Ivan the Ill

When an authority on Russia says the country is going crazy, it evokes images in the West of a nation in political and economic turmoil; of brutal regional warfare; of barons and mafiosi getting richer while the proles steadily get poorer. But when Boris Shostakovich says "Russia is going crazy," he is talking literally. He is a psychiatrist, and his diagnosis is supported by his colleague Tatyana Dmitriyeva--until 1998 no less than Russia's Minister for Health--who says "almost 90% of the population should see a doctor."

Russia does look to be truly unwell. Among its population of 145.6 million there are now 4 million registered patients with mental disorders, and the real figure is far higher; doctors say only a quarter of those who have mental problems seek professional help. Even the official figure is 20% higher than the incidence of mental illness recorded in the U.S. and most European countries.

While it can be argued that Nikolai Gogol, Fyodor Dostoyevsky, Anton Chekhov, Mikhail Bulgakov and many other Russian writers have long grappled with the issue of national sanity, the rise in mental illness has accelerated rapidly in recent times. In 1990, for every 100,000 Russians, 251 were listed as mentally disabled; by 1996, even that official figure had leapt to 386. Studies between 1974 and 1980 by the Russian Academy of Medical Sciences indicated that between 8% and 10% of Russian children had mental disorders; today the academy's mental health experts put the level at 18% to 20%. One shocking result, according to Valery Krasnov, director of Moscow's Psychiatric Research Institute, is that youths with some sort of mental disorder account for one in every three conscripts into the armed forces.

Shostakovich is a professor at Moscow's Serbsky State Research Center of Social and Forensic Psychiatry. In Soviet times it was better known as a psychiatric prison for dissidents. Today, the illness is real, and Shostakovich says the main cause is not some genetic propensity but rather the anguish and stress caused by post-Soviet chaos. "Poverty, instability, fears of an uncertain future, mass physical and moral traumas caused by crises and armed conflicts--all these have disabled the mechanisms that regulate mental health." He says the social upheavals have meant that "new powerful neuroses" have piled up upon old ones. "Many people have lost their habitual occupations and incomes," he says. "Millions were used to the idea that they were paid just for showing up at work. Suddenly people faced the necessity to work hard, to earn their money. This is the way it should be, but the changes came so abruptly that many failed to adjust."

Added to such new traumas has been the disappearance of help for those already ill when the changes hit. "We used to have workshops for mentally disabled patients who were not dangerous," Shostakovich says. "They did simple jobs like making caps or sewing bed linen. It gave them a stable occupation, which is very important for those with mental disabilities, plus a modest supplement to their meager pensions. Under the economic crisis, these workshops are closed or dying out."

To cope with these intrinsically disabled people and the burgeoning numbers suffering new stress-related mental illness, Russia has some 500 institutions and hospitals, with a capacity for about 200,000 people, or 5% of those officially registered as mentally ill. The institutions are overflowing and underfunded. Shostakovich says modern treatments for one of the most common mental illnesses, schizophrenia, are beyond the reach of sufferers in Russia, where the average pension is $22.6 a month, the average monthly salary $34.

Many among the newly ill once had salary, status and apparent lifetime security. "Svetlana," a doctor of mathematical sciences, was one of the fortunate, with a professorship at a Moscow research institute. Then, in 1992, it was suddenly shut, along with many other such facilities: the state was broke. With no effective social safety net, Svetlana and her colleagues were out on the street--in her case literally, trying to sell bed linen she had sewn. After three years of near-starvation, she found a teaching job with a new private college. She now survives on a small salary, but the psychic scars remain. "I will never get over those years," she says, "the feeling of despair that I wouldn't be able to buy a piece of bread for my son." Now 53, she is obsessed by fear that she will again lose her job.

Former Health Minister Tatyana Dmitriyeva is now director of the Serbsky Center where Shostakovich works. Her comments on the dire state of Russian mental health were made to the Moscow-based daily Trud. Under "normal and tranquil" conditions, said Dmitriyeva, "25% of the population is in need of psychiatric and psychological help." But under the pressure of crises, the proportion soars. "We have data on how the current crisis affects people's mental state. It is tantamount to an earthquake. Almost 90% of the population should see a doctor."

In Russia old and new, mental problems typically have started at the top. Ivan the Terrible, the 16th century Czar who ruled for 51 years, "very early lost the balance of his spiritual forces," as historian Vasili Klyuchevsky kindly put it. Peter the Great was called that because he was a reformer, but a stormy childhood and early alcoholism led him to nervous breakdown. Czar Paul, who ruled from 1796 to 1801, was "mentally unbalanced" when he came to the throne, according to American historian George Vernadsky. After Paul was assassinated, his son Alexander I started his reign with a nervous breakdown.

In modern times, there has been a series of at best unstable leaders. Lenin's New Economic Policy briefly offered glimmers of sanity, but the nation was plunged back into madness by Stalin, whom contemporary psychiatrist Vladimir Bekhterev diagnosed as paranoid. (Soon after Stalin heard of this, Bekhterev died in mysterious circumstances.) That dark age was followed by the disturbed and inconsistent Khrushchev reign. The ensuing Brezhnev rule ended with its leader and various of his advisers close to senility. Mikhail Gorbachev was, and is, considered mentally fit, but some have their doubts about their former President, Boris Yeltsin.

More than a year ago, Moscow psychiatrist Mikhail Vinogradov said "Yeltsin's psyche is inadequate for managerial work" and that he lacked awareness of and control over his actions.

In 1932, Ivan Pavlov, a physiologist who became best known for his work with dogs, also made a bleak observation of his two-legged compatriots. "I must express my sad view of the Russian--he has such a weak mental system that he is unable to perceive reality the way it is." But, given the nightmares ordinary Russians have had to endure in the ensuing decades, his judgment may be harsh. That cumulative "reality" might have driven an Orthodox saint crazy.

Reported by Yuri Zarakhovich/Moscow