Mental health policy and practice across Europe: an overview

406 Mental health policy and practice
organizations as key stakeholders in the deinstitutionalization movement.
Other major stakeholders, including relatives, professionals, politicians, the
general public and the mass media are heavily influenced in their views and
expectations concerning mental illness by the kind of psychiatry practised in
institutions. Unsurprisingly, since 1989 the common trend in the countries
with growing economies (such as the Baltic countries) has been to increase
government investment in improving standards of care in institutions. The
move to care in the community is seriously impeded by the widely-held belief
that the primary task of the mental health care system is the safety of ‘regular’
citizens.
Understanding political psychiatry
The silencing of science as a crucial reminder of reality, the attitude of aversion
towards the disabled, and the party hierarchy serving as a social defence
against the anxiety arising from enforced dependency (Jaques 1955; Menzies
1992) provided the breeding ground for political psychiatry. The perception
of political dissent as a derangement of the mind was only a step away. It
took a few aberrant personalities within the profession to launch a practice
of abuse wrongly construed by the unassuming many, and culpably misrepresented
by the malicious few, as humane care for the ‘non-insightful
mentally disordered’.
This practice burgeoned due to many additional aspects of the Soviet context:
the political apparatus for central control, the downgrading of the professions,
the political purges, the abolishment of democratic freedoms, the misinformation
of the public, to mention just a few. By the late 1970s and early 1980s
approximately a third of all dissident cases were processed through the ‘politically
insane’ procedure. The usual diagnoses were schizophrenia and having
paranoid personalities. The treatments were heavy, given without consent, and
had severe side-effects and debilitating consequences. The duration of commitment
matched that of the sentences given to political prisoners – three to
seven years. A growing need for more institutions was recognized by the
party Politburo under Yuri Andropov and dozens of new mental hospitals, identical
in design, were built across the country. In 1989, at the World Congress of
Psychiatry in Athens, after years of international pressure, the Soviet delegation
publicly acknowledged that, indeed, systematic political abuse of psychiatry
had taken place, admitting that setting up political hospitals had been a wrong
move. Hospitals have since been closed but what has remained behind is a
culture of passive compliance and corrupt state administration.
The change of 1989
In 1989 political change, which had been in the air for a decade, became a fact of
history. This happened by and large peacefully, revealing a significant capacity
to contain anxiety and anger across the whole of the former eastern bloc
even during the collapse of hierarchical social organizations. This was good