Psychiatry stages dialogue for government
Tatyana Bateneva
October 2, 2003

On Thursday the chief Russian specialist in the field of psychiatry appealed to Russian Prime Minister Mikhail Kasyanov in an open letter. The extravagant behavior of the doctor, who ordinarily breaks records for prudence and correctness, we will explain. The government, which made a decision to create the program "Development of psychiatric assistance in the Russian Federation," has not delivered it in two years. Psychiatric assistance is the only branch of medicine that is not financed by medical insurance. Therefore the majority of our psych patients are in asylums like the orphanages in horror films, with no treatment or food. To what this may lead, doctors know, and the government knows it doesn't want.

Somehow El Presidente Mariy Markelov decided to visit a large psychiatric clinic, from where many complaints have come. During the course of the visit one of the lady officials of the president's retinue fell in a faint from what she saw. The President was impressed enough to allot money for reconstruction, purchasing equipment and drugs, so that now the hospital in Woshkar-Ol will serve as an example for others.

This story was related to me at the plenum of the board of the Russian society of psychiatrists, which is now being held in Moscow, simultaneously with the conference of chief psychiatrists of the region and leaders of medical establishments of this type. Whether this is reality or a doctor's daydream, one thing is clear: our governors and other fathers of the people are uncommon guests in psych hospitals. The surroundings may indeed be so poor, crowded and hungry, that one could lose consciousness there.

The number of people who need help from psychiatrists is increasing every year. The mental health of the nation is under threat, think the eminent doctors; the human and economic loss from this outweighs the damages from military operations in Chechnia, the scholars add. The professional association initiated the creation of the program "Development of psychiatric assistance in the Russian Federation," Premier Mikhail Kasyanov signed the appropriate orders with the commission of eight ministers and departments. They agreed. It was unanimous.

The program was ready a long time ago, signed everywhere, it went through the government's expert committee, but once more it's not been included in the budget for next year. Why?

"All our efforts have met with opposition from the Scientologists, who have found a way into the State Duma," thinks professor Valeriy Krasnov, director of the Moscow NII psychiatric MZ RF. "The deputies, who promised support, are now refusing to associate with us."

"The active role in this opposition is played by the so-called Citizens Commissioner for Human rights, which has gotten generally out of control in our cities," said Vladimir Agishev, chief doctor of one of the largest hospitals in Saint Petersburg, psychiatric hospital No. 3. "They mass distribute leaflets, they write letters saying that psychiatric institutions ought not to receive one copeck, that psychiatrists are killers and their medicine is poison. We've had repeated conflicts with them. For example, over the summer they took pictures through the fence and made videotapes of our patients without consent. The heat stagnated and the patients were half-dressed in old pajamas (purchasing finances 5 percent of the inventory we need), and then they distributed these photographs under the title "here is how people are treated in psych hospitals."

About the activity of "CCHR", mainly with its leaders, the late Dr. Chernyi, "Izvestia" has already written. It is known that this charitable organization is closely connected to the totalitarian cult of Scientology, which is prohibited in our country but finds the City of Peter a first-rate place to be. Now the hands of the Gekachepists ["CCHRers"] have stretched to the capital, they say their letters have even found their way to Gennadi Seleznev and they got a resolution "examined and announced." It is not known for certain whether this was the reason the program was held up or if the government simply lacked the money for the "hopeless" patients. What is known is that in some regions the chief doctors of the psych clinics are seriously setting about releasing patients, which means all the ones not being fed or treated. Last year such an operation was undertaken in Vladivostok, where the government and the residents of the city were mightily displeased.

"In the regions, hospitals of our type ordinarily are removed from the finance register or financed at a minimum," said RAMI scholar Tatyana Dmitrieva, director of the Serbian Institute of Social and Forensic Psychiatry. "If the patients are located in the departments being closed, where their relatives cannot visit them or they live too far away, the hospital rations will rather resemble a starvation diet. The current medications are not sufficient for the in-patients, and the old preparations are as likely to hurt as they are to help.

During the plenum intermission the doctors joked professionally: the presence in one head of two mutually exclusive points of view, like, for example, the case with the position of the government on psychiatric aid, that's an indication of schizophrenia. It is hoped that now this will now be treated. If the money is found for a good medicine.

Get the psychologists out of schools
Rights advocates alarm parents with doctor-saboteurs

by Natalya Granina
September 2, 2003

On Monday, at the highest point of Knowledge Day celebration, rights advocates organized an action in Novopushkin Garden under the banner "How many more children will finish school as psych patients?" The activists handed out to pedestrians booklets with horror stories from the lives of Russian pupils. And those who were impressed were asked to put their signature on a demand to remove the psychologist-pests from educational institutions.

The action by the Citizens Commission for Human Rights went by peaceably enough - no fuss or musical entertainment. Overgrown girls with huge white bows and in smart little first-grader frocks gave onlookers sheets with pictures of tearful little children and informed them that in Russia entire courses of psychiatric reform were being prepared.

"In September the State Duma plans to take up an amendment to the law "On psychiatric assistance and guaranteeing human rights in rendering it," the secretary of the board of Citizens Commission for Human Rights Lyubov Belokobylskaya told Isvestia. "They essentially broaden the circle of activity of medicine and allow them supplementary money for the budget. Imagine, that in all the schools, kindergartens and even at first aid stations, psychiatric personnel are present. Go to a doctor for a nagging migraine, and you're a neuroleptic [sic]. And by law, if you refuse to take pills you can be forced to receive treatment. Yourself and in school. Your child runs too fast or, the other way around, too imaginative? That means he's sick.

According to the rights advocates' information, today in the "Diagnostic and statistical handbook for mental disorders" psychiatrists have already introduced diseases such as "reading disorder", "disorder connected with irritation caused by inability to get one's way," "disorder connected with depression from scolding," and others. It used to be that only scholars were concerned with all these problems, and they had to approach each student individually in solving them. But now when first-graders get too playful they are sent to talk with the psychologist. And it is still unknown whether such contact has any benefit. Not long ago a family from Saint Petersburg came to the rights advocates with a request to save their daughter. All the teachers had praised 16-year-old little Julia for her intelligence and talent. To more quickly enter the university, last year she busied herself with external study. On top of which the girl played the piano and even received a stipend from the cultural fund. But mama was upset about the daughter signing up for the church choir. The young woman was sent to the school psychologist. There they recommended that she be sent for examination to psychiatric hospital No. 3. When mama arrived to visit Julia, she was horrified: the daughter could hardly speak, only with difficulty could she hear or see. The medical people stressed that the patient had been injected with psychotropic preparations. They were not allowed to take the child and were advised to go to the courts.

"And there are many such cases," continued Lyubov Belokobylskaya. "I remember a first-grade boy, whose only fault was he was not able to tie his shoelace and he really liked to dream. The teacher advised his mama to send him to a remedial class, together with many people, but the mother said her son needed individualized attention. Now the boy has finished his eleventh year, but with a certificate from an auxiliary school he will not be accepted by a single college or a tech school.

The staff of the Citizens Commission have published a booklet for parents, "Security Measures in Schools." The main recommendation, "Do not allow psychologists or psychiatrists to persuade you that children need correction. ... Go to the principal and demand that children be protected from psychiatrists. And if that is not effective, save the children, take them out of school" ...

Another part of what Natalia Granina wrote from

"In every profession there are slipshod workers, but this does not mean that every one of them should be crucified," said Aleksandra Gerasimova, science staff at the RAM Institute of Psychology. "There is no need to alarm parents or to fetter psychologis ts and psychiatrists. No medical training is needed on the front lines. Psychologists deal with normal children, and there is no requirement that they be held back. We're dealing with a larger problem - developing memory, attention, expressing personal ability

But there's just not enough time. According to the statistics, Moscow has one psychologist for every 1,000 children. According to standards there should be no more than 50 people for each specialist. On top of that the majority of them are yesterday's scholars with a second-rate education. From that comes the non-professionalism and improprieties. According to Natalia Yankovska, director of the psychological-medical-social center of the Southeast district administration of the Moscow education department, they often receive parents who tearfully relate that after the initial interview of such grief-specialists with children, the whole school knows about their family problems.

Number of Russians with psychic disorders grows 40% over 10 years

July 22, 2003

For the last ten years the number of Russian citizens who suffer from psychic disorders has risen 40%. That information was cited on Tuesday in a radio broadcast on "Echo Moscow" by Tatyana Dmitrieva, director of the Serbian Scientific center for social and forensic medicine.

Besides that, according to her information, every 10 years the number of schoolchildren suffering from psychic disorders goes up 10-15%. Among Russians of adolescent age at the present time this number has reached 70-80%.

Suicides among men occur at six times the rate as among women. The most at risk are thing between 45 - 59 years old, said Dmitrieva. In talking about the reasons for the situation, Dmitrieva commented, "Our country is changing very impetuously."

Along with that, for the last two years, she says very many people have been able to adapt. According to Dmitrieva's assessment, a similar situation will remain in effect until such time that people in our country no longer feel defenseless, which includes the socially defenseless.

All this leads to upset and disorder at the nerve level, explained Dmitrieva, "This lets everyone live and work, but decreases functionability."

In this regard she reported that according to an order from RF Prime Minister Mikhail Kasyanov, the government is supposed to work out a federal program to develop psychiatric assistance for the people.

By way of a real example of psychological aid for people, Dmitrieva cited the work by psychiatrists in the period after the terrorist act on 5 July in Tushin. In her words, in only one evening after the terrorist act and only in the Serbian Institute by telephone was urgent psychological assistance rendered for nearly 200 people. "Interfax" reported on that.

Not diarrhea, but nerves

September 25, 2003

According to information from the World Health Organization, the 21st century brings mankind an abrupt rise in the death rate from depression. Some even believe that depression got a grip on the leaders of the 20th century - although cardio-vascular disease takes first place. In Russia everyone has the chance to surpass other countries on this scale: more than ten years of reforms have given us chronic stress. So what? No way out? Psychiatrist Andrei Kurpatov, director of the Saint Petersburg psychotherapeutical center, does not think so. He says that a quarter of all patients who go for therapy ought to be treated first by psychiatrists and psychotherapists.

How Russians survived Perestroika

What sort of things are depression and neurosis? Depression is when you have a feeling of despondency, an inability to receive pleasure, no interest in work or in life in general. This malady can occur as a result of prolonged stress and its nature has been studied by doctors: the brain ceases to produce a substance necessary for maintenance of a vital tone. If a person stays depressed for a long time, neurosis can emerge. That can be a sudden change of sentiment, a feeling of terror or different phobias (fear of heights, for example.) And this can take the shape of a rise in arterial pressure or an intestinal disorder. Understand? People come to therapy with diarrhea, where they begin the treatment for their diarrhea. And for their human depression and neurosis at the same time. But we go now from diarrhea back to reform.

These things are interconnected. Reforms bring us chronic stress. We consider anything difficult that requires a change in ideology. It used to be advances were made for the good of society, now it's for the good of the individual. They built communism, but failed in capitalism. In the same manner, our mental incompatibility has a greater influence on others.

First, we were compelled to change our habits and way of life all together. Second, this needed to be done (and now such a prophetic position has not changed) in conditions, where everything around was collapsing and a new system of values had not emerged. Such a mentality has carried over.

The strongest stress, not counting war, is moving to a different country. New language, new rules of life, new everything. You, of course, feel nervous and try to do your best, to the extent you can in your new medium. And in 1991 we crossed over from the USSR into Russia. We salvaged life and tried to build, if you would like, to escape, too. Through a mine field. To run nowhere, with no goal, and end up in the same place - is incomprehensible. Resulting in severe stress. The organism is under strain, builds up pressure, the pulse races (nature decides for us how to answer stress: run or fight), and you are not able to undertake activity. Your energy is drawn to the inside of the organism, destroying everything in its path.

The person seeks a method of leaving the unpleasantness: habits suggest a method for us - alcohol is a fine antidepressant. And for suppressing the majority of brief depressing episodes, it helps. During chronic depression constant use of alcohol, conversely, quickly intensifies the morbid state and leads the person to the grave. What we also observe: the country naturally takes to the bottle. What is noteworthy, the majority of heavy drinkers, to the question of why they do this, answer "to relax."

So what goes around comes around. Answer chronic depression and neurosis with a morbid habit, and the Russian people stream into therapy to cure hearts, arteries and intestines.

During this, the habit of "being anxious" is steadfastly reinforced in the minds of the former Soviet citizens: the only method to attain justice for an individual in the USSR was the "disability sheet." If you were on the sick list, then nobody in the USSR could touch you - not the party, not the trade union committee, not even the police. A solid association was formed: "to be sick was to involve yourself with your personal life." Therefore it is now with pleasure that Russians run to the doctor for every little thing for careful consideration as to health. But it should be pointed out that the doctor regards the patient's health in a professional manner. And with our system of compulsory insurance the doctors do only what they need to keep those enrolled from dying right away. If the fatal disease is not discovered, the patient is offered a "vacation."

A person with neurosis really feels very sick. He suffers from "heart pains," "vertigo," "shortness of breath," and "bloated abdomen." Natural fears in life grow into fears of riding on the metro (subway), of elevators, and of open spaces, to the point where fear is welcome. And people run for therapy. They're examined, nothing fatally wrong in the organism is found and they're diagnosed with "vegetative-vascular dyspepsia." An exclusive circle. The person is sick and the doctor has found nothing wrong. The only thing that can slow this race down is psychiatric psychotherapy.

But even if the sick Russian happens to meet a competent therapist, who, upon recognizing the hidden depression, refers him to a psychiatrist for consultation, who does he go to? From the Soviet experience we know that the only ones that go to psychiatrists are the crazy people, or those that were "twisted" in the army or in prison.

Here's a clinical example (names changed). Natasha Zamyatina, 31 years old. The first time she felt bad was in the metro three years ago. She thought it was a heart attack (shortness of breath, pounding pulse, and a chill). Assistance came from a nearby passenger with valium, (used as a tranquilizer, among other things). From that point in time every time she went on the metro Natasha had a "heart attack." She never went far from home without her valium. The district therapist found nothing wrong with her that would have caused this problem. Natasha had a little baby and not husband. There wasn't any question about her not going to work. Every day, cursing the day she was born, the girl made the horrible 40-minute trip. She went to a psychiatrist after three years of torment. Three weeks after beginning anti-depressants Natasha was substantially better.

Another example is provided by Aleksandr Kotlov, 56. He had heart attacks too, it seemed his "heart was stopping." In contrast to the young Natasha, Aleksandr experienced functional (temporary and non-life-threatening) disturbances of heart activity. This compelled him to constantly think about death from heart attacks, and the attacks grew more frequent, soon he got them at work several times a week. For four years Kotlov treated his "heart" without result, in the meanwhile he did not torment his relatives with words of dying or talk about suicide. Aleksandr was persuaded to check into the Solovev Moscow clinic with neurosis. After a month his heart stopped bothering him.

There are no reliable statistics showing how many people suffer from this sort of misfortune. The head of the department for research of psychic borderline pathology (the area in which psychiatric doctors classify depression and neurosis) of the Center for Psychic Health of the Russian Academy of Medical Science (RAMI), scholar Anatoli Smulevich, in one of his articles cited information from western researchers: there 20% of the population exhibit some sort of neurotic disturbance. There is reason to believe that Russians are ailing to a greater degree.

In this psychiatrist-clinicians have noted no increase in the numbers of patients, but conversely, a decrease in the number of visits. Member of the Association of European Psychiatrists candidate of medical science Nikolai Pyatnitskiy worked for two years in the psychiatric clinic of Heidelburg University, in Germany. Now Doctor Pyatnitskiy works in the Center of Psychic Health at RAMI and counsels at the 33rd municipal hospital of Moscow. He believes that patients very rarely visit psychiatrists because the problems of borderline psychic disorder have begun to involve those who used to be considered non-specialists in this field - psychologists and neuropathologists (by law in Russia only a doctor may treat neurosis, therefore psychologists call their type of activity "psychocorrection.") By the way, in Germany psychiatrists have gone the court route in this dispute and have obtained from the authorities a ban on treating pathological neurosis by non-professional specialists - they were making too many mistakes. Nikolai Pyatnitskiy is not so categorical: "Having turned to psychology, our patient is coping with a serious (and exclusively Russian) problem. He already does not consider himself "insane," ordinarily "at some moment a life problem appeared" with him. And after seeing the psychologist he's more willing to make contact with us. Although in some cases counseling with the psychologist will suffice. On a different matter, if the state would worry more about the education of its citizenry and teach them to be at ease in going to psychiatrists, then we would be able to avoid many medical mistakes.

The therapists themselves, who work in the hospitals, state: even if depression is diagnosed by them, making the patients consult with psychiatrists is tricky. Dina Ulybysheva, manager of the therapeutic department of the 19th municipal hospital in the city of Moscow, member of the Moscow Association of Cardiologists, says "Really, therapists who work in polyclinics cannot detect depression in the patient - this sort of doctor takes on very many patients and it's practically impossible for him to spend much time in detailed diagnosis. In the in-patient department we ordinarily do not find patients with depression, but just ordinary tendencies to the origins of this malady. And we always advise these patients to consult with a psychiatrist. But the patients becomes alarmed at the word "psychiatrist" and want to know why we think they're insane. I have a 34-year-old patient with a heart attack. I see he has massive depression and advise him to go to a psychotherapist (I even avoided the word "psychiatrist.") He never went.

Now we have to somehow find our way out of the existing situation.

Doctor-psychiatrists do not consider the situation with the psychic health of the Russians a catastrophe. Many suppose that everybody will adjust if, first of all, the system compulsory medical insurance is corrected and, secondly, we try to acclimatize to the psychological culture.

First of all the state need to recognize the impossibility of giving people comprehensive free medical support, but it needs to guarantee people the "right to life" as written in the Constitution. If there's not a threat to life, but only to the "quality of life," then it's different money. Medical insurance needs to get away from repeated futile attempts at therapy. That is, if people go to therapist a second time with some problem and they start treating it the second time then that doctor's repeated treatment ought not to be paid by the state. Only then will the therapist be interested in making the right diagnosis and, in the case of neurosis or depression, in directing the patient to a psychiatric psychotherapist. On his part, the patient cannot keep ignoring the direction: if he goes back to therapy, he just is not accepted (after all the doctor is not paid).

This idea has not met with special enthusiasm in the Federal fund for compulsory insurance (FFOMS). One of the experts observed that the doctor-patient relationship was a problem of the medical institution. "The therapist ought to be able to convince the patient of the necessity of counseling with a specialist of the needed type. With him rests all responsibility for this person's return to health," he added. If that patient is not satisfied with the work of the doctor and has doubts in the correctness of the diagnosis, then he can appeal through the company in which he's insured and they look into it. Besides that, experts say, that for all patients there needs to be comprehensive insurance support, and not only guarantee the right to life, but the right to health is also guaranteed by the Constitution. Regarding repeated visits to the doctor, the people in FFOMS think that it takes as long as it takes, "An ailment might not be found after five times, but the sixth time it could turn up."

And, finally, the notorious psychological culture of the people. In the USA, it has been shown that a depressed state emerged after the "freedom of the 60s," when society for ten years changed from the puritanical to the emancipated, it created an entire system which made a visit to the psychotherapist not just acceptable, but prestigious. From there they went to supporting professional psychiatric associations, with frank advertisements, and financial incentive (the majority of insurance companies have started including psychiatric care in their plan.) As a result, the nation has overcome its depression. Really, now in the USA they've written 300 million prescriptions for antidepressants, but that's another story.

Mad Money

July 7, 2003
by Natalya Polat, Ulyanovsk Region

Ulyanovsk Psychiatric Hospital No. 1 is the same as hundreds of other provincial "yellow buildings" in the country. Distinguished perhaps by the name of its founder, the great historian Nikolai Karamzin. A scandal in which the management of this hospital found themselves could have happened in any other similar clinic in Russia. Doctors, citing a chronic lack of money, spent the personal pension of its incapacitated patients on routine needs of the hospital.

Now, according to the Ulyanovsk regional attorney, money for all the expensive purchases put on the patients' account needs to be reimbursed by the doctors or by the state. In reply, the chief doctor of the hospital told "Izvestia" that in case the situation escalated they were prepared to shut the clinic down and release the patients on the square in front of the regional administration offices. There is no denying that the reaction of the chief doctor to the pressure from the regional prosecutor carries political implications. Next year is the election for the Ulyanovsk governor, and the hospital is financed (more accurately, is not financed) from state coffers.

On personal account

The pension of patients was spent illegally on the needs of the hospital. That is the conclusion of the Ulyanovsk state attorney after an 8-week review. The dry official facts: in 2002 clinic staff from department No. 11 expended 37.8 thousand rubles from the pensions of patients who were assigned to the hospital (45% of the state money due to patients). For 4 months in 2003, 32.3 thousand rubles (31%) of the pensions of patients in departments No. 17 and 18 were spent.

Yes, all these expenditures were requested by the patients themselves, written in the name of the chief doctor, senior assistant to the state attorney Vasiliy Zima told Izvestia. However the patients, who are in treatment, who signed the requests and "requested" their pension be spent on the needs of the hospital, are often found under the influence of medication, so that they are not able to understand the meaning of their actions.

As an example the prosecutor cited a purchase of buckets and washbasins request by a certain Ponomareva to be charged to her pension. Judging from the history of her disorder, on 14 May of this year she was aggressive, she was crying and screaming. On 15 May came her request to buy the hospital buckets and washbasins, supposedly the patient had suddenly made contact with and contributed her pension to the institution. Or here's another one. At the end of last year a sum of 10 thousand rubles was obtained from the account of 70-year-old patient Raisa Tsvetkova. A transaction was executed without the presence of a power of attorney, and also without the knowledge of the patient the funds in question were expended on the purchase of tea kettles, wallpaper, a color television, night shirts in the amount of 20 pieces and 6 mattresses.

In this same department the senior nurse Lyudmila Orlova in August of last year appropriated the sum of 10 thousand rubles from the account of patient Klavdia Larina. Out of that was bought an "Oku" washing machine for 2,100 rubles, and also velour fabric, a lamp, an extension cord, a heater, light bulbs and office supplies for 150 rubles, and 8 mattresses for 3,669.40 rubles. For a sum total of 7,312.40 rubles.

Permanent place of residence - the psych hospital

Psychiatric Hospital No. 1 was founded in the century before last by the great Karamzin. It was the ill-fated department No. 11, where the prosecutor determined that the shady transactions with the pensions were specific deliberate transgressions. I arrived there in search of Raisa Tsvetkova, whose account was used, as the representatives from the state attorney's office say, to do so much good for the hospital.

The red brick building is simply falling apart where it stands. It was built in 1897. The last time repairs were done here was 20 years ago. Even the heavy doors are hard to open; you risk having pieces of brick fall on your head. The floor is cracked and the ceiling is leaky. The steps have mold on them. I was escorted through the rotten passageway to the sleeping quarters. The mattresses were unwashed and stained, the linen was yellow. There was a ghastly stench.

"And here's your beautiful lady," the smiling nurse told me, and there was an ancient woman staring intently into the screen of a television that was turned off.

So, this was the scene of the crime. And Raisa Tsvetkova (the oldest one listed in the state attorney's documents) looked in my direction for a long time without comprehension, then at the black television screen. And suddenly moved to meet me.

"Dear, you don't need to give me a gift, I don't need candy, just a new shirt ... you bring, you promise?"

"Yes, yes, everything will be done," the nurse answered for me.

Yes, her clothes were quite poor. The old woman had on a robe that was falling apart, and her other clothes were threadbare ...

"Yes fine. If anything should be cleaned," an orderly spoke up, "here is the washing machine for patients Larina "lent" us," gesturing in the direction of the "Oku." "But of course there is no hot water after March. So the wash is not done properly, nor do patients wash. Our department is the tuberculosis. The chief doctor makes arrangements for the patients every two weeks with the head of the local bathhouse and they are driven there to "wash." Here it's impossible, it's too dangerous with the electrical wiring ... Here they manage with primitive facilities. When we can, we heat water on a hot plate and use it for washing. Weren't you afraid to come here? No one from the state attorney's office wanted to visit when they were investigating, they were afraid of being infected. They only worked with paper, they never looked at the patients."

Psych patients to the White House!

None of the staff would deny that patients' pensions were being used for the clinic's needs.

"Imagine people living here for decades," says chief doctor Vladimir Abramkin. "The hospital becomes a home for them. They want to sleep on clean mattresses, to do a normal wash, to watch television. So what can we offer them? Yes, now and then we prevail upon the patients for help for their fellow patients, some of whom are bedridden. The people who live with them are their neighbors. Relatives, as a rule, turn away from this type of people. No one needs them.

"I've worked in this clinic for 38 years and have never taken a kopeck for myself!" The old nurse Lyudmila Orlova spoke of the basic accusations from the state attorney with tears in her eyes. "All acquired belongings remain the property of the patients. They can sell them or give them away at any time. And in case of death their possessions are taken by relatives."

"We even bring things from home to help," says Marina, nurse in the 11th department, "and linen, and groceries. It's pitiful. If it wouldn't have been for purchases from the pensions, our patients would be living no differently than if they were put in a zoo. They would be sitting in dirt and filth, like in a cage. Money from the state goes only so far as feeding and, yes, our wages."

"I am ashamed to say that I come here for the bad-tasting hospital food," says Lydia the orderly. My wages are 500 rubles. The patients are miserable. ... I am from a neighboring village, where there is nothing, but if they reduce my pay I'm not coming back."

Really, judging from the documents, in 2002 the hospital received only 60% of the funding it needed. And this year things are no better. For a more or less tolerable existence the clinic needs nearly 108 million rubles, of that the region has agreed to budget them 75 million. But at the present moment the hospital has only received almost 20 million. This money barely suffices for food.

In the opinion of the staff at the state attorney's office the statements of the clinic's management are just an attempt to justify themselves.

"Yes, we know about the hospital's problems. But that doesn't give them the right to violate the law and take possession of others' property who would not have thought of doing this," said Vasiliy Zima. "One can morally justify any crime. If there's too little money allocated for the budget, it means they need to demand more, not break the law."

As a result of the review 2 cases have been initiated for administrative transgressions in connection with hospital personnel. The prosecutor has submitted a claim to defend the interests of the patients and recognize all the purchases made on patients' accounts. If this claim meets the requirements, then the hospital personnel will have to return the money to the patients' accounts from their own pockets.

"The state attorney requires that we obey the law," says chief doctor Abramkin. "OK, we will have our staff pay the patients. What are they going to do with it, put it under their mattresses? They're not allowed to take it out of the hospital! We'll be constantly fined for non-observance of sanitary standards, but have no money to pay. If this goes on, I see only one way out. Close the place down and release the patients in front of the Ulyanovsk White House. Let them sort out who's guilty of what ...

Psychological Attack

Illiterate psychologists can lead clients to suicide

January 14, 2003
by Natalya Baranovskaya

Long vacations and school holidays are not a better way of making oneself mentally fit. Problems ordinarily intensify in our land during winter depression. If in any other time of year nearly 50 million Russians, by the most modest calculations, require the care of psychologists, in winter that number increases by 10-20 percent. However, finding a good psychologist is not easy, and making use of bad services is perilous.

Per head of population

The demand for services from psychologists in Russia is steadily rising. And although it's a long way to America for us, according to the National Institute of Psychological Health in the USA, up to 51 percent of Americans turn to psychologists for help. In recent years using the services of professional psychologists and psychotherapists for us, if not usual, is not something to be ashamed of. If anything, there aren't currently enough professionals.

Today, finding a psychologist, psychotherapist or even a psychoanalyst (of which there are no more than five in Russia, the rest are imposters) is easy. For example, we even managed to sign up for counseling with a psychologist in a beauty salon and in the sports club. One can read in any paper the advertisements of individuals practicing as psychotherapists, who "effectively resolve any problem, including rescue from alcohol dependency, excessive weight, neurosis, depression and anxiety, any time day or night." This area is not controlled by the community or by the state. There's not even a license for psychological services.

"A trusting client who is in critical need of help can easily end up with someone who is self-taught, a semi-illiterate or a charlatan," warns Aleksandr Orlov, doctor of psychological science, director of the "Trialog" psychological counseling center. The consequences of such "psychotherapy" can be most grievous - increased problems, psychic trauma, in worst cases there is a real danger of suicide. In Russia psychologists and psychotherapists do not bear any responsibility to their clients, therefore selecting a specialist requires care and caution.

Who is who

For psychological assistance one can go to psychological counseling or to psychotherapy. The difference between the two [in Russia, according to this article] is this. A psychologist gets psychological education, whereas a psychotherapist, or a clinical psychologist, also has medical training. That means they can prescribe drugs for their clients.

"Specialists with medical education - for example, completing the psychological curriculum at medical school - have more options in working with patients than graduates of the psychological department at college," believes professor Vadim Zaytsev, director of the department of psychodiagnostics and psychotherapy at the Russian Science Center for restorative medicine and resortology in the Russian Health Ministry. "But in our country, the training of clinical psychologists is in an embryonic state.

Besides a diploma, which by the way can be bought and hung in the office of any dilettante, there are other criteria of professionalism.

"Before placing yourself in the hands of a psychologist, what kind of service he offers needs to be ascertained. A specialist with decades of experience will be more effective than a novice," says Aleksandr Orlov. The academic degree in the place of work also has meaning. If a psychologist works in an institution, he holds a position in scientific circules. The likelihood of obtaining the needed assistance from him is greater than from a person who works out of his house. It's also very desirable to have a recommendation.

If there is no one in your circle of acquaintances who does not go to a psychologist, it's possible to select a likely specialist from the Internet. There are a number of psychological pages on the Net. By visiting them it's possible to get counseling free or for a moderate price, get tested, and discuss personal problems on a forum.

Virtual counseling

Many practicing psychologists have their own pages on the Internet. Even though virtual counseling, as a rule, is free, they're there to make the psychologist a profit, since on-line contact frequently leads to person-to-person consultation.

"Although confrontation counseling can give the client a little bit more, it's not always an option," says Vadim Zaitsev. "For example, if a person lives in a remote place where there usually aren't any specialists, it's better to get psychological assistance from the Internet than to get none at all. The Internet is a good resource and a place to associate with friends with the same misfortunes on forums, who are seeking a psychologist themselves.

Counseling over the Net can be particularly helpful, in Aleksandr Orlov's opinion, to residents of the provinces. In small cities where everybody knows everything and the pay is poor, a psychologist's services, by virtue of cost, can be afforded only by a very small circle of people. Also, it's nearly impossible to obtain care there without anyone knowing. Rumors are mandatory that such and such a person doesn't have everything right in his head, or has family problems. In such a situation Internet counseling is the optimum course."

Be careful

Access to the Internet is not all that's needed by far for psychological care. In every village, not talking about large cities yet, they have clairvoyants, witches and fortune-tellers who solve your personal and their financial problems with a 100 percent guarantee, or even 150-200 percent. As a rule, they also use psychological methods in their rites, although they entice their clients with mysterious incantations. Or openly position themselves as magician-psychotherapists.

In September of last year Moscow magician-psychotherapist Yuri Ermolaev, whose advertisements one could come across in the newspapers, for ten hours held his client hostage and tortured her in every way possible. The woman, whose husband had left her not long before, went to the healer for help and found herself in a trap. Neighbors, upon hearing the blood-curdling shrieks, sent for the police right away. They said the "psychotherapy" sessions were almost always accompanied by screams.

"If you decide to use the services of a witch, see to your own safety," says psychotherapist Nikolai Naritsyn. "Be on the alert. If the magician sloppily juggles incompatible terms, some religious, some psychological and some medical ... If he throws different methods into one pile: "removing wrinkles and blemishes, psychoanalysis, NLP"... If he has a panacea for you, doesn't explain anything, but only says to have faith and listen ... If the mysterious methods are "unique and defy imitation" ... If the "great magician" undertakes any order, even those which clearly contradict all laws of nature, in particular, those of human psychology ... And finally, if you are being manipulated, shall we say, forced to pay in advance for some visit right away or are forced to make a purchase of some sort of remedy or charm ... Be on the alert."

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