Insane neglect of Romania's mentally ill

Pioneering Romanian psychiatrist Dr Radu Teodorescu recounts an anecdote about society’s attitude to the mentally ill in 1980s Romania

April 2010 - From the Print Edition

Before a Communist Party congress or when an important dignitary was visiting a town, the local police would bring out a list of names and addresses of schizophrenics. The police would knock on their doors, round them up, throw them in an ambulance, which drove them to a psychiatric hospital, where they were locked up until the official caravan moved on.
The authorities feared that during a speech - on the miracle of collective farming or quota-busting industrial output - a schizophrenic would heckle the visiting Minister, party official, or even the President himself.
To some degree the authorities’ dread was not that these schizophrenics would say something ridiculous - they were mad after all - but that they would stumble on the truth. A mind with a direct line to the unconscious tends to speak without inhibitions - such as asking for food if he or she is hungry or for travel, news, music, books or to be heard, especially if they notice such rights have vanished. Such sufferers were not an embarrassment to the regime, but a threat.
This story reveals a system with a bizarre relationship with the mentally ill in Romania - the subject of our undercover investigation on page 16.
Romania’s healthcare sector is heading for bankruptcy - among those patients in the conventional medicine sector, hospitals and family doctors lack funds and, despite a system which purports to be free at the point of access, bribery is endemic and hospital patients must pay for drugs and medical accessories from their own pockets. Reform is coming, but lacks the cash and institutional will to make a real difference in the short term. But for the mentally ill, it is even worse. These schizophrenics, bipolar cases and depressives are the forgotten sub-set of a system which itself is snubbed.
Our feature reveals the shocking problems in this sector, which is understaffed, overcrowded and prone to serial misdiagnosis. In some counties in Romania one psychiatrist serves a population of 320,000. Some medical doctors are forced to work in an alien discipline by prescribing drugs to schizophrenics. Asking a general practitioner to diagnose, give therapy and treat severe forms of schizophrenia is like handing a mini-cab driver the keys to a fighter jet.
In this system, some councils bundle schizophrenics, beggars, the handicapped and sufferers form Alzheimer’s into one institution - and feed them on the same drugs to shut them up.
Many institutions - with some notable exceptions - are often cut off from the community. It has been common practice for three patients to share two beds pushed together, while women and men often bunk and shower with one another. Although some local authorities do understand the need to integrate users in the community, many councils refuse to give up public buildings for the care of the mentally ill.
In Berceni, Bucharest, there is a halfway house where ex-users drop-in during working hours for therapy and activities to help them reintegrate into society – but this is inside the mental asylum where the majority of patients were hospitalised. The platform for the cure is an annex to the location of the most harrowing memories in the user’s history - this is like hosting a meeting for alcoholics anonymous inside a pub.
Clients of the healthcare system reveal a clear-sighted criticism of their own treatment - their disgust at having to bribe nurses and orderlies and even doctors, how they notice when an indifferent psychiatrist fails to correctly assess their condition, how offended they are that they must share beds with another patient and the irony of being locked in an isolation ward with up to four other users at once.
Decades on from being abused by a more sinister regime, these voices must not be discounted again as the ramblings of the insane - for they understand how their own health problems are as severe and as absurd as those of the system which is supposed to care for them.

Michael Bird