One flew over Pavlivka’s nest

Kyiv’s Pavlov Psychiatric Hospital is the largest in Europe and dates back some 200 years. During these centuries buildings have been torn down, new ones erected, asphalt roads laid, and power lines connected. The only thing that has remained unchanged is the stereotypical fear that sane citizens feel with regard to the premises and its inmates. Kyivans avoid being here on their own, and what information they have about mentally ill people comes from films and books, often blood-chilling stories like Ken Kesey’s One Flew over the Cuckoo’s Nest. In actuality, it’s not so bad. True, the doctors will tell you that they cannot always restore a patient’s psychological health. This is precisely why they are trying to teach their patients how to cope with their diseases — outside rather than inside their conditions. Here, nontraditional methods, besides the traditional ones involving pills and injections, are used. These include painting, contact with animals, and carpentry. Below is The Day’s report on the hospital’s nontraditional therapeutic methods.

HOW A CAT HELPED DISCOVER A NEW METHOD

Cultural life at Pavlov Psychiatric Hospital, popularly known as Pavlivka, mostly takes place in the rehabilitation ward, which ranks with Europe’s most progressive ones. The men’s ward has a real zoo with geckos, piranhas, water and land salamanders, cats and mice, parakeets, all kinds of other birds and fish, with chinchillas sharing some of the patients’ rooms. “We used to have a boa constrictor, but he grew so big that we decided to donate it to the Kyiv Zoo,” says Ihor Dubynin, the deputy head of medical affairs and head of the Rehabilitation Department. Zootherapy is not simply a way to keep the patients entertained; it is a sensational treatment developed by Dubynin about four years ago, when he was working in Pavlivka. During that period colleagues from Germany, France, the Netherlands, and the United States visited in order to share his experience.

“It all happened in a banal fashion,” recalls Dr. Dubynin, “when we got a patient, a man who was very withdrawn and severely depressed. He hardly responded to his surroundings and refused to communicate with anyone, until an ordinary stray tomcat appeared in the ward. The personnel started feeding it. The tomcat became my patient’s best and most trusted friend. He took care of him, fed, washed, and combed him, and cleaned up after him. In the end the tomcat settled in the patient’s room. Two weeks later the man was released from hospital without the slightest signs of depression or dejection.

Psychiatric patients are not lined up and then marched by burly orderlies to visit the makeshift zoo. The ward in which the animals are located is an open one and “acute cases” are barred from it. Here patients are allowed to have a cigarette over a game of chess or table tennis, and they can visit the zoo. Patients visit it so they can relax and enjoy their solitude amid live nature and singing birds. It is truly a welcoming environment. Patients not only play with the little animals, but also look after them. When people are in direct contact with nature, surrounded by living creatures, they tend to open up and become more communicative; a sense of responsibility emerges. The hospital zoo, which holds more than 30 animals, was created by the medical personnel and patients. The state has not allocated a single kopiyka out of budget money for this effective method of treatment. All the animals were contributed by physicians, former patients, and friends. “I often come here to watch the animals,” says patient Viacheslav, “because watching them is a very entertaining experience. Every day I feed the fish and help the labor instructor clean up the cages and change the water in the fish tanks. The other day Oksana (one of the labor instructors — Auth.) and I saved the life of a fish that got caught in the aquatic plants.”

WARD NO. 1: A FIREPLACE, LAMP, AND SCULPTURES

Work therapy is another rehabilitation method. Unlike zootherapy, this method is rather widespread, but Pavlivka has adopted a somewhat unconventional approach. When some of the chronic inpatients feel good, they can be assigned daily jobs. The hospital runs a joiner’s shop, where old wardrobes, beds, and plywood sheets are made into works of arts: carved backlit bedside tables or suspended ceilings with little luminescent lamps. Dali-style woodcarvings that embellish the walls of all the wards and rooms deserve special notice. Dr. Dubynin recalls: “Last March the patients and personnel carried out a cultural labor project entitled ‘Ward No. One.’ The patients carried out major, European-style repairs in the ward with a therapist; the result was a striking interior complete with a lit imitation fireplace, a niche for a large TV set, lots of soft, recessed lighting, a comfortable recreation area, and a lavatory. The state had no money for a project like this. Unfortunately, the women’s ward doesn’t have such gorgeous amenities.”

TERRITORY OF THE SOUL: OPEN TO ALL THOSE WHO ARE NOT INDIFFERENT

Ukrainian artists volunteered to help Pavlivka’s female inmates. The Kastalia Art Gallery on the premises of the psychiatric hospital is hosting an unprecedented project entitled “Kyiv Artists for Psychiatric Patients.” Exhibits are held here as part of the project. Next May the paintings will be sold at an auction, and the proceeds will be spent on water heaters and equipping a lounge for the female patients. Every day the gallery receives some 20 individuals, people who have overcome their fear of the notorious institution at 103-A Frunze St. The gallery is open to visitors from 12:00 until 18:00. Admission is free, and visitors can explore a display of icons and the most interesting works of art contributed by psychiatric patients to an exhibit called “Territory of the Soul.” The exhibit is open to patients during the first half of the day. But nothing happens when outside visitors encounter patients, say the gallery staff, adding that people of sound mind sometimes behave worse than psychiatric patients.

The Kastalia Gallery is not only a place of rest. It is also the site of art therapy treatment. Patients from Pavlivka and other Kyiv psychiatric hospitals, as well as outside visitors can explore these art classes. They mold figures out of dough or clay, or embroider. There are kilns to produce real pieces of pottery, figurines, and decorations. The clay kitchen utensils are as good as ordinary ones. Patients often present their crafts to visiting relatives or their favorite physicians, or they use them to decorate their hospital rooms. In a word, they are allowed to do their creative work as they please, without any creative restrictions. This is self- expression with the goal of revealing their inner selves, their inner world, and a way to rid themselves of their loneliness and overcome their illness. For example, children from Kyiv’s art schools and little Pavlivka patients have crowded the walls of the hospital’s juvenile ward with colorful graffiti — a true creative miracle. Young patients were observing this activity as well as taking active part in it. Now their works of art gladden the eyes of patients and visitors.

“It’s a process of creative self-expression,” says psychotherapist Iryna Morozova. “From these worlds emerge subconscious complexes and problems, something our patients are scared to admit even to themselves. They cannot be revealed through any other methods. Such activities allow them to untangle themselves emotionally and have a positive effect on the socialization process — in other words, they allow patients to adapt themselves to life in this society.”

“I remember the first display of works by psychiatric patients, which was organized by the Kastalia Gallery at the Kyiv Mohyla Academy,” says Semen Gluzman, executive secretary of the Association of Psychiatrists of Ukraine. “It attracted diplomats accredited to Ukraine, numerous journalists, noted politicians, art critics — and here were all those poorly dressed and strange-looking people proudly giving their first interviews, posing for the television cameras. It was a breakthrough into normal human society, normal human relationships, and normal non-Soviet psychiatry.”

Last fall the most significant event in the life of the psychiatric hospital was an exhibit by Antonina Chaikovska, a girl who has spent nearly all her life in the hospital. The exhibit was entitled “Flying over Pavlivka’s Nest.” Dedicated to people whose destinies are totally dependent on the state, this exhibit was a cry of an aching soul. We must do our best to heed these voices.