About Bridging Psy Journal

FORERUNNERS                                                                                                                                   At the beginning of the exchange between Eastern and Western Psychiatry there is the cooperation of the Italian journal “Psichiatria e Territorio” and the colleagues of Lviv (Ukraine).                                                                                                                                       A description of the organization in Ukraine at the time (1995)

Alexander Filts

LVIV REGIONAL PSYCHIATRIC HOSPITAL

Before the 18th century, there was no psychiatric care for the population of Galychyna. Part of mental patients lived in monasteries, part of them was kept into the penitentiary institutions, but the major part remained in general population. First insane asylum in Galychyna was organized at the times of Austrian-Hungarian Empire in 1790 as the department for mental patients in Lviv Krayovy Hospital at Piyariv Street. At the beginning this department was mixed for both male and female patients, and only in 1870 it was divided into two parts: male patients were separated from females.
On May 15, 1875 these departments were transferred to the newly built houses, situated in Kulparkiv suburb of Lviv, and specially constructed for needs of mental patients. The status of Kulparkiv Institution for Mental Patients was adopted on May 25, 1875, and from January 1, 1876 this institution was reorganized into an independent structure. In 1876-80 it also had two branches: one for female patients in Peremyshl and another one – for male patients in Zhovkva. At the beginning hospital provided only board and general care for patients. Later, under the Polish rule (1918-1939), active treatment of patients began to play more important role. Number of beds in the hospital increased rapidly: from 345 to 1100 by 1907 and to 2300 in 1980.
Before World War I such people as Gustav Neiser (came to Lviv from Krakow), Vladyslav Colberger (originated from Peremyshlyany in Lviv region) and Vladyslav Sohatski (who elaborated instructions for personnel) made great contribution to setting up and growing of the hospital. The reunification of Ukrainian lands in 1939-40 marked a new stage in the development of the hospital, but the hard times of World War II slowed this progress. Many patients died of infectious diseases, cold, and starvation, part of the property was lost and the buildings were partially ruined. During World War II, many patients from Germany sought shelter in Lviv, which is recorded in the hospital’s archives.
After the end of the war, these buildings were reconstructed, and new changes took place: workshops complex was built, many problems concerning equipping mental departments of the hospital with necessary services and utilities were solved. Qualified specialists came to work in the hospital, in-patient system of psychiatric care was specialized and extended, and great efforts were made to improve the methods of diagnostics and treatment. In the post-war period hospital did a lot in organizing of the psychiatric service in cities and districts of Lviv region and in nearby regions.
Nowadays, the hospital contains 1735 beds in 20 departments. The major part of the departments is specialized: for children, adolescents, gerontological patients, for patients with tuberculosis, infectious diseases; there are also forensic and intensive care units. There are special wards for the patients with epilepsy (male and female).
Two departments of the hospital are diagnostic and, also there are two Departments of Lviv Medical University. The first one is the Department of Psychiatry and Psychotherapy for Advanced Postgraduate Training. The main directions of scientific activities are: psychotherapeutic work and psychological help, psychopharmacotherapy of major psychoses and affective disorders, clinical investigations in the field of psychopathology, rehabilitation and art therapy, alcohol and drug dependence, researches concerning new psychotropic drugs.
Over the last seven years, Department of Psychiatry and Psychotherapy, Lviv Medical University, is involved in the following activities:
1. In clinical psychiatry, the problems of prediction in schizophrenia, affective disorders, and suicides are studied.
2. In the field of addiction treatment, a specific medication with a know-how technology has been synthesized. It contains dysulfiram as an active ingredient, and has a prolonged effect. The studies of anti-abuse and anti-anxiety effects of the drug. Today, the results of the preliminary double-blind study of 15 patients are available. It has been discovered that the drug has a mild anti-anxiety effect and decreases the cognitive and affective tension to caused by abuse-topic in the period of abstinence. Besides, the medication significantly improves the possibilities of psychotherapeutical correction.
3. In the field of psychotherapy, our Department, in collaboration with Ukrainian Umbrella Association of Psychotherapists conducts a continuous international project, in which more than 170 participants from Ukraine, Russia, Belarus are educated in group psychoanalysis, client-centered psychotherapy, systemic family therapy, psychodrama, gestalt-therapy.
4. A pilote project on rehabilitation of the chronically mentally ill is launched jointly with our Italian colleagues.

Our journal

Maria Luisa Figueira (Lisbon, Portugal)

Maria Luisa Figueia

Evgeny Krupitsky

Mikhail Reshetnikov

Igor Kolesnikov

Maria Luisa Figueira (Lisbon, Portugal) and Mario Di Fiorino (Viareggio, Italy)  organised a large conference in Saint Petersburg. They decided to found a journal focused on the exchanges between Western and Eastern psychiatrists.
Some selected talks were printed in the journal.
Some Russian colleagues, who have taken part: Evgeny Krupitsky (with a paper on Ketamine Assisted Psychotherapy of Heroin Addiction), Mikhail Reshetnikov, Oleg Lapshin, Igor Kolesnikov;  Manuel Paes de Sousa and  Maria Manuela Abreu from Portugal, Salomon Resnik from France  and  Rasim Somer Diler and Juli Fradkin from USA, and Oleg Anatolievic Savenkov from Canada. He was graduated at Novosibirsk Medical Institute in 1993, and at the time worked in Niagara Health System in Ontario.

Salomon Resnik, in a talk in the castle of Olescu (Ukraine)

The parents of Salomon Resnik singers in Odessa Opera Theatre

Salomon Resnik is an example of a vary famous psychoanalist in Western countries, who through Bridging, has come back to the country of his parents, already singers in Odessa Opera Theatre.

Resnik  was born in Buenos Aires and trained in Argentina, London. He worked in Paris and Venice.

“The son of Russian Jewish immigrants, I felt the need to come to the Old Continent in order to make contact with my family roots as well as my cultural aims” (The delusional person, 2001).

The first  Russian edition  of a  book of Salomon Resnik (Mental Space)

Salomon Resnik with Mario Di Fiorino, in a talk in the Antalya (Turkey) conference

Alexander Filts, Head of the Department of Psychiatry in Lviv State Medical University, explained us some important events for understanding the powerful influence of classic German Psychopathology.                                       Moscow, the capital of the former USSR, was the absolute center of academic and educational psychiatry in the Soviet Union. There were in Moscow:
– the Institute of the Academy of Medical Sciences
– the Russian Institute of Psychiatry
the Serbsky Institute of Forensic Psychiatry.
The Serbsky Institute performed a function of a political instrument of the totalitarian regime.

 

 

Prof. Alexander Filts*

Psychiatry in Ukraine: general features**

* Head of the Department of Psychiatry and Psychotherapy, Faculty of Post-Graduate Training, Lviv State Medical University

** Seminar held on 26 of September 2001 in the Institute of Clinical Psychiatry (Dir. Prof. Giuseppe Ferrari), University of Bologna

It is not that easy to describe the present situation in Ukrainian psychiatry. Psychiatry and psychotherapy encompass and focus all the contradictions, all the difficulties, and all the perspectives of development of humanistic relations. In 1996, I published an article in a philosophical magazine “Geneza”, which argues that Ukraine has quite real chances for elaborating the know-how of the social and humanistic approaches in the nearest future. Today, these chances seem even more real. They are associated with the absence of distinct bureaucratic structures (they are still being established), the actual neutrality in all political and cultural fields, and, the most important, in the vigorous search of an separate concept of nation. In the course of this search, ideas, little known in the world, but still interesting from the point of view of social know-how, keep emerging. Psychiatry, as it will be stated further, remains inert and resists these new ideas. More precisely, the ideas themselves exist, but they are presently impossible to realize. These ideas include, for instance, the argument on the necessity of a totally new systematic of mental disorders, based on the principles entirely different from the existing ones. The role and therapeutical problems of borderline condition are discussed, too. There are attempts to unite the psychodynamic and phenomenological psychopathology. But all these projects do not yet go beyond discussion. It seems like practical psychiatry should be reorganized at first, and only then more general theoretical issues should be regarded.

The history of psychiatry in the Soviet Union has its peculiarities, which are both positively and negatively reflected in Ukrainian psychiatry. The most important of them concern the following fields:
– academic psychiatry and psychiatry as a discipline;
– psychiatric education;
– applied psychiatry.

Moscow, the capital of the former USSR, was the actual and absolute centre of academic and educational psychiatry in the Soviet Union. The two academic institutes in Moscow – the Institute of the Academy of Medical Sciences and the Russian Institute of Psychiatry were the ones to carry out the main clinical psychiatric research. Another institute – the Serbsky Institute of Forensic Psychiatry performed a function of a political instrument of the totalitarian regime. In this third institute, a lot of dissidents have undergone psychiatric expertise. Nevertheless, it must be mentioned that this odious role of Serbsky Institute is significantly exaggerated in the West. A lot of individuals who claimed to be dissidents and were recognized as having mental problems, later revealed signs of various mental disorders, and even benefited from psychiatrists’ support in their further life. Today, the Serbsky Institute, along with the two others, deals merely with psychiatric problems, and is not involved in political collisions. Besides these three main schools, each one of the ex-republics of the USSR had its local research centres, but none of them had any significant scientific and methodological independence.
Paradoxical as it may seem, general bases of theoretical psychiatry, which one way or the other were imposed from Moscow, were associated with classical German psychopathology. There were specific historical grounds for this circumstance. First, many of the leading psychiatrists of the 20s and the 30s either learned from or co-operated with German psychiatrists, which at that time dominated in Europe and in the world. Second, part of Soviet psychiatrists of that time actively studied and practised psychoanalysis. Third, starting from the 30s, a part of the leading German psychiatrists immigrated to Russia, fleeing the Nazi regime. Among them were Kronfeld and Sternberg, who had built a foundation for the further academic clinically oriented psychiatry in Moscow. Through the Moscow institute, their concepts of psychiatry were spread over the rest of the Soviet Union.
One may say that even today, in all post-Soviet countries, including Ukraine, this German influence is very powerful. Perhaps, this is why the contemporary tendencies reaching us from the U.S. systematic of mental diseases, statistical research design, strong pragmatic approach, predomination of biological point of view, and diminishing of psychopathological understanding of mental disorder, etc. are still regarded reservedly in Ukraine.
Thus, a traditional clinical psychopathological orientation, rather inert to Anglo-Saxon innovations, still dominates the academic psychiatry in the entire post-Soviet region. Therefore, the studies using statistical test, scale and questionnaire methods are still not very popular in our country. Descriptive clinical studies are more valued.
Since the time of the USSR and to this day, psychiatric education in our country is scheduled the following way: after the six years of general medical education a young specialist studies psychiatry for a year of internship, after which he is licensed to practice. Besides, every practising psychiatrist is supposed to take a one-month of postgraduate training and to pass a qualification exam. There are three degrees of qualification. Physicians with the top level of qualification have a right to private practice, which is an innovation introduced 10 years ago.
Besides, there are three forms of scientific postgraduate education. They envisage writing a doctor`s thesis and habilitation. All the studies are carried out in medical universities at specialized departments. Our department is also engaged in postgraduate education. Medical university students are trained at separate departments.
In Ukraine of today, universities and their chairs, and the Ministry of Health are displeased with this present education state. In the nearest 3-5 years, a reform is planned, which will adapt education in Ukraine to European standards.
Applied psychiatry. Over the last decade, the system of mental healthcare has not changed. Large psychiatric hospitals with 1000 and more beds are the main basis; besides, cities and big towns have out-patient centres. These provide medical care for neurotic and borderline patients. Though, starting from 1998, the Ministry of Health introduced progressive reforms in decentralization of large hospitals and creation of psychiatric departments in regular hospitals, this reform still encounters inertia on part of psychiatrists. In large cities of Ukraine, small psychiatric clinics formally exist on bases of general hospitals, but they remain isolated from the general mental healthcare. Though the patients dislike large hospitals, but they still seek medical care in them.
One may make a conclusion that large hospitals remain a symbol of support and a large mother object model for patients.
Applied psychiatry in Ukraine is oriented at biological methods, among which such ancient ones as insulin coma therapy, administration of high doses of neuroleptics and antidepressants are used. Partially, it has objective grounds: large hospitals have no resources for new medications, as well as for new forms of social rehabilitation. Interestingly, psychiatrists themselves are willing to use new methods and are ready to changes, but the bureaucratic apparatus, on one part, and financial shortage and narrow-mindedness, on the other, do not allow for these changes.

Conclusions:
1. Ukrainian psychiatry has not changed significantly over the last decade;
2. Reforms of psychiatry in Ukraine still remain theoretical, and have little opportunity for practical realization;
3. The influence of the Western, especially American psychiatry, is limited, which leads to certain isolation of Ukrainian psychiatry;
4. The reform of psychiatric education has the highest chances for today.

Main drawbacks:
1. Strict traditionalism of scientific and practical psychiatry. Today, Ukraine is falling behind even Russia and other post-Soviet countries in terms of innovations, but the innovations in the field of applied psychiatry, as it was mentioned before.
2. The gap between the old rigid structure of psychiatry and innovative quests in the field of theory. Good ideas are hard to realize due to lack of appropriate structures and costs.
3. The rigidity of psychiatry makes a sad impression on the more progressive Western partners, which comlicates international collaboration. Soviet legacy still hinders the development of Ukrainian psychiatry.

Advantages

1. The readiness for changes among the younger generations of physicians is very high. It is a favourable ground for the acceptance of the most advanced new trends: it is easier to build a new modern house than to reconstruct an old one with modern accessories.
2. Ukrainian psychiatry is especially sensitive to the most outstanding achievements of modern international psychiatry. This allows hoping that, sooner or later, these achievements will find their role in Ukraine.
3. Collaboration with Western partners, as soon as it becomes reliant and steady, is especially valued among Ukrainian psychiatrists. The example of collaboration with our Italian colleagues, initiated by Prof. Mario DiFiorino, speaks for itself. We have conducted three big international conferences, started a psychiatric rehabilitation project, introduced a joint website, and we plan on extending our cooperation.
___________________________________________________

I would like to say a few words about the history of our hospital.
Before the 18th century, there was no psychiatric care for the population of Galychyna. Part of mental patients lived in monasteries, part of them was kept into the penitentiary institutions, but the major part remained in general population. First insane asylum in Galychyna was organized at the times of Austrian-Hungarian Empire in 1790 as the department for mental patients in Lviv Krayovy Hospital at Piyariv Street. At the beginning this department was mixed for both male and female patients, and only in 1870 it was divided into two parts: male patients were separated from females.
On May 15, 1875 these departments were transferred to the newly built houses, situated in Kulparkiv suburb of Lviv, and specially constructed for needs of mental patients. The status of Kulparkiv Institution for Mental Patients was adopted on May 25, 1875, and from January 1, 1876 this institution was reorganized into an independent structure. In 1876-80 it also had two branches: one for female patients in Peremyshl and another one – for male patients in Zhovkva. At the beginning hospital provided only board and general care for patients. Later, under the Polish rule (1918-1939), active treatment of patients began to play more important role. Number of beds in the hospital increased rapidly: from 345 to 1100 by 1907 and to 2300 in 1980.
Before World War I such people as Gustav Neiser (came to Lviv from Krakow), Vladyslav Colberger (originated from Peremyshlyany in Lviv region) and Vladyslav Sohatski (who elaborated instructions for personnel) made great contribution to setting up and growing of the hospital. The reunification of Ukrainian lands in 1939-40 marked a new stage in the development of the hospital, but the hard times of World War II slowed this progress. Many patients died of infectious diseases, cold, and starvation, part of the property was lost and the buildings were partially ruined. During World War II, many patients from Germany sought shelter in Lviv, which is recorded in the hospital’s archives.
After the end of the war, these buildings were reconstructed, and new changes took place: workshops complex was built, many problems concerning equipping mental departments of the hospital with necessary services and utilities were solved. Qualified specialists came to work in the hospital, in-patient system of psychiatric care was specialized and extended, and great efforts were made to improve the methods of diagnostics and treatment. In the post-war period hospital did a lot in organizing of the psychiatric service in cities and districts of Lviv region and in nearby regions.
Nowadays, the hospital contains 1735 beds in 20 departments. The major part of the departments is specialized: for children, adolescents, gerontological patients, for patients with tuberculosis, infectious diseases; there are also forensic and intensive care units. There are special wards for the patients with epilepsy (male and female).
Two departments of the hospital are diagnostic and, also there are two Departments of Lviv Medical University. The first one is the Department of Psychiatry and Psychotherapy for Advanced Postgraduate Training. The main directions of scientific activities are: psychotherapeutic work and psychological help, psychopharmacotherapy of major psychoses and affective disorders, clinical investigations in the field of psychopathology, rehabilitation and art therapy, alcohol and drug dependence, researches concerning new psychotropic drugs.

Over the last seven years, our Department is involved in the following activities:
1. In clinical psychiatry, the problems of prediction in schizophrenia, affective disorders, and suicides are studied.
2. In the field of addiction treatment, a specific medication with a know-how technology has been synthesized. It contains dysulfiram as an active ingredient, and has a prolonged effect. The studies of anti-abuse and anti-anxiety effects of the drug. Today, the results of the preliminary double-blind study of 15 patients are available. It has been discovered that the drug has a mild anti-anxiety effect and decreases the cognitive and affective tension to caused by abuse-topic in the period of abstinence. Besides, the medication significantly improves the possibilities of psychotherapeutical correction.
3. In the field of psychotherapy, our Department, in collaboration with Ukrainian Umbrella Association of Psychotherapists conducts a continuous international project, in which more than 170 participants from Ukraine, Russia, Belarus are educated in group psychoanalysis, client-centered psychotherapy, systemic family therapy, psychodrama, gestalt-therapy.
4. A pilote project on rehabilitation of the chronically mentally ill is launched jointly with our Italian colleagues.

Paradoxical as it may seem, general bases of theoretical psychiatry, which one way or the other were imposed from Moscow, were associated with classical German psychopathology. There were specific historical grounds for this circumstance.
First, many of the leading psychiatrists of the 20s and the 30s either learned from or co-operated with German psychiatrists, who at that time dominated in Europe, and in the word.                                                                                   Two prominent German-Jewish psychiatrists emigrated in URSS: Kurt Sternberg in 1935 and Arthur Kronfeld in 1936.
They, working in the Serbsky Institute, had built a foundation for the further academic clinically oriented psychiatry in Moscow. Through the Moscow institute, the classical German perspective was spread over the rest of the Soviet Union.

Oleg Lapshin

Ivan Pavlov, one of few Russian scientists – doctors known in the West. He actively argued with a regime, existing in the Soviet Union. In 1929 on ceremonial meeting of Physiological company dedicated to100 anniversary of Ivan Mikhailovich Secheniov , Pavlov has said: “ We live under domination of a severe principle: the state, authority is all. The person of the customer is nothing. ” Later, in the letter to N.E. Bukharin, he wrote: “Oh my God, how difficult it is now, even for a little bit decent person to live in your Socialistic Paradise”.

He has died by his own death in 1936, when global fame could not save from prisons and executions other famous scientists. It is possible to consider as irony, that under his name, those who attempted to limit science by severe frameworks of a communist system, were united on integrated session of Academy of the science and Academy of medical science of USSR in 1950, which was noted in the history under the title “Pavlovskaya”. High evaluation of a name of Pavlov and implantation of the “Pavlov’s” approach in psychiatry, psychology, the physiologies has held back development of the Soviet and Russian science for decades.” Oleg Lapshin

“The incarceration of free thinking healthy people in madhouses is spiritual murder, it is a variation of the gas chamber, even more cruel; the torture of the people being killed is more malicious and more prolonged. Like the gas chambers, these crimes will never be forgotten and those involved in them will be condemned for all time during their life and after their death.”
Alexander Solzhenitsyn

Anatolij Korjagin

Snezhnevsky proposed a new variety of “schizophrenia“, the “sluggish type”Vladimir Bukovsky commented on the emergence of the political abuse of psychiatry 1996. In almost every case, dissidents were examined at the Serbsky Central Research Institute for Forensic Psychiatry in Moscow, where persons being prosecuted in court for committing political crimes were subjected to a forensic-psychiatric expert evaluation.  In 1990, Psychiatric Bulletin of the Royal College of Psychiatrists published the article “Compulsion in psychiatry: blessing or curse?” by Russian psychiatrist Anatolij Korjagin.
In the same year a Korjagin’s article “Forgiven and Forgotten” was published in the Italian journal “Psichiatria e Territorio”, linked to Bridging project.
It contains analysis of the abuse of psychiatry and eight arguments by which the existence of a system of political abuse of psychiatry in the USSR can easily be demonstrated.

Anatolij Korjagin

Forgiven and Forgotten


All along, the issue of psychiatric abuses has, regrettable as this may be, concerned merely an insignificant number of psychiatrists all over the world. Everyone has doubtless read or heard something or other about it, but let each one ask himself whether he has devoted to this even a few hours of his life and whether he could name at least some of his colleagues who would not act as he himsef. Defending the honour of their profession for the overwhelming majority of specialists has proved to be a matter not worth any special attention.

Those occupying an active position divided up into two groups diametrically opposed to each other: some took the facts, which meanwhile were known worldwide, seriously and voiced clear censure, while the others, facts notwithstanding, pharisaically defended the culprits. Sceptics with their philosophical “ifs” joined either of these groups.

There is no need to convince anyone today. Only some particularly lazy person might still be ignorant of the unlawful actions committed by official psychiatry against individuals objectionable to the powers that were the authorities not only in the Soviets’ land, but also in Romania, Czechoslovakia, Cuba, and other socialist patrimonies. As the facade of communism’s bastion crumbled, light penetrated into its torture chambers, spotlighting certain figures in white smocks bustling there. So what happened when the doubtful became certain? Did all rush to the victims’ rescue and handcuffing of the criminals? By no means. There has been a paradoxical effect: the victims were forgotten right awav, and even those were no longer heard to mention any crimes who had assured all the world they were going to conduct a tribunal against Mengele’s worthy followers.

How come? The overall reason is to be seen in the disintegration of the former USSR with a crumbling of the former power of its totalitarian regime. This joyful event entailed as a political consequence the utilization of the theory of “the system’s fault’ by way of the main factor in assessing past and present events in this country. It is on the fallacious sociopolitical system that all the guilt for all misfortunes having occurred in the former Soviet Union, and also in its torture chambers, is being placed. Immediate participants of unlawful actions and atrocities are now themselves being labelled as victims of the Soviet system. This means blasphemously putting them on a par with the people they had tortured or killed. The same old story we heard before, but not always were its champions allowed to get away with it. German nazis could but dream of such devence counsel. However, the twin brother of Soviet bolshevism, Hitlerist nazism, as a result of the war was condemned to eradication, whereas the West, according to its reasoning, does not wish chaos as a result of disintegration on the territory of the former USSR. That’s why we have such a double-entry bookkeeping. That’s also why the Human rights committees in Western countries are no longer interested in the issue of abuses of psychiatry in the countries of the Eastern bloc. Abuses will disappear along with the disappearance of the system that engendered them – this is today’s simplistic theory of human rights and freedom fighters.

However, the system that is breaking up into territorial pieces continues to exist in these parts, if in a reduced and somewhat modified fashion. lt does so in that representatives of psychiatry continue doing wrong with impunity, in point of fact having been acquitted not only of their past crimes but also of possible future offences. After all, they are victims, and it is not that easy to change stereotypes worked out in the course of many years! This writer has received dozens upon dozens of letters from people living in the various member states of the Commonwealth of Independent States – people pronounced mentally healthy by independent psychiatrists – informing him of illegal psychiatric examination and hospitalization, of threats on the part of psychiatrists and of the KGB, of official public health institutions refusing to rehabilitate them, of trying experiences in seeking a job, of unlawful dismissals and other social limitations entailing material need or even penury.

The public organizations formerly concerned with the issue of psychiatric abuses on the territory of the former USSR have virtually renounced such activity or are giving it just the slightest of attention. The reason is, obviously, that sponsors are not prepared to finance projects not in line with the trend of government policy. What could be expected of others if even the former APUP was ashamed of its name and changed its signboard into some abstract “Geneva Initiative”, leaving but a pitiful postscript in a small print line beneath. By its present-day style of work it will almost predictably change into a Dutch-Ukrainian print-shop for distributing instructive literature of a psychiatric profile among Ukrainians. To cultivate close contacts with the official bodies of public health in the former Soviet republics – this is the actual orientation of activities of the “Geneva Iniziative”. Not for the purpose, say, of clearing Ukrainian psychiatry of the criminals from the Dnepropetrovsk special mental hospital but for the purpose of cooperation. Now the victims of psychiatric terror do not experience any tangible benefit from such a rapprochement. As to the national psychiatrist associations, they seem to have buried the issue of psychiatric abuse right after the Athens congress, considering it to have been settled once and for all. True, the APA did demand a reconsideration of the Soviet All-Union Psychiatric Association’s membership in the WPA, but it did so only after the former had practically fallen apart.

The conditional reservation voiced during the WPA congress in Athens was never taken seriously by official Soviet psychiatry, which continues flatly to deny all accusations against it. Serviced by their foreign champions, the leading Soviet psychiatrists brazenly exploit the theory of “the system’s fault”, reducing the whole matter to those notorious “possible individual mistakes” and referring to the “factor of subjectivity in making a diagnosis”. They could fell all the more invulnerable as many national associations were vying with each other in inviting exSoviet delegations without excluding persons involved in psychiatric abuses. Only once American public opinion (to APA’s shame!) succeeded in blocking such a visit because the guest list included psychiatrists who had collaborated with the punitive institutions.

The leaders of Soviet psychiatry tried, in direct collaboration with the KGB, to split up the Independent Psychiatric Association (IPA) and to replace it by an analogous but controllable association having appropriated its name. Official psychiatric institutions refused to acknowledge the legal competence of any IPA experts’ psychiatric conclusions. As the Soviet Union disintegrated territorially there emerged psychiatric associations of the republics; these new associations assumed the epithet “independent” while retaining all the former structures and subunits as well as their staff – thus we now have an Estonian and a Ukrainian Psychiatric Association. A splitting up also took place within Russia. After the IPA a St. Petersburg Psychiatric Association was founded, and on 26th October 1991 the All-Russian association emerged from the All-Union Association of Psychiatrists. Yet the latter, proclaiming itself as Federation of Psychiatrists, pretends to continue existing. All these newly-founded bodies represent nothing else but a reshuffle of the same old Soviet psychiatry functionaries, according to territorial or nomination criteria. Among the members of these organizations there still are persons directly responsible for psychiatric abuses in the past or perpetrating them now. Only the IPA, which was the first to stand out against the background of Soviet psychiatry, has in its by-laws an item precluding a psychiatrist involved in psychiatric abuses in the past or at present from becoming a membar of this association. This is the basis on which its independence rested from the very beginning, along with its total difference from all other Soviet psychiatric associations. The former nomenklatura psychiatrists continue, as a rule, to hold leading positions in the new bodies of public health, including psychiatry. Their real power, their financial options and their close union with the punitive system -accomplice of their crimes – permits them to block the flow of disclosures as well as to prevent any meaningful changes within former Soviet psychiatry.

Being one of the reasons for neglecting the fate of victims of punitive psychiatry, the present attitude of former dissidents and today’s democrats deserves special attention. These people just slobber over such topics as “the system’s fault” and “the guilt of all and sundry”. Regarding yesterday’ 5 partocrats or lickspittles adjusting to “run with the pack” all is clear. They are out for self-justification. But how is anyone to understand those who had paid a price for the right to defend human dignity if today they behave in a way altogether crossing out their entire former behaviour? What’s the worth, for example, of Sergei Kovalyov’s apprehensions, expressed in front of former political prisoners, that as a consequence of disclosing the names of informers (an act he considers undesirable) the democratic group of the Russian parliament might lose a great number of its members? A fine lot in which this former prisoner of conscience finds himself and which he is so anxious to preserve! Or Vladimir Bukovsky, nowadays shaking hands with the boss of a certain criminal department and seeing eye to eye with him regarding the inexpediency of publishing the KGB secret agents’ names. A hero indeed! Semyon Gluzman, whose name is linked with General Grigorenko’s history, readily put this name of his at the disposal of the Soviet semi-official organs which had decided nominally to reorganize a part of the former All-Union Psychiatrists’ Association as the Ukrainian psychiatric association. With “independent” added. The entire psychiatric nomenklatura of the Ukrainian oblasts (districts) alongside with Gluzman turned into active founders and members of the new organization. Including the head psychiatrist of the Ukrainian ministry of the interior. Why then mention the punitive doctors of the past! Well, up to now it has not come to our knowledge that the ethical commission, headed by Dr Gluzman himself, has raised the question of inadmissibility of offensive persons, say, from Dnepropetrovsk special mental hospital, to an “independent” association. Maybe just because Gluzman, like many others, adjures us all “not to take revenge”.

The theme of non-admission of “revenge” against Soviet party apparatchiks, KGB officers, punitive psychiatrists and others responsible for crimes perpetrated during the Soviet period of history, is being imposed by the same champions of “stability” and put forth as a primitive speculation by anybody deeming he would not be up-to-date were he not to parrot banalities repeated on every street corner. Publication of the crimes committed by the regime and of the names of the persons involved must first and foremost result in the removal of these individuals from public and economic domains, which afford them power over society on all levels. Psychiatry as an important branch of medical science certainly is one such domain. Today anyone guilty may say: “I won’t do it again, only don’t disgrace me before society, and let me keep all I have.” But who will guarantee that scoundrels, not having been exposed and removed in good time, won’t resume with new energy their former activities if tomorrow dictatorship will again seize power? We could rather guarantee the contrary. Anyway no person in his senses is able to explain why a single mother of several children should be judged “with all strictness of the law” for shoplifting a jacket for one of her little ones, while the people who killed Alexander Mironov in Kazan mental hospital should “not be exposed to revenge”.

The present fate of yesterday’s victims of psychiatric arbitrariness in the former USSR is awful. Particularly in the case of those not bearing a big name as political dissidents: they are subject to administrative persecution. In despair they turn first to Soviet authorities that won’t lift a finger for them, then by old memories to former dissidents, or to Western organizations. But the former champions of the “insulted and injured”, by means of such charity having gained fame and financial contributions to their organizations’ funds in the past, today have turned away from the victims of a regime whose ruin they do not perceive as everybody’s joy but rather as approaching apocalypse.

What is to be done? How are we to help people who by suffering have more than earned the right to help? There seems to be just one single means – to try and do all we can for each victim individually. The IPA has records of such people and is prepared to take upon itself the work of giving help and distributing support of every kind. This team of enthusiasts is to be wished that they may honourably discharge the ethical traditions refflected in the by-laws of their organization.

Zurich, 23rd February 1992

Authorized translation by Hanni Tarsis-Dormann

Psichiatria e Territorio, vol. XII numero 1-2, 1995.

Bogdana Tudorache *
* M.D. Psychiatrist “Gh. Marinescu” Hospital Bucharest

Post-totalitarian doubts of psychiatry

Psichiatria e Territorio, vol. XII numero 1-2, 1995.

Any reference made to health – and especially to mental health or psychiatry in Romania – must necessarily be taken against the background of a simultaneous analysis of the Romanian historic context and the psycho-social problems devolving from this context.

The social ideology of the last forty years, intolerant as it was towards the diversity of opinions and options, aimed at forcibly levelling the human soul, at changing the individual into the “representative” of a doctrine which wanted to annihilate any really personal way of expression. Psychic ailment was changed into an “opinion misdemeanour” , in that kind of society. Completely absorbed by his or her experiences (which could not be added to every-day worries), the psychotic was considered as completely responsible of this “betrayal” of the society, which tried, in its turn, to retaliate by a rejection and isolation hardly hidden by the idea of a need for expert care and protection.

In order to build up communist society, certain categories were completely indesirable, starting from the assumption that minorities of all kinds had to be either assimilated, or done away with. The psychotic used to be a minority, a trash, which was not worth any effort, its existence being completely ignored. The reaction of the authorities towards psychotic suffering had become more and more intolerant and aggressive, in keeping with the unwritten rule: “he who is not like us, has no right to live”.

These concepts materialized in a lack of material and ideologic interest of the Romanian socialist society and of the authorities in improving the situation of the psychotics or in any attempt at updating the outlook on the psychic suffering.

Under these typically socialist circumstances, Romanian psychiatry has had a unilateral development, during the last thirty, forty years, which was inssuficient both theoretically, doctrinally and practically, in point of patient approach, with its complex problems and multiple suffering.

Romanian psychiatry had the general evolution of European psychiatry, after WW II. After the instauration of the communist system, the country’s self-isolation, its ideologic dependence on the Soviet thinking made psychiatry totally dependent – in the first half of this interval, and partially afterwards – on the dogmas of Soviet psychiatry (by an popularized implementation of Pavlovism), fencing it into a reductionist organicism, which marked the practical, social side of this science too, triggering off mainly on the psychotic himself. The chronical character, specific to a certain extent to this medical branch, was incorporated into the notion of “irrecuperability” in a simplist way which was highly detrimental to the patient.

The purposeful isolation of Romanian psychiatry from the grat trends that inspired the European psychiatry (antipsychiatry, desalienism, social psychiatry, development of psychanalysis, etc.), led to a complete cut off of its access to modern theories, innovating trends, to a rough rejection of psychosocio-therapeutic techniques.

The logical consequence of these phenomena is the fact that the Romanian society has got only very few establishements for the protection of mental health, except the nursing home-type psychiatric hospitals, which are still the only official altemative for psychiatric care in most parts of the country.

Romania has got 22,458 beds (1 to 1,000 inhabitants) distributed as follows:

– 42 psychiatric hospitals, out of which 2 with over 1,000 beds, 36 hospitals with a capacity of 100 to 1,000 beds and 4 hospitals with a capacity of under 100 beds.

– 65 psychiatry wards in general hospitals, out of which 22 wards with a capacity of 100 – 1,000 beds and 43 wards under 100 beds. The average number of days spent in hospital is 32.7, varying according to the types of wards (neuroses – 18 days, chronical diseasses 68.5 days), while the patient hospital days relation is 13 per cent of the total patient-hospital days figure; the bed usage index is of 288.7 days.

Certain attempts at completing the psychiatric care system by creating some out-patient and semi-outpatient units, in the sixties and seventies, which should have introduced new types of activities by working from within the community, led nowhere. Such units are still playing a role of selection and control, of guiding the patients. Under this circumstances, any psycho-social intervention in Romania is extremely limited.

In fact, the staff in the field of the mental health is very reduced: 3.8 psychiatrist (even 1.4 in certain regions), 5.7 psychiatric nurses, 0.87 psychologists and only 0.53 social workers for 100,000 inhabitants. To this one can add the contents of training, which is still mainly biologistic.

Psychiatric training (resumed after a ten-year pause) lasts for three years, out of which one of theoretical courses, having no organized psychoterapy training. The psychiatric nurses have no special training other form that of the ordinary nurses; after two years of post-highschool training, they join the psychiatric services straight away. The psychology department of the university – offering for years traning – resumed its courses after a twenty-year pause. A school for social workers was created in 1990, as this profession is quite inexistent in Romania.

The structure, the contents and the form of the present-day training of Romanian professional mental health experts have unfortunately remaind almost the same; they can be altered only very slowly and with many obstacles.

In fact, that situation of Romanian psychiatry has not changed too much two years after the december 1989 events. One might even say that things have even deteriorated in certain respects , as a cosequence of the disastrous economic situation and of the unstable political status of our coutry.

Only nine per cent of the national budget and 10.65 per cent of the budget of the state administration were yearmarked for health last year, and these funds have decreased even more in 1992 (7.7 per cent and 9.94 per cent respectively). The budget of the Ministry of Health is 70 thousands millions Lei under the level of bare necessities this year, the Romanian health system being on the verge of collapse.

Under these circumstances, the Romanian psychiatry is still one of the most disadvantaged medical branches (though the psychiatric diseases are fourth cause of illness in this country), ranking in no way among the top priorities of the Romanian health care system. Thus the social, moral and biologic disaster is joining in the economic nighmare. The political instability the struggle for power – to which one may add the cold, poor food, unemployment, the extraordinary percentage of emigration ( a frightening percentage of which is represented by youngsters and intellectuals), disappointment, the lack of opportunities, the current apathy manifested even among most mental health professionals, are defining features of this post-totalitarian age. “We are experiencing now the disaster coming after the disaster; during these last two years we have passed from misery to the misery of post-misery” (Gabriel Liiceanu).

The so-much expected revival has not taken place, under these circumstances, in psychiatry either, which may be accounted for by an obstruction specific for all post-totalitarian societies brought about by the persistence of the old systems.

Several societies dealing with mental health have been created in Romania during the last two years (The Free Psychiatrists’Society, the Romanian Psychiatric Association, the Romanian Psychoanalythic Association, The Association of Clinical Psychologists, the Romaniam League for Mental Health, etc. ) as a natural outcome of the end of totalitarian darkness.

The conflictual interests on the one hand, and the attempts of certain psychiatrists to put behind their past compromises or of others to overemphasize these compromises, have unfortunately divided the Romanian psychiatrists in three categories: first those struggling for power and privileges, second, those who, despite conjunctural situations, are trying hard to be up the level required by the future of this profession and a third category – which is unfortunately represented by the greatest number of Romanian psychiatrists – relinquishing in noncommitment and apathy, who seem to have surrendered even the modest weapons they used to have.

The few attempts at making changes that have taken place of late in Romanian psychiatry (most of which are a result of certain actions made by private persons or by foreign organisations) are capable of rousing certain hopes, though they are not too conspicuous as they are still too scarce to be generalized.

Action must be taken at present at all levels. It is absolutely necessary to change individual and social mentalities, to keep a minimal balance of the economic and social life, to stir the interest of the political circles and state bodies (which are obviously concerned whith other things they deem of prior importance at present and in the near future and last but not least to create a favourable atmosphere, unfortunately, inexistent in professional circles either.

At the same time, there is a great need of getting the absolutely necessary funds, of having certain persons of organisations to cooperate with.

It seems easier to build from scratch than to mend!

But we are fully aware that this act of building or mending will be the task of whole future generations to come.

Romania ’92

In our sodalitium there are many perspectives.  In the photo  a talk of Roland Kuhn,  the  Swiss psychiatrist, who discovered  the antidepressant properties of imipramine. Kuhn was  important in the  existential  phenomenological psychiatry. He was connected to  Ludwig Binswanger, pioner in the humanistic psychotherapy “Daseinsanalyse”



Roland Kuhn

Forty years of antidepressive drugs

Summary. New antidepressants represent and extraordinary flooding of the pharmacological equipment. Depression is very frequent, determines a great suffering in the patients and may constitute a suicidal risk. The heavy burden for the public health system of new drugs cost is sometimes underlined, without the consideration of the therapeutic results and of their impact on the family and social environment.

From the experience made with the use of the new antidepressants we may obtain useful indications either for psychiatry either for general medicine. The drugs take effect not only on mental symptoms but also to somatic level. Don’t remember this may determine superfluous and expensive assessments. This refusal of the body is legate to the return of a dualistic conception about the separation between soul and body.

[…]

2. Psychogenetic hypothesis of depressive states.

These facts allow acknowledging a biological fundament of depressive states, which – yet – has been often recognised. It is known that depressive states show a certain similarity with the mourning following the loss of a beloved relative. Also other hard events can provoke a depression. When such a cause for a depressive state is found or even only hypothesised, one speaks of a “reactive” depression and therefore considers that many depressions have a uniquely psychic origin. Consequently, distinction has been drawn between “reactive” depressions, and “endogenous” depressions, which appear without a visible cause. “Symptomatic” depressions appear as a consequence of a sure organic brain damage.

Now, reactive depressions show not only psychic but also somatic symptoms. On the contrary endogenous and symptomatic depressions show not only somatic but also psychic symptoms. Among somatic symptoms you can mention: sleep disorders, tiredness, difficulty and slowdown of mobility, of brain activity and of decision taking capability. Feelings of oppression and heaviness derive from it. Often these manifestations are more accentuated in the morning than in the evening. Psychic symptoms of depression are above all depressed tone of temper, loss of capability of feeling pleasure, of cultivating their own interests and of establishing contacts with other people, and finally delirious and suicidal ideas.

Manifestations of depressive states that occur at the level of somatic functions are called “vital”, following Kurt Schneider who referenced to the philosopher Max Scheler. It is logical to think that somatic symptoms could be eliminated firstly also through an intervention on the body.

3. The discovery of medicines that act specifically against depression.

During the 2° International Psychiatric Congress, in September 1975, in Zurich, in front of a dozen of those present, I have presented a short report on a new chemical substance capable of improving and often healing depressive states. It was a summary of a more detailed account published in the special issue of Schweizerische Medizinische Wochenschrift, Swiss medical weekly (Vol. 87, pp.1135-1140, 1957), devoted to that Congress. It was the substance afterwards called imipramine (Tofranil). Chemical structure of Imipramine resembled at first sight the one of chloropromazine (Largactil). Yet, the new substance showed clearly an effect, which was different from the one of chloropromazine. It acted above all on functional disorders which – as we have just said – accompany depressions, that is on the vital symptoms.

The first paper was based on experiences collected in 40 clinical cases after an exam of a little more than one year. Once, important Belgian psychiatrist Bobon has said to me: “Your description is surprising. Particularly surprising is the fact that 95% of all that is essential for the clinical use of this substance can already be found in the first publication”.

The full text has been published in Italian Psichiatria e Territorio, Vol. XIV, N, 1 (1997).

This version has been traslated by M. Garuglieri

Also the Portugues colleagues are interested in the esistential psychiatry.    Maria Luis Fuguiera has cooperated  with Manuel Paes de Sousa. Their work has been influenced by Henrique João Barahona-Fernandes,  one of the most important psychiatrists of the 20th century, in  direct contact with Carl Kleist, Kurt Schneider, Karl Jaspers .

His work  deserves all the attention of students and academics in the field of psychopathology and phenomenological  psychiatry.

The Psychiatric Department of the  Jagiellonian University of Cracow has been managed for twenty years by Professor Adam Szymusik, a protagonist of the conferences in Lviv (Ukraine), from where his family came.  He was  commemorated by Maciej Pilecki in the Cracow conference in 2001.

Giulio Perugi (Pisa, Italy) at Lviv conference in a  presentation on Bipolar Disorder.

Also Pedro Varandas (Lisbon, Portugal), Fabrizio Lazzerini (Massa, Italy) Krzysztof Szwajca and  Grzegorz Iniewicz (Crakow, Poland) were speakers in the conference.

,

Maria Luisa Figueira with Manuel Paes de Sousa and Lara Severino in Lviv

Manuel Paes De Sousa, Maria Luisa Figueira and Lara Severino (Lisbon, Portugal) at Lviv conference

The conference in Yerevan (Armenia) in 2003, organised by Kostantin Danielyan.

The  Moscow conference in 2005 was held in the Serbsky Institute of Forensic Psychiatry, in cooperation with Valery Krasnov, president of the Russian Association of Psychiatrists. Amongst the speakers Johan Reutfors (Sweden), Alexander Bystritsky (USA),  Sergey Igumnov (Belarus), Maria Manuela Abreu (Lisbon, Portugal) and Alexander Filts from Lviv (Ukraine).

Alexander Bystritsky is an example of coming back, through Bridging, to his roots. He graduated from Pavlov Medical University in St. Petersburg, Russia in 1977. In 1976 his paper won the Gold Medal for the Best Student Scientific Paper in the USSR among all sciences. He emigrated to the US in 1979 to New York and in 1985  he moved to UCLA.

Some years ago the  vice Mayor of Forte dei Marmi, Ermindo Tucci invited MArio Di Fiorino for introducing la Première of  Andrej  Konchalowskj’s “The house of madmen”. The presence of Konchalowskj offered a  privileged opportunity for discussion.

Probably even for him it was an unusual setting, some film critics and film lovers, but above all there psychiatrists, patients, nurses.

The psychiatric institutions (the “house of madmen”, the mental hospital) undoubtedly do not enjoy good press and good cinema.

They have not had it in Italy too where, after all, a movement of opinion and of antipsychiatric struggle carried out a state law that enacted the end of mental hospitals, the only case in the world.

If we limit the horizon to the cinema, it is enough thinking to how “One flew over the cuckoo’s nest”, the famous film with J. Nicholson from Ken Kesey’s novel[1], represents the psychiatry.

The patients are released and are token out from that place of insensitivity, sadism, and denial of freedom.

And then we know how much taking out of the hospital the patients has been emphasized: because the freedom is revolutionary.

The freedom is derisive, if a person has a severe mental illness, if he has not awereness of its own conditions and he needs to be helped and treated.

I could remind that, after the attacks to the mental hospital, many patients have gone into the streets, out of the therapeutic way and without protection. And we know how much this cultural climate deters patients without insight from treatments.

But the image of the Russian mental hospital is also associated with the political use of psychiatry during the Soviet age, with the abuses committed against dissidents like Pliusch.

Di Fiorino remembered his first visit to a Russian hospital, the Serbsky Institute in Moscow in April 1986. He was part of the Italian delegation: they were keeping in touch when the Russians had left the international organizations in order to avoid the expulsion for the political use of psychiatry, and for the abuses against the dissidents[2] (Just at timeDi Fiorino published Koriagin’s writings).

It is surprising that from Russia today comes this gift. A work that reminds us that the mental hospital is first of all a protection.

“The house of madmen” tells a story among the horrors of a terrible war like the Chechen one at the time of front passing. There are not telephone system and electric line anymore, the train has not gone, it is happening something serious and the psychiatrist goes to look for a motor vehicle in order to remove the patients from the danger. The nurses leave the hospital.

In the hospital, the patients organize themselves to survive.

There is an emphasis on the protection.

While the hospital is bombed Alì, who is the patient who, for is collaboration with the nurses, is tied up during the short euphoria when the patients realize that they are remaining alone, succeeds in tranquillizing everyone; and he does it repeating  the orders as usual.

While the bombs are falling on the hospital, he orders the other patients to wash the floor: and everyone carries out. And the element restoring the calm is to remain in his own place, and to fulfil his own duty.

In other movies Konchalovski offered us a very realistic image of madness. I think about mental illness of Anastasia, the wife of “The Inner Circle”, gone mad by despair because her husband did not protected her against sexual harassments of a nomenclature important exponent. But still before, because she could not adopt a child, daughter of two transports in a Gulag.

The woman has a psychosis gravidarum, she asks the husband for naphthalene to remove the little animals that she feels, she talks about a fully hairy son, and finally she hangs herself.

In “The house of madmen” instead the tone is so different, at times there is a surreal vein, when the accordion is playing like the fife of Hamelin’s fifer, the scenes go busy, the colours are brighter and everyone begins to dance.

The leitmotif is the song by Brian Adams, the Canadian singer, object of Janna’s erotomaniac delusion.

The song sometimes shows us Janna’s delusional theme, sometimes the dreams, the hopes that insert the greyness of everyday life.

Di Fiorino wrote: “If a work always opens to so much readings, it is certainly a privilege to debate about it with the Author. I say what I see in it: it seems that Janna can hold together in her world the different registers, that of reality and that of delusion.

I avail myself of the presence of Andrei Konchalowski to draw a parallel and I will mention the cult-movie “Andrei Rublëv” by A. Tarkowsky, a 1966 movie of which Konchalowski wrote the film-script.

I refer to the episode entitled “The bell”.

We are in the XVth century. Even there the war is imminent (in a previous episode there is the capture and the devastation of Vladimir by the Tartars for the treason of the Great Prince’s brother).

This is the background, and Boris, the son of the smelter, lives a dramatic situation. The father, before dying, did not transfer to him, did not teach him the secret of the fusion; all the smelters were died by plague.

Boris takes these responsibilities of continuing the fusion. He is extremely anxious, he plays for time; besides, like he reveals  to Rublëv, he bears a grudge against his father, because the father did not transfer to him the knowledge.

He risks and he is able to obtain a very good bell.

I have always seen a metaphor of tradition, even if there is a transmission of knowledge.

Tradition: it is not only to receive a transferred knowledge, but it is the “invention” and the risk of reconstructing, like Boris does, with what one knows.

Going back to the hospital, even in this case the event of war, to remain suddenly without doctors and hospital nurses, determines a taking of responsibility.

And it is a litmus paper: when many patients put themselves in service of those more serious with neurological handicaps, they display what they have learnt, what has been transferred to them.

And it reveals that evidently the mental hospital is not a total institution that has crushed the persons, but certainly not “the place to recover” that the old psychiatrists claimed to have founded at the Age of Enlightenment  or Laing at Kingsley Hall.

It is only a mental hospital, where treatments and protection are assured.

Thanks you for reminding us the true meaning of mental hospital. This is a privileged opportunity that psychiatrists, patients, relatives of patients, lovers of cinema discuss with Konchalovski, therefore I will call upon him to speak for some prearranged speeches.”

 

 

 

[1]                      Albert Hoffmann, the researcher who discovered LSD, writes that the novelist wrote under the effect of LSD and other hallucinogens.

[2]                      Wing published the Pliush case close to that of Hamsun and Ezra Pound. To show that the temptation to bend the psychiatry to a political use has not been only Soviet.

In 2005 Maria Luisa Figueira organised the seventh conference in Lisbon. She invited many speakers from Eastern countries, Konstantin Danielyan (Armenia), Alexander Filtz (Ukraine) and Oleg Lapshin (Russia). In the photo she is with Mario Di Fiorino, Oleg Lapshin and Manuel Jara (Portugal).

The purpose is to bring together a wide range of approaches. Exploiting some of the differences we found a more classic nosological culture in eastern psychiatry, versus a more pragmatic and evidence based approach in western psychiatry.

In 2005 we have had a Bridging conference in Iasi (Romania) with  many speakers from Portugal, Italy, Poland, Moldova and  Slovenia. Amongst the others   Andrej Marušič (Koper, Slovenia)

In 2006 Ovidiu Alexinschi organised in Iasi this first course of Behavioural Therapy, with Isaac Marks and other speakers like Cosmin Popa and Mario Di Fiorino.

Alessandro Del Debbio (Viareggio, Italy) was speaker for the first time at this conference.

The dance of dervishes inaugurated the Bridging conference of Antalya (Turkey), organised by Rasim Somer Diler, a Turkish friend working in Pittsburg. He participated also at our conferences in Saint Petersburg and Lviv.

In  Saint Petersburg (Russia) in June 2007 a Satellite Meeting of 10th congress for Bridging Eastern and Western Psychiatry was held on “Anxiety and Affective Disorders”

Amongst the speakers Oleg V Lapshin and Mikhail Reshetnikov (Saint Petersburg, Russia), Yuli Fradkin,  Boris Mekinulov (New York)  Maciej Pilecki (Cracow, Poland),  Giulio Perugi (Pisa, Italy), Francesco M. Saviotti (Desenzano, Italy.

In 2009 we had the first Bridging conference in Baltic States, beginning with Estonia, in Tallinn.  Also Andrees Lehmetz, president of the EstonianPsychiatric Association, partecipated to the conference.

In 2005 Maria Luisa Figueira organised the seventh conference in Lisbon. She invited many speakers from Eastern countries, Konstantin Danielyan (Armenia), Alexander Filtz (Ukraine) and Oleg Lapshin (Russia). In the photo she is with Mario Di Fiorino, Oleg Lapshin and Manuel Jara (Portugal).

The purpose is to bring together a wide range of approaches. Exploiting some of the differences we found a more classic nosological culture in eastern psychiatry, versus a more pragmatic and evidence based approach in western psychiatry.

In 2009 we had the first Bridging conference in Baltic States, beginning with Estonia, in Tallinn.  Also Andrees Lehmetz, president of the EstonianPsychiatric Association, partecipated to the conference.

Andrej Marušič (Slovenia) participated in many conferences in Iasi, Moscow and Viareggio and was in the Board of the Journal. His main interest was the  Suicide Research. He died in June 2008

Johan Vanderlinden (Lovain, Belgium), in the conference of Kiev. Vanderlinden has been very active in the cooperation about the residential centers for Eating Disorders. He started to work in 1981 at the Eating Disorder unit of the University Center St-Jozef in Kortnberg (Belgium).  In the photo with Riccardo Dalle Luche, speaker in many conferences of Bridging

The yearly Bridging conference, held in Kiev ((Kyiv, kraine) in 2010 on “Contemporary Psychiatry Facing Issues” under the presidence of Alexander Filts. Amongst the speakers  Igor A. Martsenkovsky (Kyiv, Ukraine), Alexander I. Mironenko (Lviv, Ukraine), Orest Suvalo (Lviv, Ukraine), Alexander Anatoloyovich Revenok (Kyiv, Ukraine), Johan Vanderlinden (Lovain, Belgium) ,

In the photo some participants and speakers in the conference

Maris Taube with Maria Luisa Figueira and Mario Di Fiorino

Maris Taube (Riga, Latvia) is since 2004 member of the Internation Scientific Committe of Bridging.  He was the organizer of 2 conferences in Latvia in 2010 and in 2017

The 15th conference of Bridging Eastern and Western Psychiatry  on  “New paradigms of the treatment of Mental Disorders” was held in Moscow (Russia) in June 10th-13th 2012

 

According to the Russian doctrine of the “Third Rome” Russia or, specifically, Moscow succeeded Rome and Byzantium Rome as the ultimate center of true Christianity and of the Roman Empire.

 

Maria Luisa Figueira chaired with Vladimir Mendelevich (Kazan, Russia) the conference. Other speakers  Yu.Sovilap (Moscow, Russia, Vyacheslav M. Zobin (Moscow, Russia), Oleg Lapshin (St. Petersburg, Russia), Mikhail Reshetnikov (St. Petersburg, Russia), Boris V. Mikhailov (Kyiv, Ukraine), Paolo Lucarelli (Livorno, Italy), Giulio Perugi (Pisa, Italy),Michele Procacci (Rome, Italy) and José Manuel Jara (Lisbon, Portugal)

Michele Procacci (Rome, Italy) chaired many sessions in these twenty years of conferences in Moscow, Cracow, Riga and Iasi

In the Bridging conference of Vilnius (Lithuania), in June 2013, we have had the large support of an hystorical member of our sodalithium Igor Kolesnikov and his wife, the Lithuanian childpsychiatrist Evelina Petrauskaite .

Daniela Toschi (Viareggio, Italy)  and Riccardo Dalle Luche  (Massa, Italy) involved Adomas Butrimas (Vilnius, Lithuania) in “A tribute to Marija Gimbutas on the Origin of Old Europe, Indoeuropeans and Balts: Between Matrilinear and Patrilinear Cultures”.

Amongst the speakera Jelena Vrublevska (Riga, Latvia) and Laurynas Bukelskis (Vilnius, Lithuania)

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In 2014 Maciej Pilecki of the Psychiatric Department of the  Jagiellonian University of Cracow  with Maria Luisa Figueira was the President of Bridging conference in Warsaw (Poland).

At the beginning  of  the cooperation between  the Chair of Cracow, Lviv and the Italian journal “Psichiatria e Territorio”, since the past centyry Maciej Pilecki has worked to strengthen scientific exchange between East and West in order to implement and adapt common research, academic and other strategies. Since 2006 Member of the Editorial board of Journal “Bridging Eastern and Western Psychiatry”,   his  articles reflected his deep understanding of utilization of health care resources and delivery of psychiatric care to patients combined with splendid research and analytical skills.

He was speaker in in Kiev (Ukraine) in  2010. in Riga (Latvia) and in Moscow (Russia) in Year 2012 and  was  the main organizer of our yearly  of  Bridging Eastern and Western Psychiatry in Warsaw in June 2014 and in Cracow in 2016

Also Yuli Fradkin (Boston, US), often speaker in Bridging  events,  participated at the conference.

Organising the future conference.

In 2015 the 18th conference was scheduled in Lviv (Ukraine), twelve years after the previous one. Alexander Filts was the President. We were forced to suspend it because of the military operations that took place on the border with the separatist regions.

In 2016 our 18th conference of Bridging Eastern and Western Psychiatry on “The Varieties of Delusional Experiences. Human rights and Psychiatry” was held in Cracow (Poland), under the presidence of Maciej Pilecki.  Tomasz Gondek (Woclaw, Poland)  organised a symposium of  psychiatric trainees’ organizations” with  Irena Wojciechowska (Wroclaw, Poland), Orest Suvalo (Lviv, Ukraine) and  Alexei Bandati (Chisinau, Moldova).

Also Jacopo Massei (Viareggio, Italy) was speaker at Cracow.

Luís Madeira and  Ludgero Linhares (Lisbon, Portugal) discussed about the subjectivity help in there varieties of psychotic experiences  and about the new findings on the Psychopathology of 1st episode of Psychosis

 

 

 

 

In February 2013 in Marrakech (Morocco) a Bridging symposium on Dissociation  was hekd in the”Winter workshop on psychosis” with Maria Luisa Figueira and Mario Di Fiorino, Christa Kruger (Pretoria, South Africa), Alessandro Del Debbio (Viareggio, Italy) and Luis Madeira (Lisbon, Portugal)

In 2017 the second conference in Latvia was held in Riga, under the presidence of Maris Taube. Besides many Latvian speakers and chairpersons as Jelena Vrublevska, Ilse Berzina and Kevere, in the photo some speakers from Italy, Rosanna Ceglie (La Spezia), Angelo Maremmani (Viareggio), Laura Caccico (Florence), from Portugal, Ludgero Arruda Linhares (Lisbon), from Sweden Johan Reutfors (Stockolm).                                                                                                     The booklet “Temperaments, Melancholy and Mania”, of the Bridging series, was presented.

At the end of our conferences, the thought goes to friends, who have participated for years at the life of our sodalitium and have taken leave: Manuel Paes de Sousa, prominent Portuguese colleague, Adam Szymusic, director of Cracow and a forerunner of Bridgng, Andrej Marusic from Slovenia, who died too young, Salomon Resnik from Paris, Jorge Maltez and Virgina Ramos, from Lisbon, unforgettable friends of many of us.
In this photo Virginia Ramos, a dear friend, founder of “Bridging”, who has passed away. She was subjected to surgery in the spring of 2017.
We want to remind, among other important contributions to the study of psycho(pathology ), her translation in Portuguese of the Emil Kraepelin’s masterpiece A demência precoce , edited by Maria Luísa Figueira and Hagop S. Akiskal in 2004 .

In October 2013 Maria Luisa Figueira (Portugal)  has inaugurated the first conference in Tbilisi (Georgia) with the Georgian colleagues Tata Bazgadze,  Tinatin Ormosadze, Manana   Sharashidze,  Nana Zavradashvili  and  amongst the other speakers Riccardo Dalle Luche (Massa, Italy) and Paolo Lucarelli (Livorno, Italy), Jorge Maltez  (Lisbon, Portugal), and colleagues  from  Moldova and Azerbajan.

The second conference in Tbilisi (Georgia) in  April, 2017, with a satellite meeting in Svaneti region. It was organised by Tata Bazgadze.

Primo Lorenzi (Florence, Italy) has been a speaker in the conference, together with  Alexei Bandati (Chisinau, Moldova).  Indrek Alberg (Tartu, Estonia) and Taras Dasho (Lviv, Ukriane), managers of the conferences partecipated at Tbilisi Bridging conference.

In Iasi (Romania) in 2018 Ovidiu Alexinschi organised this second course of Behavioral Therapy, with Isaac Marks,  with many speakers Cosmin Popa, Tomasz Gondek and Mario Di Fiorino.  For spreading the techniques of behavioral therapy a booklet, with a foreword of Isaav Marks,  has been published “Exercises of Behavioral Therapy” with the lessons and courses held in Viareggio (Italy)  and Iasi (Romania) in the last twenty years.

In 2018 this second Bridging conference held in Tallinn, organised by Taras Dasho and the Estonian Indrek Alberg,  we’d like to remember some speakers: an Estonian psychiatrist, working in France, Piirika Piir Crépin, an Estonian veterinary doctor Pillerin Pawkson and 3 Latvian colleagues Ilze Pelne-Bērziņa, Jelena Vrublevska and Laura Kevere.

In 2019 Ovidiu Alexinschi organised the 21 Bridging conference on “Transdisciplinary approaches in Psychiatry” in Iasi (Romania). Among the speakers Marcel-Alexandru Gaina (Iasi, Romania), Domenico De Berardis (Teramo, Italy), Michele Fornaro (Naples, Italy), Gabriele Massei (Viareggio, Italy) and Francesco Simonetti (Massa, Italy).                                                                    Alexandru Duca Dorosevici (Chisinau, Moldova) is in the phto with Ovidiu Alexinschi.                                                                                                             The booklet “The Italian Experiment, fruit of ideological passion”, of the Bridging series, was presented.

Tomasz Gondek is organising the Bridging conference in Wroclaw (Poland)

Save the date. The 23th conference of Bridging Eastern and Western Psychiatry will be held in Saint Petersburg (Russia) on May 6-9 2021: “Psychiatry in a changing world”

Maria Luisa Figueira will be the President of the conference, with Igor Kolesnikov, Pavel Kuzmenko in the scientific committe and Mikhail Reshetnikov and Oleg Lapshin like invietd speakers .

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