In the post-Soviet space there are enough stereotypes, defining psychiatry as closed, corrupted and penal science. ForUm has had an interview with the chief psychiatrist of the Kyiv Pavlov's mental hospital Vyacheslav Mishiyev to clarify the situation and may be to bust some myths.
- What can you say about mental health of the Ukrainian nation? Is it mentally healthy?
- Ukrainians are neither sicker nor healthier than any other world nation. Mental disorders are predetermined by complicated and global factors, let's say something more that a fight with a girlfriend and low salary. There is a common biological pattern, which leads to mental instability. It is determined by the very course of man's life and affects 1-3% of Ukrainian population in particular and the world population in general. Besides, the Ukrainian nation was not born yesterday, but evolved from the common European family. We do not possess something the rest of Europe never had.
- We've learned there is an infant care unit in your hospital. Why would you hospitalize small children of two, three or five years old? And what are the treatment methods exactly?
- A part of little patients has been born with mental disorders, and they need a therapy. A part of children has born disposition and our task is to prevent the illness from development. There are also children affected by external factors, like stress, a family tragedy or fear experience. They all need professional help, otherwise they would not be here.
We apply complex treatment, including medications, psychotherapy, and social rehabilitation therapy. If to speak about children with born mental deficiency, which is incurable, we use therapy to correct psychomotor agitation and behavior of a patient.
- According to some data, 80% of Ukrainians with mental disorders are hospitalized, while in Western countries only 20% are in hospital stay, which is considered more humane. Is it true?
- Don't believe everything you hear. In Kyiv, for example, there are 60 thousand registered patients, but only two thousand hospital beds. As you see, the majority of patients are treated at home.
- In Ukraine compulsory psychiatric care is applied by court decision only. But in the street you may sometimes meet people, who look inadequate. Don't you think such people are like loaded firearms without safety lock?
- I believe that authorities and mental clinics should act within the law and follow court decisions. The law "On psychiatric help" says we cannot force mentally ill person into treatment, unless he poses a threat to himself or to the public.
There are people, who do not like migrants of Caucasia origin and who honestly believe they must be locked up, for example... These are all biased opinions. The only unbiased factor in this question is to determine whether a person poses a threat. You know, it's not amusing to tie somebody to a 16-kilo kettlebell, especially for those tied up.
- Here or there we hear about infamous crimes, like the one on Oksana Makar case. Does it mean the Ukrainian society is becoming more aggressive and cruel, or those are some single cases?
- I would not say there is a pattern or tendency. I believe these are single outbreaks of aggression, which exist in every society of all times. Norwegian Anders Breivik killed 77 people. Some years ago in Germany a schoolboy brought a gun and killed a dozen people in the school. Similar cases happen in the US. All this public reaction is conditioned not by the increase of violence, but by availability of information. 30 or 40 years ago the mass media was not so spread, and people learnt about infamous crimes belatedly or did not learn at all. But similar crimes did happen before. So I don't believe our society is becoming more aggressive and cruel.
- Ukrainians are known for their weakness to self-treatment. They do all by themselves: diagnosis, prescription, treatment. How dangerous can it be?
- If you compare the amount of drugs the Americans consume, our society will appear as an innocent baby. Americans take drugs in every case: fight with a wife, overweight, bad mood...Hence, I don't think we have such a bad situation with groundless medication. Besides, more or less serious drugs cannot be bought without a prescription, only harmless ones.
- The state service on drug control wants to cancel criminal responsibility for possession of drugs for personal use. Do you thin in this case you'll have more patients?
- Abuse of drugs is not common for our culture. Alcohol, on the other hand, is. But if we legalize drugs for personal use we will give birth to a separate group of people who will justify drug abuse following the law. Besides, possession for personal use is already legal for sick people.
- There is a new therapy based on methadone being introduced in Ukraine to treat drug addiction. But methadone is also a drug. Don't you think we will repeat the sad story of the therapy treating opium addiction with cocaine, which was widely used in 19th century?
- Back then they also used heroin to cure opium addiction. But yes, you right, we can easily let out a jinni. Methadone can be applied for heavy addicts, especially for those infected with AIDS, so they don't needle the veins. But the very fact of methadone introduction will foster a group of people, who will use this drug for fun and will eventually get addicted.
- They say that due to the financial crisis in Ukraine the number of alcoholics has increased...
- You know what. We did not start yesterday. It all began three hundred years ago. And if, let's say, our alcoholism had been increasing for all these years, we would have been doing this interview totally wasted. We drank under Peter the First reign, during the war, in 1960ies...Those who declare growth of alcohol addiction just want to promote themselves.
- Have you ever had cases of gambling addiction?
- Yes, I had several cases. In such cases patients need psychological treatment and medications to strengthen their will and reduce the craving to make a bet. We must make such patients to abandon their style of life. By the way, I do welcome the decision to forbid gambling at the legislative level.
- How successful was the treatment?
- Well, one patient recovered in full and never played again, while another one snapped once and came back for the repeated tour of therapy.
- What about internet addiction? Is it wide-spread in Ukraine?
- I believe that all those talks about internet addiction are just the latest thing in mass media world. There are, of course, some single cases, but it's not like mothers standing in line to treat their children.
- In early 60ies there was an anti-psychiatry movement originated in Ukraine. The followers of this movement accuse traditional psychiatry of being penal medicine. What is your opinion on this?
- Nobody forces anybody into treatment. We discussed this at the beginning. If a person does not want profession help, he does not get it. If a person hears voices, but goes to a voodoo-hoodoo doctors to be cured with moonlight or solar energy it is his business. Psychiatry is a medical science with long history. Ukrainian psychiatry is successful enough. Schizophrenia, for example, used to be a fatal disease, but now we can beat it. In 30-50% of mental disorder cases we achieve positive results.
- You mean full recovery?
- I mean positive results. We achieve a high level of remission. You know that gastric ulcer cannot be cured completely, but somehow nobody says that gastroenterology is unsuccessful or even penal medicine...
- There is an opinion that not all psychiatrists are equally honest. Allegedly, certain doctors fake diagnoses "insane" to help criminals escape prison...
- Oh, this is absurd. The institute of legal psychiatry has skilled doctors with many-year experience. If a person tries to fake mental illness he will be discovered very quickly. Speaking about some plots on fake diagnosis, believe me no decent doctor will not go for it. At least, I've never heard about such cases for the whole period of my practice.
Alina Yeremeyeva, author's photos
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