Czech's mentally ill still facing stigmas

PRAGUE, Czech Republic — Jirí Švarc strides down a corridor in the building where he works, cheerily greeting the people he encounters by name and sometimes chatting with them briefly in Czech.

A patient is playing the song "Fly Away" by Lenny Kravitz in his room, and the sound echoes out into the hallway as Švarc passes on his tour of the building.

At the end of the hallway he stops at a wooden door labeled with a gold plate reading "Izolace" in Czech.

This is the isolation room, accommodation for one, he says with a laugh. No one is in the room right now because all of his charges are being friendly today.

Sometimes the atmosphere is not so calm in his building, Švarc explains.

As psychiatrist and forensic science expert at Bohnice Psychiatric Hospital in Prague, Švarc is in charge of up to 35 patients who are court-ordered to get treatment for mental illness.

A recent study by the Czech Institute of Health Statistics showed a 30 percent increase in the number of Czechs who sought psychiatric help from 2000 to 2006.

This is a trend that started even earlier, according to Jirí Raboch, a professor at the psychiatric department of Charles University in Prague.

In a 2007 study, he reported a nearly 50 percent increase in first outpatient consultations from 1994 to 2006. He also noted an increase in the number of psychiatrists in the Czech Republic, especially in the field of outpatient care.

However, many Czechs still have negative impressions of psychiatry. According to a 2000 study, when asked to rank a profession on a scale of one to five, with five being the worst, Czechs placed psychiatry last.

Still recovering from old wounds

These negative connotations toward psychiatry stem, at least in part, from the Czech Republic's history as a former Soviet bloc country.

"In the case of the former Soviet Union, psychiatry had deliberately been used for the pursuit of the political goal of controlling minds," according to a study on the culture of former communist countries by Toma Tomov, Robert Van Voren, Rob Keukens and Dainius Puras in the book "Mental Health Policy and Practice Across Europe."

"This brought about an institutional culture in the psychiatric domain which is difficult and painful to leave behind, even to this day."

The study continued: "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."

As demonstrated by Raboch's study, this stigma has lifted slightly, but some of the negative connotations of psychiatry remain.

Changing opinions

In the Czech Republic, students go straight from high school to specialized universities, including medical school, for a six-year education. When Švarc graduated from high school in 1989, he couldn't foresee the impending revolution that would bring his country out of communist rule.

"My thought at that time was to finish university and emigrate to the West," he said.

After entering medical school, things didn't go as planned. Švarc found his medical classes too difficult and soon decided to change courses and pursue a career in psychiatry.

Other doctors looked down on him for this decision, saying psychiatry was not real medicine, he said.

But Švarc didn't seem too bothered by this condescension. After all, he doesn't do complicated procedures and work with the human body like most doctors do, he said.

Having been a psychiatrist for 10 years, Švarc is now the chairman of forensic treatment at Bohnice.

He does see that there are more visits to outpatient psychiatrists in the Czech Republic, although there has not been much of a difference at Bohnice in the past few years.

This does not necessarily mean there are more patients, he said; perhaps the data indicates more people are coming back for continuing treatment.

Either way, this is not necessarily an indicator of better mental health in the Czech Republic, Švarc said. Rather, it may mean these facilities are more accessible and less stigmatized in society.

The view that people with such problems are inferior, weak or even lying about their symptoms has lessened to an extent in the past few years, especially for certain illnesses, Švarc said.

For example, it's popular to diagnose people with depression because it's a treatable illness people are more willing to accept.

On the other hand, people will always be reluctant to accept a schizophrenia diagnosis.

"Psychosis will never be popular. Nobody wants to be psychotic," he said. "People are ashamed of it."

However, more outpatient psychologists are misdiagnosing patients with depression, Švarc said, in part to get the patients to return for further treatment.

If they get an unpopular diagnosis, patients will not come back, and the psychiatrist will not keep that customer, he said.

This means that when patients come to Bohnice after an outpatient doctor told them they have depression, the hospital is often forced to re-diagnose the person with a more serious, more stigmatized disorder right off the bat.

"Outpatient psychiatrists want to be a friend to patients," Švarc said. "But in the hospital there is no reason to tell them something that isn't true."