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89/99 - 10 YEARS AFTER: MENTAL HEALT

Slovak psychologists and psychiatrists warn that people are coping poorly with economic pressures and social change

Róbert and Ľuba's 23-year marriage is in tatters. Róbert lost his construction job in January, while Ľuba was fired a month later. Marital problems have kept them literally at each other's throats; Ľuba has had her left arm in a cast three times this year, while her right wrist is grooved with scars from self-inflicted wounds. Both drink, and are heavily in debt due to a fondness for slot machine gambling.
"I'd say we're an average Slovak couple," says Róbert. With national unemployment at 19.1%, annual inflation expected at 15% and money more scarce than ever, Róbert says he and his wife have fallen into the same lifestyle traps - gambling, alcohol and marital violence - that have snared many of their friends.

Róbert and Ľuba's 23-year marriage is in tatters. Róbert lost his construction job in January, while Ľuba was fired a month later. Marital problems have kept them literally at each other's throats; Ľuba has had her left arm in a cast three times this year, while her right wrist is grooved with scars from self-inflicted wounds. Both drink, and are heavily in debt due to a fondness for slot machine gambling.

"I'd say we're an average Slovak couple," says Róbert. With national unemployment at 19.1%, annual inflation expected at 15% and money more scarce than ever, Róbert says he and his wife have fallen into the same lifestyle traps - gambling, alcohol and marital violence - that have snared many of their friends.

Slovak mental health experts say that while cases like this may not be average, they have become depressingly common as the country struggles to cope with the change from communism to free-market capitalism. Ten years after the Velvet Revolution, disintegrating value systems and skyrocketing levels of stress are making it difficult for many Slovaks to cope with life's ordinary problems. Alcoholism and other forms of addiction are up, experts say, while an ever-growing number of people are visiting counselling centres in their search for help.

Morally disoriented

The Centre for Counselling and Psychological Services (CPPS), which offers free counselling and professional treatment of psychological problems, performed 59,963 consultations nationwide in 1998, up 20.1% from the year of its founding in 1991. More importantly, the nature of visits has changed. CPPS has seen its divorce counselling figures fall from 2,317 in 1991 to 1,427 last year, while counselling for 'personal' matters - addiction, depression and psychiatric afflictions - has more than doubled from 1,296 to 2,857.

Jolana Kusá, deputy director of the CPPS Head Office, said that the increase in personal consultations shows that people are becoming overloaded with stress. "People have a limited capacity to deal with problems," she said. "In times of great social change, as problems multiply, people's ability to cope breaks down."

In Kusá's view, the greatest blow to the nation's mental health was the sudden disappearance of the communist system and its rigid system of rules. "For 40 years, everyone knew what they had to do. Then the rules suddenly disappeared, the value system changed, and parents even began to question their competence to raise and educate their own children. That was what shook us the most."

Kusá said that this sense of moral disorientation had prompted her centre, which had been known since 1972 as the Centre for Pre-Marital and Marital Counselling, to broaden its role in 1991 into the current CPPS. "We wanted to teach people to take responsibility for themselves as individuals, something unknown under the collective ethos of communism," she said.

Working mothers

But as rising alcohol and drug addiction rates soon began to show, social change and economic hardship created pressures beyond the abilities of counselling centres, and their 'individual responsibility' messages, to contain.

Psychiatrist Ivan Novotný, who runs the AC Sanatórium drug treatment clinic in the Bratislava suburb of Petržalka, said that Slovakia's rising drug and alcohol addiction rates were directly related to changes in the country's workforce makeup.

"The complex of norms now affecting people's mental health was created during the period when women first began to enter the workforce [in the 1980's], when the process of raising children [in nuclear families] became disturbed," he said.

"After the revolution, this family disturbance became a general problem," Novotný continued. "Women who were themselves raised in daycare centres put their own children in daycares. Mothers began to seek a closer emotional contact with their children by being more permissive and tolerant of aberrant behaviour. And this permissiveness in turn has affected the level of responsibility shown by the entire society - just look at the irresponsible way people drive, for instance."

Novotný said that drug addiction levels have soared since 1989 "not only because borders opened and drugs poured in, but because our permissive mentality allowed people to become addicted." Similarly, he said, "alcoholism has increased, and the average age of alcoholics has decreased. Before the revolution this was just over 46 years, but now it is not uncommon to have 16 year-old patients addicted to alcohol. This is connected with family problems caused by social and economic stress."

Kusá added that the behaviour of Slovak politicians since the country's founding in 1993 had deepened society's moral confusion. "If families are going to work, they have to function according to certain rules, " she began. "But these rules lose their force if they are constantly broken by the ruling elite. This has had an especially large impact on the conduct of young people."

Joblessness

Psychologist Valéria Popeláková, the director of a CPPS clinic in downtown Bratislava, also said that she has noticed a troubling deterioration in the mood of society since she began practicing in 1987. "We no longer act like a peaceful and balanced people," she said.

"I see a great deal of uncertainty and fear out there - for the future, for our kids. Just walk around the streets and see how many people are smiling. Many of the good things in life are being lost through our fingers, and we don't even notice it."

But rather than blaming moral values and broken families, Popeláková said that job troubles, principally unemployment - something unknown under communism - was behind many of the cases she treats every day. "Losing a job puts great psychological pressure on people, which then upsets the balance of families," she said. "The number of people with psychological problems related to unemployment is growing."

On the othe side of the coin, Popeláková added, was workaholism, a disease well established in the West, but virtually unknown in Slovakia before 1989. "Businessmen who want or have to work hard to earn a lot of money find less and less time for their families, and this is a growing cause of divorce," she said.

Mental illness taboo

While the causes, dimensions and treatment of psychological and psychiatric problems have radically changed over the last 10 years, however, one element has remained stable - the social taboo on mental problems and the shame felt by people who seek treatment for them.

Róbert and Ľuba say they have never sought help for their marital or personal woes, even though the nearest CPPS treatment centre is only doors away. "Everyone wants to solve his own problems, and while I might listen to a counsellor, my wife would take whatever was said about us as criticism," said Róbert.

Róbert added that having recently found a job as a sewage inspector, he feared what his employer would do if the company heard Róbert was seeing a psychologist. "There isn't enough of a line drawn between psychological and psychiatric problems in this country," he said. "People think that if you have a problem you're a psycho, and they don't want you on the job."

"This is not a naturally existing barrier, but one created by society's refusal to accept people with mental problems," agreed Novotný. "For us, an alcoholic is still far more acceptable than someone with schizophrenia."

Kusá of CPPS said the failure of society to accept people with mental problems created problems even at a governmental level. The CPPS was directly funded by the Labour Ministry, she said, but was facing 10% staff cuts and a funding freeze next year that would force the Centre to get rid of its 40-odd part time employees and close some of its regional offices - even though case loads are rising.

"At each moment someone is suggesting that we privatise these services, because he thinks it should not be publicly funded," she said. "But this social service exists in many other countries, and it is the only chance for people who can't afford to pay a psychologist privately. It's absurd that we are facing cuts when the [leftist] SDĽ party is in charge of this ministry."

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