Do qualified psychiatrists exist in Ukraine?
One of the noticeable changes in Ukraine in the past couple of years has been the emergence of a significant number of psychotherapists and psychoanalysts. Significant number sounds rather abstract, indeed, but the reason is that no one has attempted to ascertain exactly how many. It is also true, however, that there is a substantial demand and supply there. In a way this phenomenon indicates that Ukraine is approaching the European standard. And there is the enigma of all those faith healers, although the kind of techniques they actually practice is far from what is observed in the West. It is no secret that a Ukrainian psychotherapist is increasingly often associated with what we know as real hard work, relieving one of various sorts of curses and so on. Also, one well-advertised as a physician may turn out to be a former accountant or suchlike. Experts in the field make it clear that psychotherapy in today’s Ukraine fails to meet universally accepted requirements. This is in part because the Ukrainian clientele simply cannot tell the original article from a charlatan. Meanwhile, psychoanalysis and related therapies have evolved in accordance with the law of supply and demand.
The Day asked Semen HLUZMAN, Executive Secretary of the Association of Ukrainian Psychiatrists, to comment on the situation that has finally developed in the psychotherapeutic and faith-healing domain, as well as on customer specifics.
WESTERN PSYCHOANALYSIS IS NOT ACCEPTABLE IN THE LAND OF SOVIETS
“I lived and studied in the Soviet Union where no one was allowed to use words like Freud officially (the last officially permitted reference to Freud appeared in the Russian Annals of the Communist Academy in 1930 in the report of a lecture by one Wilhelm Reich, one of the more colorful characters in the history of the movement — Ed.). The head of my academic chair would whisper, in a narrow friendly circle, that Freud had been the author of a great scientific doctrine. I felt inspired and eventually got hold of two works by Freud at a medical library. I read both avidly and then thought I hadn’t received answers to any questions I’d set myself, so the founder of psychoanalysis remained at the back of my learned consciousness, as a luxury I coveted yet could not have because it was officially banned. Why luxury? Perhaps because I was a born albeit spontaneous anti-Sovietist. The communist regime hated Freud, meaning one [opposed to that regime] had to learn more about his teaching.
As an upper-level student, I indulged in a different kind of psychiatry, leaving no room for psychoanalysis. I could see the dreadful aspects of Soviet psychiatry, when two patients would be confined to the same bed, and when it was clear that one should discuss not psychoanalysis, but others more important and specific things. As my graduation approached I had serious doubts about the very notion of psychoanalysis. I thought that Freud was long dead, that his concepts were obsolete, and that my friend and I were talking about something that sounded beautiful but totally unnecessary in Soviet psychiatry. Suddenly, I came up with a thesis reading that psychoanalysis was very close to Marxism, even though both concepts refused to accept each other, because each tried to explain everything. I shared my idea with a noted — albeit underground — Moscow psychiatrist. I asked him why Stalin was so opposed to psychoanalysis; after all the latter was supposed to confirm to his ideology. He replied, “Psychoanalysis was not born here, it has come from the West, meaning that it will never be accepted in the Land of Soviets.” While in a prison camp, I was fortunate enough to meet someone from what was then known as the All- Union Institute of Medical Information. He had translated foreign literature and sent it via the mail-order books service. Thanks to him, I could choose among much literary material, selecting what I thought would help me with my world view. And then I noticed that practically all those literary sources were packed with psychoanalytic theories.
The years passed, it was perestroika, and I had an opportunity to address a gathering of British university psychiatrists. It was an occasion I thought I would remember for the rest of my life. I had not prepared for it, so I just told them some of the problems facing Soviet psychiatry, about abuses and social hardships. I wanted my British audience’s sympathy and understanding of what we had to wade through, so I said, “Imagine! Even after Gorbachev came to power, people in the Soviet Union are still unable to find works by Freud and other [noted Western] psychoanalysts.” Afterward, I was approached by James Berlie, President of the Royal College. He said he liked my presentation, except for one thing. When you told us you had no works by psychoanalysts available in the Soviet Union, you made all of us think you must be a lucky devil living in a country free from them.
SECONDHAND TECHNOLOGIES AND ERSTWHILE PHILOLOGISTS
How does this explain today’s renaissance of psychoanalysis in Ukraine? Is this just more confirmation that we look like Europe did twenty or thirty years ago?
Hluzman: The fact that psychoanalysis flourished in Ukraine and all the other post-Soviet states is a phenomenon explained by the course of history. After the collapse of Marxism-Leninism people here were left with a gap in their mentality, their attitude toward the only correct decision and the only correct teaching. People in other countries realized that this was contrary to common sense, as every individual should be free to choose his own decisions, his own beliefs. We, in contrast, had discovered that we were eager to get an insight into what we believed was the all-explaining science of psychoanalysis. And this considering that psychoanalysis was not even considered marginal in the West at the time, but also, owing to its inability to be proven, existed as a structure formally known as rendering psychiatric and psychotherapeutic help. I was afraid of psychoanalysis being expanded, for the post-Soviet region offered ample room for such all-penetrating and all-explaining teaching.
Even now I am openly opposed to the kinds of psychoanalysis that have appeared in this country. I understand that certain things are inevitable. If there are hundreds of thousands of people avidly reading all those horoscopes, if Derkach, former head of the SBU, publicly stated that he had astrologists on his payroll, what can you do about all those individuals consulting all those psychoanalysts? Actually, there would be nothing wrong there, if only we had real psychoanalysts. Let me say that I know of only three or four such professionals. Now take the Lviv school. What they’re doing is not psychoanalysis, and it’s not surprising that they are not recognized by the International Psychotherapeutic Association. I have met Western experts in the field; they believe that what we have by way of psychoanalysis in Ukraine — a flourishing business, I might also point out — is a dubious phenomenon. Psychoanalysts constitute a narrow branch; these people have had to undergo many years of special training before receiving their licenses, meaning years of professional experience. While it is an established fact that most posing as therapists in Ukraine are quacks, few among us are aware of this. How do we go about professional training? What we know as young specialists — psychologists and psychiatrists — desperately try various “schools” in order to survive. Most such schools turn what’s best described as second- hand techniques. Say, we learn about a former accountant arriving from St. Petersburg who after spending a week here starts teaching us psychoanalysis. And this knowing that [the real] schools of psychoanalysis exist in Western Europe and the United States.
Then perhaps the Ukrainian state ought to keep all of them under rigid control, rather than let the whole thing turn into Bonanza for charlatans?
Hluzman: I don’t think that it’s a responsibility our Ministry of Health needs to bear. After all, psychotherapy, like faith-healing, is out of the reach of medicine. In the West, this burden is shouldered by whoever ventures in the field, then such people join professional associations, so they can decide who should be admitted or not in order to maintain their professional reputation. Ukraine, obviously, still has to travel a long way to reach that level. While in the big cities one can find at least a handful of professional psychotherapists (among them owners of genuine international diplomas) here, it’s very different in the countryside; people will eagerly accept whomever can put up an impressive appearance, pretending to cure man of incurable ills. Too bad we have no authorities in a position to explain things to people. As a result, people pay good money and are lucky to remain no worse afterward. Psychotherapy is a prohibited area now, trespassed upon by separate individuals eager to earn fast money on the side, where all kinds of quacks prosper at the expense of trusting patients who can afford to get what they think is better treatment at places other than government-run hospitals and clinics.
Personally, I believe that our government should oversee all such self-proclaimed experts, make them pay taxes, and prevent harm to their clients. For example, while in the United States, I was shown their Academy of Naturopathy. It’s true that they have nothing to do with the official health system, and they do have people believing in sorcery and all that, but all such people are closely followed by the authorities, so the slightest digression, a single patient’s complaint brings the naturopathologist’s career to a dishonorable close.
PSYCHOTHERAPEUTIC TRUTH
Do you think we have a purely Ukrainian traditional affection for miracles and for those presumably capable of working them?
Hluzman: I’d rather call this a disease resulting of our national mentality. All those following in Kashperovsky’s footsteps, believing all that nonsense, are manifestly trying to seek something very special, a cure-all that will help become right there and then. Say, I want to lose weight, yet I don’t want to stay on any diet or do any exercises. Why? Because it seems so much easier, so very more effective to go see a certain faith healer saying he’s sure to turn me into a premier danseur. Visiting the United States, I realized that they didn’t care to know about psychiatric abuses, dissidents, or social hardships. Everywhere I was confronted with basically this question: Is it true that you can watch this on television?
What I mean is that this disease is characteristic of not only our times. Even as I worked for a psychiatric hospital in Zhytomyr, I happened to witness the following interesting exchange. A ninth grade girl visited the physician in charge of the ward, asking if he could please give her some certificate, saying she ought to be exempted from exams. It transpired that the girl was on our patients’ lists, having undergone treatment for encephalitis. She had been administered all the required medications, yet nothing seemed to help. After that, in her words, her parents had taken her to an old woman in a village who rolled eggs. The girl insisted that she had been healthy after that. What does that mean? The girl may have been diagnosed the wrong way, so all the “miracles” subsequently worked should be attributed to this. Actually, there is no use trying to persuade people otherwise in Ukraine, considering that this country is still to learn to live in a civilized way. Yet we have to tell ourselves the truth, even if gradually.
Therefore, the psychotherapeutic truth is that there is demand but no supply of quality products?
Hluzman: Absolutely. Why do the Moslem countries have no psychiatric problems? Simply because most people are religiously affiliated, which means that they have their psychotherapy every time they offer up their prayers. A secular, agnostic individual finds living considerably more complicated. At present, the number of mental cases is not increasing, yet we certainly have many people in need of psychotherapy. We live in a country that has undergone substantial transformations. Previously, a woman, having discovered that her man was cheating on her, could visit the local Party cell chief and complain. This would mean a lot of trouble for the man. Our society has considerably changed since then. An individual could feel less comfortable, chilled by the vast horizons opening up before him and simultaneously one might experience a degree of uncertainty, fear, slight depression, and insomnia. There have appeared many prosperous individuals. These are dominated by the problem of reaching the ultimate goal. Quite a few of these — we all know this — are confronted by the question, What’s next? We know about Sisyphus rolling the stone up that hill, but in our case the stone never rolls down. His work is done and there seems no reason to exert any further effort. Or take all those young people from prosperous families turning into addicts past the point of no return. Here all those fake therapists find vast hunting grounds, for those drug addicts’ wealthy parents never seek aid at any of the certified medical centers. And then they know that there is such-and-such faith healer sure to help them, no strings attached except five-digit bills. No mention of social rehabilitation, without which any kind of drug addiction treatment proves useless. But that’s beside the point, of course.
What should be done about a situation like ours? Should we sit back and watch all those terrible things happen before our very eyes? Or should we risk finding someone we would believe to be a real psychotherapist?
Hluzman: I believe that we’ll have a database relating to such genuine psychotherapists before long. We cannot expect this from our government. This is something to be accomplished by those very genuine therapists, after they have cleaned their own stables. I know this is easier said than done. Not so long ago I met with two noted Kyiv psychotherapists, saying all sorts of quacks were stealing their clientele, leaving them practically jobless. I told them so what’s the big problem, why don’t you have your colleagues certified. They said they knew what was cooking and who was behind it, yet they couldn’t say it out loud, could they. Now I say that corporate liability, joint responsibility, whatever, seems the only way out. Getting a medical school degree is not enough in the psychotherapeutic field; it must be corroborated by trustworthy colleagues.
Yes, we are a downtrodden nation, we have been denied true psychology and genuine psychotherapy. Yet all this cannot justify our saying that we can do this and that, knowing full well that we can’t — or having only a vague idea about any of it.
