Mental health policy and practice across Europe: an overview

398 Mental health policy and practice
(Walt et al. 1999). This chapter will touch on these issues in an attempt to
demonstrate the importance of hidden agendas in the interpretation of mental
health service data obtained through positivist research in societies in flux. The
hope is to attract attention to the key role of governance. In this we are guided
by the concern that dictatorial cultures, with their blatant disregard for human
decency, humane approaches and individual dignity, seem to survive long after
the dictators are formally removed.
The spurious similarity
The downfall of the Berlin wall revealed that the assumed similarity between
eastern bloc countries was more fictional than real, resulting from a suppression
of differences. What appeared to be similar was, in fact, a misleading impression
created by biased data, obstructed access to information and the manipulation
of findings.
On the other hand, observers of the sociopolitical scene in the former eastern
bloc began to identify the lasting impacts of totalitarian rule on individuals
and communities, such as a poor ability to manage change and a failure by
human services and the economy to respond to the challenges of transition
(Dahrendorf 1990). In particular, the huge public health crisis was attributed to
an inability to cope with unexpected and prolonged psychosocial stress, resulting
from the failure of coping strategies built on social passivity and a dependence
on the state to guide countries in their transformations into open societies
(Cornia and Paniccia 2000).
In distancing themselves from the imposed image of ‘Second World’ nations,
these countries took different routes. Those from central Europe snugly settled
into the mould of western democracies, and established mental health care of a
kind that is accountable in terms of comparative quantitative analysis, with all
its strengths and weaknesses. The relatively high degree of structuring of their
services, and the considerable uniformity in their handling of the constructs
involved, have contributed to this accountability. These countries are outside
the focus of this chapter.
In the rest of the eastern bloc, mental health systems had been reconciled
with the excessive control of the previous regimes to a much larger degree. The
more pronounced the role of traditional values in regulating communal, family
and professional life prior to dictatorial times, the easier it was for health
systems to yield to authoritarian pressure. In the case of the former Soviet
Union, psychiatry had deliberately been used for the pursuit of the political
goal of controlling minds. This brought about an institutional culture in the
psychiatric domain which is difficult and painful to leave behind, even to
this day.
Although little research has been done, it is important to bear in mind how
this practice has left an imprint on the culture of psychiatry in the countries of
the former Soviet Union and how pervasive this imprint is. It is evident in
hospitals and nursing homes, but also in the infamous dispensaries which
became outposts of institutionalism in the community. Azerbaijan, Georgia,
Ukraine and the Russian Federation are used here to illustrate this analysis.