Manuscript from April 2, 2005, published
with the title "Niet op de agenda" in Dutch language
in: Deviant (The Netherlands), Vol. 12 (2005), No. 46, pp.
Not on the Agenda Clients and Psychiatry in
As a result
of happy circumstances my son Stefan and I had the opportunity of making a study
trip through Central 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 Lehmann (Berlin), Gábor Gombos
and his wife Kathy (Budapest), Piotr Iwanejko (Cracow) and Vahid Dulovic (Tuzla).
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.
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
lived, but whole groups of people. That is the reason we find it a moral duty
to tell about the things we've seen, so that as many people as possible are informed
about the situation of our Eastern Europe neighbours. And our friends over there
specifically urged us to tell their stories.
1. Clients are active everywhere
in Europe under difficult circumstances and with no or very few means, clients
are helping each other to be independent, to have a vision and to fight for their
rights These organisations of patients have the very important task to democratise
psychiatry and society and most of all to fight for their human rights.
Central Europe the Hamlet Trust is doing good things. This Trust has realised
extremely important projects.
Nowadays there is a new organisation MHID,
what is doing the same work as Hamlet Trust and wahet exists out of some of the
professionals of Hamlet Trust.
And besides these activities there are patients who are drawing
and painting, proudly making exhibitions of their work. In order
to show these works to other people in Europe and to give other
patients the opportunity to do the same, we have started a website
on the European Network and so we built an Art Gallery.
We did not only experience impressive activities by
clients, but also by managers, psychiatrists, nurses and social workers. In Hungary
for instance we were given an enthusiastic excursion by a manager of a social
pension. This man booked very important results with scarce means in making a
large scaled institution in small parts.
Striking was the proud with which
all people spoke about their work, the booked results and the results booked by
their clients. Where both clients and professionals were working with very little
it seemed that sometimes this shared poverty created a mutual solidarity between
professionals and clients. This solidarity we are often missing in the Netherlands,
Because most people depend on their family due to the lack of welfare
the hospitality was overwhelming. So overwhelming we were surprised and impressed
by it. At the same time there is corruption at a large scale. Where there are
few social services and social securities and everyone depends on the support
of friends and family under difficult circumstances, everyone tries to get money
out of corruption. In relation with this we impressed by plans of self help organization
Fenix in Tuzla to earn money with self made souvenirs, furniture and biologically
breed plants and herbs to be financial independent.
is a fundamental European problem that is lacking an answer. One of the most shocking
things to realise during our journey is that there has come an end at Auschwitz-Birkenau,
but that genocide in Europe never ended. 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
Slavish people to be exterminated.
Genocide is as much older than Auschwitz.
We spoke in Auschwitz with an Irishman, who said that British people in the 19th
century set out to starve the Irish people. Several millions died.
that in Turkey during World War I genocide was being committed to the Armenian
people. We also know about the role Belgium played in Rwanda. We know about Bush
not having 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, coming September 2005 exactly ten years ago.
In relation to psychiatry
we heard stories about a clinic in Bosnia where the Serve management killed who
or three hundred patients who were not Serve (Sokolac).
The stories about
Srebenica and Sokolace us realise that in Europe genocide is still being executed.
Therefore we propose to change the slogan: "Never again Auschwitz" into "When
shall make an end to practices like Auschwitz?"
We are not the only ones
who make this comparison. There are reports about Dutch soldiers who were right-extremists,
brining Hitler greetings and getting enthusiastic about the Nazis and what they
They also voluntarily helped to kill Muslims. There are even rumours
(unbelievable, but strong) that Dutch soldiers gave sweets to Muslim children
with the purpose to kill them.
4. Nazi Euthanasia
to genocide is a black page in the history of psychiatry and the medical sciences.
idea of systematically killing the 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 defects.
The biological medical model
was combined with a social-Darwinist politics and thoughts about 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.
than to repress and trying to forget one should strive to process these histories.
We should all realise that genocide and Auschwitz can happen tomorrow again seeing
that the factors causing the rise of these things are still existing. A fine example
of the way to deal with history and traumatic experiences is the monument on the
grounds of the psychiatric hospital in Cracow. It was given to the hospital by
the Germans. On the monument the names of all the murdered psychiatric patients
and the psychiatrists, who stood by the patients, are listed. Each year patients
have a memorial service. As 'Wiedergutmachung' the Germans also built a house
for the rehabilitation of patients, allowing for 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.
5. Neo-liberal misery;
The Social Darwinist way of thinking (for a part
family of neo-liberal thinking) in combination with a refusal to give enough money
results into a world wide kind of social euthanasia.
In Eastern Europe clinics
do not have enough money to give help in an adequate way. We have heard stories
about a high morbidity rate of fifty percent during the first year of hospitalisation
as result of cold and unhygienic circumstances, flack of food, poverty and a shortage
of medicine. New medicine are too expensive and sometimes even the old medicine
are not 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 as the Netherlands there is not
enough money spent allowing for chronically psychiatric patients in the hospital
to have 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 they are killing people..." Also Clemens Huitink,
spokesman of the Organisation for Mental Health Care Institutions in the Netherlands
describes a bad situation. For interested people at www.poianamare.org you can
see photo's about a situation in a psychiatric hospital. At www. mdri.org you
can see the situation in Paraguay. Even still worse…
Stalinism psychiatry was a part of the ruling system. The biological medical model
Psychotherapy and psychoanalyse were stigmatised as western bourgeois
inventions and were forbidden, because it was dangerous to talk with 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 one lady who experienced this for two years. And a man,
who was forced to take anti-depressive medicine, said that he would do so, if
he got also a kind of psychotherapy.
He was send to a body movement therapy.
He spoke 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 was denied psychotherapy and talked about the situation. 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.
Everywhere in the streets, at the bus stop, in the
bus, in the cafe, in the museum, people told us stories about the situation under
Stalinism. People, who were in prison, people who had destroyed bodies.
we saw the museum of Staatssicherheitspolizei (Stasi) in Berlin.
these results of this recent history is that culture is still repressive and based
at authoritarian relations.
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 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.
Over there people experienced how quickly friends or family turned into enemies,
killing each other.
8. Authoritarian systems
The more authoritarian,
the more violations of human rights, psychological and physical maltreatment,
and sexual abuse there is. As a result of what we have seen and heard, we expect
that 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 exist on a large scale and much more so than we realise.
hospital were a place where political dissidents were sent to and psychiatrists
even invented the diagnosis of creeping schizophrenia...As an example of sexual
abuse we advise you to look at http://www.mdri.org where you can download a report
titled: "Not on the agenda..." about the clinic Schtyma in Kosovo, where a lot
of sexual abuse was being committed among unacceptable things. Based on this report
the government of the Netherlands sent 2.million Euro for improvement. These Euro's
were shamefully spent on cosmetic surgery. The management built marble staircases
and Italian bathrooms and nothing changed… The general manager was a Dutchman.
He has gone, but asked about the situation Clemens Huitink says, that he has heard
nothing about an improvement and that the international community has lost changes
to do good things. He thinks that international community is hardly interested
9. Lack of privacy
In most places there are large
bedrooms, the small ones are for six persons. We saw no possibilities for enjoying
some privacy. Never alone, only at the toilet or bathroom. Sometimes psychiatry
uses bed-cages to keep people locked up.
10. No work, no money, no future
there is more freedom at the moment in Central Europe there are great social economical
problems. Capitalism with the accompanying ideology of neo-liberalism is not offering
a solution for the problems in Central Europe. There was work, homes and health
care. Nowadays that 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."
is your freedom worth if you don't have any money to spend? The majority of people
are unemployed, they have no income or hardly any money. (Ex) psychiatric patients
are in a double way suffering from these problems. They are more often stigmatised,
poor, unemployed and have grave difficulties finding a job. They are excluded
on a large scale.
As a result of the social-economic problems a lot of people
suffer form psychological or psychiatric problems, are depressed and/or addicted.
Many of them( alarmingly much young people) use drugs or alcohol as a form of
self medication. Hungary makes a melancholic impression and in Poland we heard
and saw a lot of people using drugs or alcohol.
11. Dangerous religion
respect to the positive sides of good religion (as in Buddhism) we are no longer
accustomed at the ways of the religion we saw. Young people kneeling on the floor
of the church and many of them. This is something we do not see in the Netherlands.
Sometimes as in Bosnia religion played a dangerous role.
Sometimes as in
Poland, but also in Bosnia, religion has nationalistic sides to it.
War is also a European phenomenon, of which we are not
freed at this moment and will not be for a long time. In Bosnia we saw and spoke
with an organisation of ex-soldiers who are suffering from post-traumatic stress
disorder. We have seen that in a 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 invalid on to the streets, where they joint the army of
The results of the war are disastrous. Not only we saw
in a dustbin a lot of packing material for medicine (neuroleptics, benzodiazepines,
antidepressants) but we have also seen and spoken with people who were greatly
traumatised. Almost everybody has lost a family member, a father, brother, husband
or child in the war. Daily there are dying people by exploding mines. Srebenica
is very, very poor. The whole city still caries traces of its destruction. 40
% of the people are unemployed and poor. The Netherlands has done nothing (or
was able to do anything.) We heard from the United Nations spokesman there, that
there are plans coming from the Netherlands to withdraw their help, because Srebenica
is not longer a current topic and a sexy case…
Especially young people in
Bosnia are the victims of the war, they are traumatised or demoralised. They deserve
our complete support. It makes us sad to realise that the fragment out of the
song: "Over de Muur" van het Klein Orkest from 1984 is still true.
what is freedom without a house, without a job. So much 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.."'
Together we are stronger
When client organisations mobilise or succeed
in mobilising other organisations, we stand stronger. It is a good thing that
Amnesty International is fighting for the human rights of psychiatric patients.
Also it would a good thing to get our problems on the agenda of groups of activists.
Not only the official international community is not interested in problems of
psychiatry and psychiatric patients but also groups fighting for another or better
world should be 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 good changes then we expected. After our voyage
we received Epidemilogia
e psichiatria sociale, March 2005. In this Italian magazine (in the English
language) about psychiatric issues there is an article of Benedetto Saraceno and
Shekhar Saxena about mental health services in Central and Eastern Europe.
on the agenda?
Before we started on our journey my son and me were not
informed about the bad situations I have described to you. We think that these
problems are not discussed enough. How can we raise awareness?
On the other
side, we have to ask ourselves whether concrete and great problems such as genocide,
war, poverty, exclusion and refugees are perhaps neglected by the client movement
as well. And psychiatrists are telling 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.
But I cannot
help it, I keep having to think of the Dutch soldiers who gave Muslim children
sweets with the purpose to kill them. Perhaps as clients we miss the possibility
not to see and hear the reality and suffer from it. Are schizophrenics people
who are suffering from reality, from truth?
2004-2010, ENUSP Deputy Board Member for the North West European
6301 VX Valkenburg aan de Geul
Tel. +31 43 6013857