitising projects etc. etc. And sometimes we are really surprised. We had a day of the mentally ill in October and the reaction from the population in Ukraine was extraordinary. We attempted to collect clothes and shoes and stuff like that for mental patients in psychiatric hospitals because there is an enormous deficit of this. I mean we are doing this in a population which is poor. They don’t even have enough money to feed themselves. But the amount of things they were willing to donate for the mental patients in the hospitals was really quite exceptional. So yes, there is a sense of commonness starting to develop and a sense of responsibility towards their fellow human beings. You just need time.
You’ve been listening to Robert van Voren, the general secretary of the Geneva Initiative on Psychiatry. My thanks to Eric Beauchemin and to technician Ronald Hofman. I’m Dheera Sujan saying goodbye for now. Join me again for Siren Song next week.