Identity problems and depression

The German psychologists from the Dresden University of Technology have recently made public the results of the research showing that over 160 million Europeans or nearly 40 percent of the European population suffer from various mental disorders. Depression is among the most common ones and the experts predict that by the end of 2020 it might become the most usual non-infectious disease in the world.

The situation in Ukraine is close to the European: people, especially those living in big cities are disposed to depressions, phobias and worries. We have more than enough reasons for this. However, in the developed countries people mainly search the purpose of life (their identity) and are anxious about this but in Ukraine the question of identity crisis is accompanied by the problem of surviving. It concerns not only the youth and mature people but those who have already retired as well. The Day talked to the psychiatrist of the Kyiv Pavlov Mental Hospital No.1, psychotherapist Volodymyr POHORILY about depressions and mental disorders typical for the Ukrainians, their reasons and the ways out of the crisis.

The experts predict that in a few years depression will become the most usual mental disorder and some of them even talk about “depression with a smile” when people pretend that everything is OK but are ready to drop when they come home and do not want to live. Why is people’s life getting sadder with the years?

“Let’s start with the reasons. The Third World countries characterized by poor medical provision development often have infectious diseases outbreaks just like it was in Europe in the 18th-19th centuries. Cardio-vascular, stomach and pulmonary diseases are typical for industrial countries. In the information society where psychic load is quite significant people often have mental diseases. In the 1990s in Ukraine we had all the three outbreaks: infectious, somatic and mental diseases. To some extent the infectious diseases are still common in our country because of tuberculosis and AIDS. As for the mental disorders, their number increases day by day since we enter the information era: we adopt the technologies and lifestyle of the developed countries. Ukraine, just like the whole world that is changing falls under the following principle: the society is changing, people’s relations are changing, so diseases are changing, too.

“One more peculiarity of our society is that our generation feels what happened in the country 50-60 years ago. I mean the sudden change of the traditional lifestyle. Formerly people traditionally went to the church, lived in small communities where everybody knew each other, knew about each other’s problems, it was normal to take interest in people’s life and help them if needed. People could count on someone equally in towns and villages. They got married within the communities and thus strengthened ties. Now most people live in cities and the traditional way of life and thinking is being lost. We have not created new traditions instead and nobody cultivates them. It means that modern people do not have their culture. The same happened during the period of industrialization in the 20th century. Valerian Pidmohylny described it in his novel Misto [The City. – Ed.] (depicting the feelings of a person who had just moved to a city). When old traditions are not maintained and new traditions have not been created yet there is a vacuum. Diseases spring from uncertainty when people cannot define their identity and understand themselves. If there is no identity people feel depressed, worried, afraid, etc.”

Does defining one’s identity mean that people have to “make” themselves? Build the system of social ties, find like-minded people and get accustomed to the society?

“Yes, it also requires the skills how to make oneself. Formerly people passed their professions from grand-fathers to fathers, from fathers to sons and they passed the traditions, too. Now it is very rare. Naturally, skills are not passed either. Moreover, the world has changed a lot: a lot of new jobs appear and the old ones disappear. I will give you an example: one of my classmates has finished a radio school. At the alumni reunion it turned out that he is jobless but previously he used to be the “coolest”: he had a lot of clients and orders. It means that if people do not have an identity – professional, religious, etc. – they face the emptiness that has to be filled in. People have a choice: to learn something new or fill it in with alcohol...

“Another example: someone’s parents have spent all their lives working at a plant. They live in a city but they have never read books or visited a theater, they have only worked for their child so that he or she could have a better life. However, even if their child has two higher educations he or she will face this vacuum of the identity crisis since parents have nothing to give, no traditions (how to behave in the world, communication skills or cultural traditions). Education cannot catch up with the changes in the society: technological changes happen faster. The emptiness leads to depression. One of the kinds of depression is the loss of purpose of life since when one is identical he or she has the purpose of life. But if one has acquired one’s identity and technologies have changed and one was thrown out one has to go the same way once again: go through depression, find the way to fulfill oneself and learn something new. By the way, people have the same feelings as if they have lost an intimate person. The psyche reacts to the loss with the same mechanism. It is a loss of an important object. This is how we are organized ontologically and genetically. New way of life requires new efforts for the adaptation.”

The Ministry of Public Health should deal with the issue of mental disorders. However, it looks like they do not take depression seriously.

“The reason is that the public health system in Ukraine was intended for treating other diseases but not mental ones (I mean the disorders requiring a psychologist or a psychotherapist), so practically the official medicine does not accept this challenge. Instead, the unofficial medicine does: private psychologists, psychotherapists that study psychoanalysis, Gestalt-therapy and other things on their expense. They provide help the people need. As a rule, we are approached by the people who are more or less cultured and educated. I mean that someone saw in an American movie a person visiting a psychoanalyst who helped; someone saw a working group, etc. Abroad, people go to a psychoanalyst when a neighbor, brother, sister or friends did and it helped. It does not exist in our country. Sometimes we have paradoxical situations. For example, someone is sent to a psychiatrist and the latter sends this person to a psychotherapist. Practically, after the hospital we rehabilitate the patients. In cities the situation is more or less good since people can find a psychotherapist or psychologist but in small towns or villages the situation is worse.

“I often talk to my colleagues (therapists, cardiologists and others) and ask them: ‘Why don’t you send your patients to the psychotherapists?’ For example, ischemic heart diseases, bronchial asthma, gastric or duodenal ulcer or hypertension – all of them are psychosomatic disorders (firstly all the symptoms are provoked by certain mental state). Then the soma (the body) suffers. That is why they have to be treated by the psychotherapist, too, otherwise these patients might have an improvement for a certain period of time but if the cause is not discovered their health will become worse again. But my colleagues reply that they repeatedly recommend their patients to address the psychiatrist but they get offended: ‘Am I crazy?’”

Why do we have a habit not to trust psychologists and psychotherapists and get embarrassed when hearing these words?

“The situation is the same all over the world. I cannot say that we differ a lot. There is a notion of stigmatization (biased attitude). If one has visited a psychotherapist or, especially, psychiatrist it means that this person is unbalanced, unreliable, etc. Such people might become pariahs. Even their acquaintances and relatives start avoiding them. It is very difficult to go through this isolation and nobody wants it. That is why people are afraid of being different.”

If the society is always changing is it possible to pass this identity to children once for all? Or will the life change again the way children will face it one-to-one?

“I cannot answer for everybody since this responsibility should be shared to some extent between the school and parents. New conditions require new ethics and new behavior. We have to somehow give our children certain basis they could rely on. I can only recommend and explain something to my children since if I insist I may crush them. I have to give them a guideline what to do, how to behave and what to choose. If I do not do it something else will fill this gap in and it is unlikely to be better. We should teach our children to get accustomed to the new circumstances and open something new in them. But if one’s parents have been humiliated for all their life what dignity will they teach their child? The same goes when parents’ priority is to provide children with food and clothes. What values and traditions will they give them? None. Children have to be given an example: if one has fulfilled oneself in the life he or she will pass their experience. I can only teach what I have learnt. There is no other option.”

Does the identity problem concern only young people who are socially active and want to fulfill themselves or the older generation as well? It is no secret that elderly people suffer from depressions and even commit suicides. Is it caused by poverty?

“No, poor people rarely commit suicides. Elderly people were educated in the Soviet time and not only people of advanced age but younger people, too. For example, my elder brother is 52 and he lives in Canada but he thinks using the Soviet categories. He memorized them in school, at university and at work and he continues thinking this way though the life is different. As for Ukraine, the social setup and values have changed and people have been told that their values are wrong. Does it hurt? Of course, it does. It is equally difficult to go through it like going through depressions, neurosis and worries. Elderly people who have retired have to to do something. But people do not know what exactly since they got used that their identity is their work, bringing up children, keeping the house, etc. Only few people are able to switch to something new: grow vegetables or start a business. The problem is the same: identity crisis of the elderly people.”

Is it normal to cope up with competition and rush somewhere all the time? Is “getting out of the race” a mental disorder or the sign that one is unsuccessful? Some efforts are needed to decide on this…

“Of course, living in a country without electricity as people do now in the ecological settlements without any facilities of civilization requires certain efforts. However, these efforts are different, the efforts to fight the nature. Everything is more or less clear. Here the competition requires being more self-organized and understanding oneself. We return to the question: do people know themselves, can they differentiate their emotions? We understand other people’s world through our own emotions.”

How would you characterize the Ukrainian society, is it infantile? What do people lack to increase their standard of living and enjoy the life?

“I would say it is adolescent since we believe politicians’ promises and we want to have a Messiah that would come and resolve all the problems. I will not resolve them but someone else will. I am speaking about paternalism of the Soviet Union when these functions were performed by the government. But even then it was impossible to protect people completely and now it is even less possible. Instead of getting more mature and assume the responsibility for their life people still rely on the state. I can give an example of my colleagues. Everybody complains that their salary is 1,500 hryvnias. It has lasted for 20 years now. Instead of thinking how to change their life, how to earn money another way people are still outraged and speculate about the good life in the West. I say: ‘I can help you, learn English, got to England, they lack psychiatrists there...’ No, for this a lot should be done… But nothing comes without efforts. Whatever our parliament, president and government are, nobody relieves us from responsibility for our lives and families.”