Greeks and Psychiatry in Crisis

Living in Greece, a country that faces a permanent crisis, and having completed my PhD research in the cultural construction of the psychopath, I started wondering whether psychiatry is affected by the financial crisis and recent state policies, or if its essence is immutable. In this article, I connect my PhD results about the cultural construction of psychiatry with the recent Greek financial crisis which has negatively affected psychiatric care in Greece. In this paper, I refer to the term “crisis”, which is used both for the Greek financial crisis and a psychiatric behavioral problem; Greeks also use the term “crisis” in everyday life and culture to express difficulty. Afterwards, I describe the way institutions formed the psychiatric reform in Greece, to show that it created instability and failed to reform the problematic context.

For my research, I follow the ethnographic method, better known as fieldwork. My study is based on long-term fieldwork in Athens and Tripolis, which was conducted with my participation in the daily procedures and activities that took place at two main psychiatric clinics in Greece for 42 months. I used semi-structured interviews for collecting my data, paying attention to verbal and non-verbal communication (captured using photos and videos). I collected more than 50 narrations from psychiatric patients who were living in the psychiatric clinics. This happened gradually, as trustworthy relationships were created, because of the awareness of “invasion” into a patient’s personal space. My personal communication with the respondents during the time transformed them from being “informers” to “donors”, using Seremetaki’s (1997) term, as we did not have a simple research relationship but a deeper communication, which usually resulted friendship. Some participants did not want to be recorded, so unstructured interview were used. After the end of the research, pictures and videotaped data were given to the participants.

My data gathered from urban and rural Greece has shown both a financial and an ideological crisis, which I would argue also has an historical background. Moreover, I was also induced to write this paper because of the 3000 people who have committed suicide in Greece due to financial difficulty (Proto Thema, 2014). According to Savopoulou (2000), whoever kills oneself suffers from a psychiatric disorder. I ask the question: Are all these people psychiatric patients? Another point of view in Greeks’ everyday life is the appearance of official documents showing a lack of money to feed the psychopaths inside clinics (Argyriadis, 2014). However, if one excavates historical sources (e.g. Foucault, 1974), they realize there has always been a psychiatric crisis, in addition to patients’ mistreatment. And then comes one more question: How long has psychiatric crisis existed in Greece? After in-depth research, one can find very useful information about the term “crisis” and its use in the historical past, as well as the “crisis” in psychiatry. In many parts of the “developed” world, there is a slow but steady decline in the numbers of medical graduates who opt for specialist training in psychiatry (Agrafiotis, 2003). According to Torres (1991), in most of the “developing” world, a chronic shortage of psychiatrists continues to work against reducing (not to speak of closing) the “treatment gap” between need for, and supply of, even basic care for the majority of the world’s mentally ill. This situation still exists in countries such as the UK, Australia, and the United States, where public mental health services would collapse without many immigrant doctors from low- or middle-income countries filling the vacant positions (Davis, 2012).

The term “crisis”

Τhe term “crisis” comes from the Greek κρίσις – krisis. It represents any situation that is, or is expected to lead to, an unstable and dangerous situation affecting an individual, group, community, or whole society (Kouzelis, 2005).

As I (2011) suggest, the term “crisis” usually refers to a negative change in the everyday, but in mental health terms, a crisis does not necessarily refer to a traumatic situation or event, but to a person’s reaction to an event (Kouzelis, 2005). One person might be deeply affected by something that happened, while another individual suffers little or has no side effects, in similar conditions.

During my recent research, I found out that the term “crisis” is used very often by Greeks in order to describe the financial crisis as a factor that makes people insane. In that way, the psychiatric crisis is strongly connected to the financial crisis while Greeks support the idea that the one brings the other.

However, the history of Greece is full of crises, either related to war or economics and political reactions. For instance, in case of a war, fighters acted with a passion comparable to madness. In fact, during periods of crisis, Greeks were always in panic, but were able to overcome their problems quickly. Actually, as Laing (1990) states, the feeling of crisis most of the time goes with the feeling of panic, but at the same time, this panic works creatively. This is very optimistic for the current financial crisis that has become a generalized phenomenon throughout Europe. In other words, the view of crisis as an incentive for making things better is more preferable than the pessimism of the crisis as destructive.

For a deeper understanding of how Greeks face crisis, I use the historical method. In anthropology, this method is essential for the understanding of a present situation, while many of us believe that history is always revised. Hobsbawm (1989) discussed an economic crisis in Europe, and Trevor-Roper (2010) saw a wider crisis, “a crisis in the relations between society and the State”. Trevor-Roper argued that the middle years of the 17th century in Western Europe saw a widespread breakdown in politics, economics, and society, caused by a complex series of demographic, religious, economic, and political problems. Taking into account this connection and the fact that most types of crisis are constructed, according my PhD research results, the Greek economic difficulty can be classified in this “general crisis”.

Another historical example is the social impact of the 1997 financial crisis that was evident in several ways (Lee, 1998). First, the sharp contraction in production reduced the demand for labour, which resulted in a reduction in real wage rates and an increase in unemployment. Second, a bout of high inflation during the crisis and its aftermath dented real household expenditure. Third, higher import prices as a result of real currency devaluation reduced the purchasing power of household income. Fourth, a substantial loss of property income (dividends, capital gains, and rents) reduced total household income. In addition, the welfare of poor households further deteriorated as the respective governments lowered spending on education, health care, and other social services as a consequence of the economic downturn.

The social impact of the crisis was substantial and, more importantly, the impact on poverty was much more severe in some countries than others. One important reason is that workers displaced from the formal industrial sector were absorbed in agricultural and (informal) service employment. (World Bank, 2000).

So, if we look back to the past, we can assume why the economic crisis matters for the rest of Europe.

Assumptions for the future

If investors stop buying bonds issued by other governments, then those governments in turn will not be able to repay their creditors – leading to a potentially disastrous circle (Proto Thema, 2013). Moreover, if banks in the weaker Eurozone countries that are already struggling to find enough capital are forced to write off even more loans – something that becomes more likely if the Eurozone economy falls deeper into recession – they will become weaker, undermining confidence in the entire banking system.

Eurozone banks may then find it even harder to borrow, and therefore to lend, potentially sparking a second credit crunch, where bank lending effectively dries up, hurting the economy further (Savopoulou, 2014). This problem would be exacerbated by savers and investors taking money out of banks in vulnerable economies, such as Greece, Portugal, and Spain, and moving it to banks in safer economies, such as Germany or the Netherlands.

These potential scenarios would be made immeasurably worse if Greece were to leave the Euro. The country would almost certainly reintroduce the drachma, Greece’s previous currency, which would devalue dramatically and quickly, making it even harder for Greece to repay its debts, and setting an even worse precedent (Proto Thema, 2014).

The psychiatric reform in Greece

The current financial crisis, and the responsive European political decisions, have negatively affected psychiatric care in Greece. The history of madness, as much as conceptualization and psychiatric activity, is in a great degree the history of society, the way in which it creates the Other (Foucault, 2004).

Having acquired EU membership, Greece adopted the Regulation of the Greek Council 815/84 on 26 March 1984, which provided emergency economic support for the psychiatry treatment program in Greece. This program was created for the development of new structures and services, aiming at social and professional reintegration of mental patients and persons with intellectual disability, and at the improvement of patients’ treatment conditions in the public sanitariums. An important result of Regulation 815/84 for psychiatric reform in Greece was the reduction in number of long-term diseased in public psychiatric hospitals. As a result, a new form of mental health service appeared with the development of dispensaries, centers of mental health, psychiatric units in general hospitals, pre-professional and professional training programs in restoration centers, and the creation of guest-houses and protected apartments in the community.

To re-ensure the continuation of these important initiatives of reform after the end of the special funding support by the EU at the end of 1995, the Ministry of Health and Provision made a long-term commitment to continuing the reformatted psychiatric services in Greece. A ten-year program was developed during the period of 2000-2009, called “PsychArgos”, which aimed at the continuation of the rhythm and the dynamic of the reformation with a stronger emphasis on social reintegration and the entry, in the working place, of people with mental health problems (Agrafiotis, 2003).

The first phase of the program implemented during 2000-2001, in the framework of co-financing by the European Commission, aiming to fight blockage of the working market for people with mental health problems. It was focused on continuing reinstitution of patients who are hospitalized in big public sanitariums in Greece. The second phase of PsychArgos was completed in 2009, during which the European Commission and the Greek government signed an agreement referring to the re-inurement of the continuation of psychiatric reformation. The third phase of PsychArgos started in 2010 and will continue until 2020. For the new phase, “Psychargos C”, a working group was created to expand the plan of the revised program, through three parts. The first part is programming development actions of structures in the society for the coverage of the total needs in the field of mental health, and it is formed on a district base. The second part is promoting awareness of mental health to the general population and preventing mental health issues. The third part is organizing the psychiatry treatment system (precinctation, observation, evaluation) and for research and educational actions.

As an in-progress program PsychArgos, is under evaluation for deficiencies related to selected goals, as they are specific to general strategies and to the applied politics of the Ministry of Health for achieving the Psychiatric Reformation in Greece, according to the Greek law 2716/99. However, discontinuity of funding will nonetheless lead the reformed psychiatric framework to a dead end.

I would suggest that one of the reasons for Greek psychiatric reform’s dead end is the lack of study of socio-cultural diversity. In other words, the to enforce a new psychiatric system does not take into consideration the socio-cultural structures and substructures of the country.

A culturally constructed psychiatry

Connecting crisis with psychiatry and taking into account the results of my thesis, I find it interesting to discuss all that madness in terms of the anthropological view and cultural construction. My ethnographic and historic research shows that the term “psychopath” is culturally constructed. In other words, the understanding and perception of madness and the psychopath are differentiated among social groups from time to time. In fact, if psychiatry is culturally constructed, the same happens with “crisis” in all its uses.

With such an analysis, the present article highlights the change of understanding madness, and connects it with the economic crisis.

According to Comaroff (1982), all forms of human societies provide medicine, a system of specific knowledge, practices, and healers, who observe and study the phenomena that cause anguish and threaten human life. The main issue is how, over time, mainstream medicine is created through symbols and knowledge, how it is legalised (and for whom), and how other forms of medicine are marginalised (Comaroff, 1982). The same questions appears about the quality of psychiatric care, which is related to a state’s economy.

The results of my research show that madness is sometimes characterised as ultra-power, sometimes as demonising and sometimes as a disease. The different perceptions of healing have at times moved to a metaphysical level (exorcism) and at other times are achieved by using drugs or mechanical support (such as electroshock). According to my research, we can conclude that even today both medicine and metaphysics co-exist in the perception of madness.

With the power of diagnostic truth, medicine imposes a variety of procedure to reset to a “normal” social background. A procedure of achieving this goal is the incarceration and the enforcement of discipline, something that is incorporated into other social institutions.

However, the constant changing of diagnostic criteria and their focus on the human body, as other research demonstrates (see for instance Rosenhan, 1973), proves that “patients” with the same behaviours are diagnosed differently by different psychiatrists. The rationale for incarceration in any situation is the hazard and fear of causing damage to others. The rationale which, according to researchers, enables doctors to perform experiments for therapeutic methods on psychopaths’ bodies, methods that are proved ineffective (Foucault, 2004). Foucault (2004), also talks about the power of state. This power is clearly captured in the Greek psychiatric care and the psychiatric explanation of desperate peoples’ extreme reactions. Especially when the reasons that cause those reactions are political and economic choices.

Conclusion

To conclude, “crisis” is a term with multiple meanings, but it is recently used by Greeks due to the financial problems their country faces. The financial crisis has also created a generalized crisis in the field of psychiatry. On the one hand, the psychiatric reform froze and psychiatric clinics are not able to supply their patients with the essentials, like food and clothing. On the other hand, ordinary people who find it difficult to maintain themselves or their families commit suicide. Greece is in crisis because subsequent governments in the country follow policies that help numbers prosper, but people feel depressed and unsafe. However, because of my recent research, I propose the historical method in order to show that crises like the one Greeks live are historically revised. I claim that we are not able to understand the present without its historical depth. I also argue that psychiatry today faces sociopolitical, economic, and philosophical pressures that threaten its existence as a medical specialty.

According to the data of the ethnographic research and the theoretical sources on which this article is based, there is an ambiguity between those who espouse the social-cultural model. Moreover, it comes under methodological questioning, the unexamined acceptance of the meaning of the “psychopath” and psychiatry. If one adds the results of studies (e.g. Rosenhan, 1973) that support the cultural construction of the crisis, then we are able to prove that it is important to find one common way of behaving to psychopaths (Davis, 2012).

I claim that psychiatry, in order to be saved, needs to embrace evidence as the standard that is applied to all practices (including psychopharmacology), return to the centre of the mental health field by embracing prescribing as only one tool among many, take a leadership role in reaching out to primary-care physicians, and embrace a population health perspective to think about the community as a whole, not only to treat mental illness, but also to increase mental health.

This study, based on local research data, expands the pre-existing research from rural to urban Greece, performing comparative analysis of both, up to institutions of incarceration with structures of social reintegration in modern Greece. By analysing them, it hopes to become a source for further ethnographic and historic research and studies in this specific matter.

In sum, the financial crisis has created a total change in human life that can be characterized by most Greeks as paranoia. This situation has negatively influenced the psychiatric system, the psychopaths who starve, and ordinary people who sometimes are characterized as psychopaths. The confusion of normality is a crucial temporal question that coincides with the psychiatric reform in Greece of crisis.

References

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