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Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004)
Y. Yur’yev


Y. Yur’yev

* Publication details:
Yur’yev, Y. (2004). Ukrainian “victimization” phenomenon and psychiatry as a science that deals with human mental and behavioural disorders’ studying. In: Yur’yev, Y. Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004), pp. 104–116. Dnipropetrovsk: Porogi.

So, on opening the “Kobzar” collection by T. Shevchenko there is a verse “Prichinna” that is about a woman, mad under the influence of bewitching magic. Then, his famous “Katerine” verse follows. From the one side, there is a mad girl, failed to meet her intended bridegroom, and from the other, there is a turned down and disgraced woman who ended her life committing a suicide.

What is that? Have the most honourable genuine classical author created the image of Ukraine, the image full of soul pain? Or may it be much deeper — maybe it’s our fortune? At last, why, after gaining the statehood and independence and having the best perspective chances to be a strong European country on the start are we taking a back seat in the world society? Why do we lose more people from committing suicides and hard drinking than the whole ex-USSR has lost soldiers during 10 years of the Afghan war? An objection can be made here on the subject that the quantity of people lost in Russia is higher (Russia takes the second place in the world on the suicide level: over 60 thousands of people are perished annually) and, in general, by the level of forcible death Russia is far ahead of Columbia, thus making it the most dangerous country to live in. But maybe we shouldn’t strive for the fact that in Russia there are 15 litres of drunken pure spirits per every citizen, including children and people of old age. Today in the majority of ex-USSR states, including Ukraine, there are:

  1. The most intensive decrease of the national gross product.
  2. The most miserable salary rate — 5–10% (60% and higher according to the world standard).
  3. Annual payment increase for public utilities.
  4. Gradually ruined institution of family.
  5. Serious ecological problems.
  6. Emigration of the most active population.
  7. Death rate increase (it exceeds the birth-rate in 2 points).
  8. The highest suicide rate among the population (Russia is on the 2nd place; Ukraine has the 8th).
  9. The increase alcohol and drug abuse rate.
  10. The aging of the population.
  11. “Life fear” phenomenon.

In his article “Valeology in solving the Ukrainian demographic catastrophe” (“Zdorov’ya Ukraini, no. 10, 2004, pp. 8–9) Gennadiy Apanasenko wrote: “The situation occurred in the post soviet area is not an exclusive one. For example, in the USA during the time of Great Depression by 1932 the industrial production was 47% reduced in comparison to 1929. The investments were also reduced in 4. The production was loaded 15–20% more then the capacities were available. The third part of population was unemployed. Millions of those who had shares were ruined; the country was overflowed by a bankruptcy wave. The situation was very similar to ours nowadays. The scaled similarity of the crisis permitted to predict the similar deterioration of the demographic indexes. Nothing of the kind happened. The majority of health indexes of the population, including death rate, saved a favourable dynamics. The suicide rate in America in 30s was up only for 5–8% more comparing to the dynamics of the previous years. In Ukraine the suicide quantity 58% increased from 1988 to 1999 and in Russia it increased for 60% (from 1990 to 1994). In 30s the expressed economic decay and the life level deterioration took place also on the territory of Europe. Although, the demographic situation did not have considerable changes: a death rate of England increased for 5%, in Germany — 2%, Sweden — 1%. In other states the health indexes stayed stable.

There is one more example that would lead you to non-material factors, that defines the life of a society. The post war years are characterised by the welfare increase of almost all the word’s countries, including socialist countries. At the same time the death rate was getting decreased.

But starting from the 60s under the increasing Gross Natural Product the death rate in the countries of the Warsaw agreement was increasing. In the so-called countries of the free world the death rate dynamics had the same positive character. What are the reasons of that phenomenon?

Table 1

Suicide dynamics in Ukraine (1999 — 29.8 per 100,000)

Region 1986 1987 1988 1989 1990 1992 1996
Ukraine 18.5 19.6 19.0 21.1 20.6 22.5 29.9
Crimea Autonomous Republic 18.0 19.4 18.8 22.6 24.0 25.9 38.1
Vinnitsya region 21.2 22.4 20.9 25.1 23.9 26.0 28.8
Volyn region 1.5 12.4 9.9 10.7 12.6 14.1 18.6
Dnipropetrovsk region 21.3 23.0 20.4 24.6 22.0 24.9 33.0
Donetsk region 21.6 23.4 23.0 25.3 23.9 25.9 38.2
Zhitomyr region 16.6 17.0 13.2 18.6 20.0 19.6 29.2
Zakarpattya region 10.1 11.1 10.7 12.2 11.2 13.4 14.4
Zaporizzha region 20.4 22.4 23.7 23.4 22.5 31.0 40.6
Ivano-Frankivsk region 10.2 9.5 10.3 8.3 8.3 10.2 13.0
Kyiv region (excluding city of Kyiv) 17.9 22.9 19.2 22.6 21.1 21.1 29.7
Kyiv (city) 11.3 13.4 14.2 13.0 13.1 12.9 13.7
Kirovograd region 23.0 22.5 22.9 29.4 27.0 31.6 38.2
Lugansk region 19.6 18.4 19.9 24.0 22.8 26.6 39.2
Lviv region 10.1 9.7 8.5 9.6 7.6 6.6 9.2
Mykolayiv region 19.7 22.4 23.5 24.6 21.7 23.5 29.4
Odesa region 2.9 21.3 23.6 23.6 25.3 26.2 34.0
Poltava region 21.6 24.1 21.9 25.6 26.6 27.7 35.2
Rivne region 12.4 12.8 11.5 11.0 13.8 16.2 17.1
Sumy region 24.1 27.2 28.3 28.5 31.0 32.6 44.4
Ternopil region 9.1 10.7 9.3 9.9 11.8 10.2 12.0
Kharkiv region 21.0 21.5 20.3 23.2 22.1 22.8 37.0
Kherson region 22.9 24.4 26.7 28.9 25.3 28.4 37.2
Khmelnytskiy region 17.1 17.1 16.2 18.8 17.6 19.4  
Cherkasy region 24.0 22.1 23.4 26.4 28.2 29.4 31.9
Chernovtsy region 11.9 9.6 10.4 13.3 11.0 13.0 13.2
Chernigiv region 25.1 30.6 25.2 25.6 24.8 31.3 39.5

So, our politicians and economists still cannot define whether “we should live or not, and if we should then in what way”. Let’s have a look at the world’s experience. In Britain, for example, in 1989 there were one or two projects on the mental health estimation of the population considered; now there are 50. Under the estimation of the Britain specialists, 1/4 of the population suffer from problems connected with mental health nowadays; and the mental illnesses are 4 times more frequent in the poor regions than in rich ones. Approximately 20% of the population of Canada that have the highest level of living live in general 6 years longer than the others.

If we look at the world’s costs for the scientific researches, we’ll find that USA has 39.4%; countries of the European Union have 26.2%, Japan — 15.0. Why then in Ukraine, despite the last Chernobyl warning, there are so few attempts to make the situation better. Tomorrow our “misfortune” may turn into “destiny”. Let’s try to think it over and realise the reason of our misfortune.

“In the middle ages, — said Jacob Burkhart, — two sides of consciousness — the one that turned to the inner world of a person and the one that turned to the external — rest like under the one veil (sheet) in the state of a dream or sleepiness. This veil dissipates first in Italy; a new objective attitude to the state and to all the surrounding things appears; but beside all the subjective start to appear: a person becomes a spiritual individual and learns himself as he is. In the process of intellectual (spiritual) and development a new class of people appears. A spiritual individual is changed by a writer, professor (scientist). The science rejects to obey the middle aged scheme of a religious way of life perception; it breaks off the mediated connection between the religious ideas as the constructive means and the reality… an objective approach and a positive science appear. A new attitude to the reality appears. With the development of self feeling and the subjective approach formation the outlook variety and the religious independence, the independence of Art and Science increase, and therefore the individual becomes free from narrow corporate life. If we try to find out the sense of the Christianity experience and to define its content we need to analyse the consciousness’ facts of a person of the epoch, as a definite spiritual system was initially put into the Christian mind. The above mentioned spiritual system permitted to create theoretically cognitive justifications of the inner world’s reality. The interests of the Christianity protection required the existence of such a justification. But another tendency won”.

The tragedy of Christianity included the fact that the most secret experience of a human heart life was taken from the individual life calm and turned into one of the mass movement forces of the World’s History. “In the result, — W. Diltey wrote, — along with the morals mechanism a mechanism of hierarchical hypocrisy appeared”. From the historical point of view we can watch the hard consequences of it nowadays.

Let us explain in order to bring the content of the “inner experience” up to the clear society consciousness. Any ideology or doctrine that is made by a certain group of people should be included into the complex of the external world representation having arranged it in the aspect of time, expanse, substance and causality. Many people still can’t digest a very fresh “experience” of the hypocritical “Christian-communistic outlook”. It happens because on the definite phase there was a trial to combine metaphysics and science by the cloning method. And the most tragic thing is that the experience continues to be carried out by some countries of the former USSR. Nowadays there is a kind of modern tendency of the feudal-serf system in Ukraine and in most countries of the former Soviet Union. Having been deceived, people have been taken the right for the part of the public riches away. But the most terrible thing is that they have been taken the real outlook that has been substituted by the “virtual reality”.

Now we need to touch those historical and other processes that were realised and are being realised now in Ukraine. “The collision of two Christian churches symbolised the collision of two cultural-civilized worlds: traditionally conservative, the Russian Orthodoxy with its definite characteristics, and western rationalistic, expansionistic, that was united into the single system by the catholic church” — B. Glotov wrote (2002). — “Separation of the cultural civilised, existence of people on the joint of civilizations and different influences of Poland-Lithuanian, Russian and Tatar-Turkish tendencies caused the duality of Ukrainian existence. Ukrainian people permanently thought what was better to follow the plough or to earn for living with the help of sabre”.

The analysis testifies that the historical existence of the Ukrainian people in many situations is not organized, negative and sometimes even tragic. And the whole history of Ukraine and Ukrainian people as a nation is the history of oppression, humiliation and enthralment. Thus, we can see that in the historical past we constantly were slaved and as for the cultural point, we were under the influence of other cultures. All this caused the formation of predisposition to different superstitions and prejudices, ambivalence and autism, irrationality, inability to assert interests, bad adaptation to the changing conditions, alcohol predilection and self destroying behavioural forms from the psychological and psychiatric point of view. There are also examples of other peoples, when guilt- and shame-based cultures were formed on the definite development stages, but we also can see how these difficulties are being overcome (Japan, Germany).

As it is known health protection is a system of state and public measures taken in order to preserve health, to prevent and treat diseases and to prolong human’s life. The governments of many countries, trying to provide a high qualified health protection of the population, face the increasing difficulties of financing and controlling the costs intended to be spent on the health protection. In many things it is caused by the existing disharmony between the nominating resource and the real one, and besides the addressing usage of the resource. At the beginning of 60s USA spent approximately 5% of its economical resources to the health protection. Economists predict that without the medical doctrine change the costs for the health protection can reach 20%.

The tragedy is that every two years one of four citizens of any country is deprived those medical possibilities he has. Health protection organizations all over the world note the annual increase of the sick rate of the population and this appears along with the constant updating of the health services’ diagnostic and medical basis. The modern society faces such difficult processes as global integration, the increasing ecological deterioration and the demographic situation, increasing suicide rate especially among the youth. For today there have been made a conclusion on the inefficiency of the existing doctrine that is based on the diagnostics and treatment of the disease’s results, the ending of the pathological process. The formation of new values and society regulations, the formation of personal motivation to health perseverance and strengthening, to upbringing a new civilization of active, healthy and successful people are placed on the first place. “A disease of a person — one of the psychosomatic trend representatives, Dr. Wolf wrote, — has more deep meaning as the adaptation aiming tend not only to the social and psychological threats and symbols destruction as they involve it into the interaction with other people”. According to American philosopher J. C. Cliton, “The society that is in the decomposing state and a state of a crisis causes the increase of mental disorders, misfortunes, confusion and even serious mental diseases”. There is a theory of “social disorganization” that got the widest spread in USA. It is considered that deep contradictions appear in consciousness and morals of the modern society. There is a conflict between traditional individual “norms-aims” and the retraining “norms-limits” that causes the “social integration” infringement and leads to the “social disintegration”. And many human diseases mainly mental appear on the basis. These conflicts according to the point of many supporters of this theory occur in different social pathology forms, such as crimes, amoralism, suicides and others. Besides, speaking of the social disorganisation and personality disintegration in any society we can’t miss the notion of “life fear” (Lopes Ibor). Philosophy and Medicine along with their difference from the first sight have too much in common and first of all — the reference to the immemorial points of a human being. Especially it concerns the most humanitarian medical field — psychiatry. Every of the notion, usually used by psychiatrists in their everyday practice – personality, consciousness, mental disorders, delirium and so on — in their basis are the main philosophical categories. The modern psychiatry can’t be dynamically developed on the basis of only medical texts as any society can’t develop and identify itself without scientific instruments mainly psychiatry and psychology.

Let us try to make a scheme of a suicide as self-destructive behavioural phenomenon.

Scheme of a suicide as self-destructive behavioural phenomenon

Y. Yur’yev, 2003

In addition there is a need to define also several important psychological and interpersonal adaptive factors that have a definite influence to the formation of suicide behaviour.

  1. Egoism and egocentricity.
  2. Low threshold of psychiatric and physical pain bearableness.
  3. Ambivalence, contradictory feelings and ambiguous attitude to the experienced problem.
  4. Rigidity of cognitive functions (judgment, attention concentration, limitation and life experience scarcity).
  5. Adaptive difficulties to the changing conditions: isolation-aggression and withdrawal as sufferings’ avoiding.

Now if we put all these factors together it will become why many people go away from life.

In the developing world in the result of scientific and technical progress there are huge resources that are stored and a big field of interaction between people and states was created (and the world’s integration processes are increasing in the present). And a modern human being’s consciousness can’t hold the amount of the gained knowledge. A modern person is still trying to find the answer to where there is the true and if it exists. Besides, any modern society need clear reference points of where and what way the development process would follow and what we are to wait for in future.

The social direction of medical researching includes not only the connection of medicine with sociology and not only the fact that medicine uses social discipline methods under the studying of a personality but also the fact that it causes the occurrence of such science fields that study the lows of organism functioning and human psychic on the public level. That’s why today one of the most important strategy directions of the successful development of any modern state is the formation of the effective psycho health managing system. It means the organisation of the optimal influence system for all the levels that form human psycho health. Nowadays, in the countries of the European Union there is such a notion as a personality’s right for a qualified and professional state management.

So, from the first side there are historical development processes of many peoples and from the other there is psychiatry. From the first sight these are incompatible categories but it’s only from the first sight. Let us examine what notions psychiatry operates. Facing the psychopathology, specialists study the symptoms that testify the disorder existence of the processes of perception, thinking and mood. At first there is a consciousness function disorder (adequate self-perception and the surrounding situation). Then there is a thinking disorder, the occurrence of thinking process disintegration. More often there are crazy ideas (ideas of reformation, prosecution) and also there is a notion of a definite integration level (adaptiveness of a person to the surrounding changing situations). And finally the mood of a person on the present moment (the pathology expresses as a depression or vice versa as a mania that is shown in inadequate high mood). It’s also important to examine the aggression and autoaggression.

The term of psycho health is as philosophical notion as psychiatric. Why then we are afraid to except the theory that the symptoms of psychic disorders can belong to the society as the single functioning on the same laws organism? Symptoms are signs, the dynamic and changeable notion and the problem is in their expressiveness levels. We are aware of the North people’s predisposition to alcoholism according to their ferment system. We are also aware that many people, especially Finnish-Hungary group have a high suicide percentage.

Today there are researches in which a parallel between traditional Russian weakness to alcohol and the ferment system features of Mongolian was made. Why then we should be surprised for what happens to people under the external influence.

Now let us examine those terms psychiatry operates.

Aggression —
psychological defense strategy of the subjective reality of a person based on instinct. Aggression instinct is one of the main four: hunger, sex, fear, aggression.
Agitation —
expressive anxiety and excessive impellent activeness accompanied by alarm; or alarm accompanied by excessive impellent anxiety.
Alarm —
fear feeling connected with the trouble presentiment.
Alcoholism —
a syndrome of alcohol dependence.
Ambivalence —
the notion that initially has been used in psychiatry for the characteristics of a personality state that feels polar emotions towards the same object (emotional ambivalence) shows mutually exclusive ideas (intellectual ambivalence) and constantly hesitates in between two contradictive decisions (will ambivalence). It was transferred to the psychiatric lexicon by E. Bleuler and was approved by S. Freud; this notion was widely used in psychoanalysis to characterize inclination and repulsion, sympathy and enmity, impulse to react and fear at the same time.
Avoiding —
a psychological defense strategy of the subjective reality based on the economy of intellectual and emotional resources.
Consciousness —
a state that permits to orientate in the surrounding reality and own personality.
Delirium —
fake statements based on wrong conclusions as for the external phenomena that do not meet the cultural level and the intellect of a sick person and can not be corrected.
Delirium caused by mood is a delirium the content of which coincide the mood (for example, a depressive sick person considers he is guilty in world destruction).
Delirium that is not connected with the mood is a delirium the content of which doesn’t meet the mood (for example, a depressive sick person considers himself a Messiah).
Depression —
from the everyday point of view it is a state of despondency, depression, sadness. In a medical sense it is used to define psychic state that is characterized by low mood, accompanied by the whole range of symptoms, such as fear, agitation, suicidal thoughts, low appetite, psychomotor blocking and different somatic symptoms, psychological dysfunctions (for example, insomnia).
Disorientation —
a disorder of time, place and own personality perception.
Consciousness’ gloominess — not full, not clear comprehension of the surrounding situation.
Fear —
alarm connected with conscious real danger perception.
Guilt-based culture —
a culture, in which an individual feels lack of self-respect under the inability to act in a socially allowed way.
Identity crisis —
a state of psychological disorientation and role combining connected with psychosociological alteration occurred in a very short period of time. It can occur in a transitive life cycle periods (for example, teenaging, maternity, paternity.
Imagination —
a mental activity that is not meet logics and experience.
Mania —
a disorder that is characterised with high mood, it can be ranged from carefree cheerfulness up to the uncontrolled excitation with high energy. The self esteem is usually overestimated; there are greatness ideas and an excessive self-confidence. The loss of the normal social limits can lead to the thoughtless, precipitate and inadequate behaviour.
Overvalued ideas —
thoughts that include inadequate statements, crazy way of thinking.
Perception —
a transformation process of physical stimulation into the psychologically estimated information; it is a psycho process with the help of which sensor stimulus are transferred into the consciousness level.
Psychosis —
inability to distinguish the reality from the invention.
Shame-based culture —
when the inability to act as in a socially allowed manner causes shame for the family, friends and other social groups.
Suicide —
conscious and intentional acts of a person aimed to stop life ability.
Thinking —
purposeful systems of ideas, symbols and associations, occurring in the process of a solution search; the thinking is in norm if its result is a logical system of conclusions.
Victimology —
is the examine process of rudely turned on victims that includes not only the research of a post trauma reaction but also other aspects such as how the victim became the attack object, what exactly physical or psychological influence did it experience, what are the consequences.

All those terms occur in our everyday life today. Besides, “we can’t deny that a conscious self harm causing, — E. Golovaha and N. Panina wrote (‘Social madness’), — is a sign of psychopathology. In that sense a state self-destruction initiated by its master and finished by the common efforts of the nation is a sign of a mass psycho anomaly at least. Suffering from mass psychosis society continues the disintegration processes moving from republican sovereignty to regional, class and parochial. The far the process goes the more it looks like disintegration and personality degradation for who pluralism means not democracy but schizophrenia”. Although the authors underline the difference between scientific analysis of the social disintegration problems and its allegorical or ironic interpretation in order to avoid the temptation of interpreting the society from the psychiatric point of view, making an analogy with consciousness’ disability and individual behaviour. In order to prove that they use C. Jung’s sayings: “From ancient times reasonable people understood the motive to serious dangers, such as social and political madness that do not represent causally required consequences of the external conditions but mainly were initiated by unconsciousness”.

Surely several thousands mentally sick people won’t make a big influence on the psycho health of the whole nation but when the quantity of behavioural and psycho disorders among the population increases progressively (the statistics is in the previous articles) it will increase the percent of erroneous political and economical decisions that are taken by definite people who have power.

Besides psychiatrists are aware of the induced psychoses (revolutionary insanity according to M. Foucault) and what about the erroneous political choice of the population who allocates the politicians with power? And in that point under the behavioural psycho disorders’ increase the percent of nervous and sometimes thoughtless decisions will also increase, thus making an affect to the state development in general. Examples for the fact we can watch by the election processes. And philosophers and politicians still deny a postulate about the influence of thousands and millions of people with behavioural and psycho disorders on the historical processes. It has been already clear for the West that’s why such a huge attention is given to the psycho health in the developed countries. And what is about the developing countries? May be they are not being developed only because its members’ psycho health should be better?

That’s why one of the attractive images of Ukrainian people nowadays is “Verka Serduchka” (similar to Ivan the Fool in Russia) and the dancing with the words “everything will be fine, everything will be fine, I know it” reminds Zar cult* dancing that was used for recovery. People are trying to recover by themselves breaking the “misfortune” stereotype. Methodology of philosophy and history goes far away from the borders of traditional cognitive reflection methods and makes an accent on the feeling of a human being. Nowadays political and ethical level of nation phenomenon is considering from the point of anthropological approach when it is represented as one of the collective identification forms.

I’m talking about global integration processes where developed countries gather together with the most powerful and perspective leaders. I think that in the third millennium there won’t be three separate worlds: the developed world, the developing world and the world of derelicts but the reasonable world of states with effective and centred on a human being life able organisation. USA and China has already becoming the leaders and the new states of the former USSR will finally find the referent points of the further development. There is a hope that European civilization having overcome such cataclysms as Middle Ages, mongolo-tatar yoke, the first and the second world wars will hopefully overcome the Soviet Empire destruction.

The only thing we need to remember is that there is just one step from the individual madness to the collective one and we need to do all the best in order to have the leader who understands that:

  1. Ukrainian people do not need a great Ukraine; they need a peaceful and satisfactory “Switzerland”, safe surrenders and for the own people.
  2. A lie of any kind is a killing factor for policy.
  3. The main sciences development, medicine development and the development of the Ukrainian culture should become a priority (only the reconstruction of high Ukrainian spirit is the way to progress).
  4. Psychic, spiritual and moral health of the nation are the main values and conditions of the normal historical development.
  5. The health processes’ management (first of all psychic) is one of the main functions of any state and any personality.

* “Zar” cult is a religious movement of Eastern Mediterranean in which group dancing, music, trance and canticle are used in a recovery process.

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