Living in hell

The World Health Organization (WHO) has just released its 2007 World Mental Health Report. The shocking findings summarize the latest studies of epidemic mental disorders in 30 countries, including Ukraine. The researchers who focused on Ukraine were shocked to discover that only a mere 20 percent of individuals who suffer from a variety of serious mental disorders — and who undoubtedly require medical assistance — actually seek professional help. In contrast, 50 percent of people seek medical help in the United States and almost 90 percent in Italy, France, and Spain. What about such “ordinary” psychological states as excessive anxiety, phobias, or depression? According to the WHO’s findings, these psychiatric disorders have become the general emotional backdrop in the lives of contemporary Ukrainians.

Psychiatrists and psychotherapists can only spread their hands helplessly. No one is seeking their assistance, although help is available. Women suffer from depression, especially when they reach retirement age, and men suffer from alcoholism. Ukraine’s level of alcohol consumption is the second highest in the world, after the US. It should be noted, however, that Russia did not take part in these studies, and it is to Ukraine’s credit that it was the only post-Soviet country to carry out these epidemiological studies in conjunction with the Association of Psychiatrists of Ukraine, Kyiv’s International Institute of Sociology, and the Institute for Social Studies at the National Academy of Sciences of Ukraine.

Says Iryna Pinchuk, chief psychiatrist with the Ministry of Health of Ukraine: “We interviewed 4,725 individuals. When we visited people in their homes, we saw something we could not have predicted: people suffering from serious mental disorders, who wouldn’t even think of consulting a physician, let alone a psychiatrist.”

These studies also indicate that official statistics on the numbers of people with psychiatric disorders in Ukraine are very provisional. The Ministry of Labor’s records show that there are 57,000 Ukrainians currently in hospitals and special boarding schools for children and adults, where they are receiving medical assistance; nearly 30,000 of them have developmental and psychiatric problems.

Stanislav Kostiuchenko, a psychiatrist who took part in the study, explains: “Data relating to the spread of mental — as well as other — diseases in the former Soviet Union are borrowed from the health ministry’s reports, which are in turn based on reports from hospitals; in other words, all these data are information about the way people use the services of medical facilities. But this information by no means reflects the actual situation. Epidemiological studies are another matter. Over the past 25 years, 22 representative studies of mental health have been carried out in 14 European countries. Since these studies are expensive, not all countries can afford them. This time, WHO’s objective was to include countries where no such studies have ever been carried out. So for us, this was a rare opportunity that we simply couldn’t afford to miss out on.”

Psychological disorders — popularly described as a “person that hasn’t completely gone off his rocker” and scientifically defined as depression, anxiety, and alcoholism — were also the focus of the study. Once again, Ukraine turned up at the bottom of the list. According to Dr. Kostiuchenko’s statistics, Ukraine is the only country in the world where depression ranks first among emotional disorders. Whereas in Europe depression affects mostly young people (who are searching for the meaning of life, have everything within easy reach, and have problems discovering values and something “to struggle for”), in Ukraine depression affects mostly elderly women (lack of money, worries about their children struggling to find jobs, uncertain prospects). Men mostly take to the bottle, matching their counterparts in the US, France, Colombia, and New Zealand — although they refuse to acknowledge their problem.

The researchers were confronted by a mystery. “In developed countries alcoholism is most widespread among young people or the older generation. People of middle age suffer least from alcoholism. American experts believe that such favorable factors as middle age, work, home, and family encourage people to pursue a healthy lifestyle. Even if a person consumes alcoholic beverages, his family and work are favorable healing factors,” explains Dr. Kostiuchenko.

In Ukraine, however, it is the other way around: middle-aged men with jobs and families turn out to be those who are most susceptible to alcoholism: “After the US colleagues familiarized themselves with these statistics, their first question to me was, ‘What kinds of treatment for alcoholism exist in the workplace?’ I said I didn’t know of any. I think this question requires the involvement of a number of experts.”

Doctors have two possible answers to the question of why Ukrainians do not seek medical help. The first is that many people are simply not aware that they are alcoholics or are suffering from depression; to them their serious afflictions are just problems. Second, people are afraid of all specialists whose occupations are defined by words starting with “psych-” (although this prefix means “soul”). Worst of all, the World Mental Health report indicates that in terms of the level of professional treatment of mental disorders, Ukraine has one of the worst rankings, on a par with Lebanon, Nigeria, and China. It should not come as a surprise that the frequency with which Ukrainians seek psychiatric help is as low as in these countries.

Oleksandr Filts, president of the European Association for Psychotherapy, believes that existing psychiatric services (hospitals and rest homes) must be reformed and that even the qualifier “psychiatric” should be replaced by “social.” “After the Sknyliv tragedy I examined 510 people who required psychological assistance, and I realized that all of them responded negatively to the word ‘psychiatrist’, although I am one. My colleagues and I had anticipated this attitude, so we organized consultations with “social workers” rather than psychiatrists or psychologists. People responded best to social workers: they visited us and received the required help.”

However, the Sknyliv tragedy at Lviv was an extraordinary situation, so in order to restore their psychological equilibrium its witnesses made an extraordinary decision and turned to psychotherapists for help. Daily life with its chronic stresses is an altogether different story. Here the kinds of stress people have to endure are less noticeable. People get used to living in hell; they are afraid to consult specialists. Experts note that people’s fear of any word starting with “psych-” is prevalent throughout the world. This is a stigma that needs to be overcome.

The specialists who participated in the mental health study in Ukraine are working on recommendations to state institutions, which will contain substantiated demands to reform psychiatric services in Ukraine. The project coordinator, Dr. Evelyn J. Bromet, of the Department of Psychiatry and Behavioral Science at the State University of New York at Stony Brook, warns: if this kind of work is undertaken, it should begin with something concrete, without a global approach. For example, efforts should be undertaken to solve the problem of alcoholism among men and depression among women.