Our Experience in the Baltic States – 2004
Written by Ann Rosberg
In 1998 a woman psychiatrist by the name of Nijole G. Midttun from Vilnius, Lithuania made contact with us. She wanted to invite us to do some presentations in Lithuania. Since we were already committed to other projects, it was not possible for us to agree, even though we were interested. However, in the latter part of 2003 we resumed contact with her and she invited us to come to Lithuania to teach at the university in Kaunas, which is the second largest city in that country and also to make some presentations in Vilnius, which is the capitol. We agreed to come however, before we left, we made contact with another key person in the field of mental health in Tallinn, Estonia. The person we contacted was Harri Kyynarpuu. We also made an effort to make contact with the Psychiatric Association in Riga, Latvia, but did not succeed. We agreed a to accept the invitation from Harri to do some presentations at the Seewall Psychiatric Hospital, in Tallinn
When we arrived in Tallinn, we met Harri at the Copterline Airport that came from Helsinki to Tallinn. Our initial impression of Harri was very favorable. After we settled in our hotel, he took us to the Old Town and showed us around Tallinn and asked Jack if he still agreed to come and do the presentations at his hospital. Jack agreed and on Monday, we went to the Seewall Psychiatric Hospital and Jack gave his first presentation on the treatment of schizophrenia. This presentation was given on Harri’s ward which is dedicated to dealing with early onset patients based on the Finnish approach using a psychiatrist, psychologist and social workers. We were impressed with the apparent dedication of the personnel and their openness to new directions.
The next day, Jack did a presentation for the psychiatrists and psychologists at the hospital. The following day, Jack was asked to work with a young woman who was still in the midst of her first episode with schizophrenia. Her psychiatrist presented her and discussed the difficulty she had in dealing with her. It became clear that her focus was on the symptoms of this condition and not on some of the healthy parts that obviously this woman had. As a result of Jack’s consultation it became obvious that this woman was extremely frightened and felt that the hospital provided her with safety she didn’t feel outside of the hospital. So she did what she could in reference to her psychiatrist to retain her symptoms so that the psychiatrist would not discharge her from the hospital. Jack felt that the symptoms were more contrived than real and it was a very productive session.
After our stay in Tallinn, we traveled to Riga, Latvia by bus taking in the countryside. As I mentioned, we were unable to meet any professionals in Riga, so we spent a few days in the city enjoying some of its sights. We then took another bus and went to Kaunas, Lithuania where we were going to teach graduate students at the Vytautas Magnus University about psychotherapy and psychosocial rehabilitation.
The first day was an Orientation day with the students and this was very interesting because they apparently were quite shy and hardly anyone talked or if they did, it was in a low voice. You might say that they were either shy which was a part of their cultural makeup. As the days went by, they gradually started to speak more loudly. I think that I helped in that regard as well, as I talked to the students and tried to have them join us in our discussions.
In the beginning of our course Jack wanted the students to get involved and talk to him and answer questions or ask questions if they had any. Getting the students involved took a little friendly persuasion. The students were very bright and frequently they blushed shyly which we found quite refreshing and charming. After some time, they became more active. Surprisingly, there was a woman psychiatrist amongst the students who we found to be very interesting. She did not have to be there, she wanted to be there because she wanted to know more about the psychology of schizophrenia rather than the typical psychiatric focus on medication.
Let me tell you that I had the good fortune to be trained in this field of schizophrenia by Jack for the past 15 or 20 years, so as a team, we work well together. I specialize in psychosocial rehabilitation, Jack in psychotherapy of schizophrenia and other related disorders.
We were very pleased of course to find the students and the one psychiatrist open to new ideas. Not like so many of the traditional psychiatrists we have met over the decades who want only to prescribe medication. Which to me, translates to the patient, go away don’t bother me, I’m too important. It’s easier to just prescribe medication. I can hear the psychiatrist now, ‘oh, you’re a little anxious or depressed, - here you are, take this medication or let’s raise your medication’. Let’s not forget the pharmaceutical companies sponsor the psychiatrists meetings and they give them bonuses to persuade them to prescribe their medication. We are not opposed to medication if it’s given in proper therapeutic doses as part of the treatment package, which includes psychotherapy and psychosocial rehabilitation.
The woman psychiatrist in the class was warm, sensitive, kind and I truly believe when she does an intake on a patient, she listens with deep concern and being the sensitive kind woman that she is, she prescribes medication judiciously. I believe that she could help someone get well just with her concern and kindness and her strengths, a very positive attribute to have if you are a psychiatrist prescribing. Also, in our opinion, if psychiatrists prescribed medication and took the time to effect a treatment alliance with their patients we believe that the medication would be more useful.
Over the next two weeks Jack lectured and also showed many video taped unedited treatment sessions, which he had done over the years in several countries. The point being that actual demonstrations of active treatment methods are very useful in pointing out to both students and professionals that psychotherapy can help if the psychotherapist is willing to participate in the life of the patient that he/she is treating. At the university it proved to be an extremely helpful tool in helping the student to understand active psychotherapy methods. In fact, we were told by one psychiatrist in Vilnius that they were very tired of the traditional methods of psychotherapy, which included gestalt etc., etc. In this course Jack also included role playing as part of the course requirement. One student would be the psychologist and the other the patient. This seemed to activate them and help them understand the treatment ideas that were presented.
Another day, he had the students do a group, i.e. one student was the psychologist the other three were students who were the patients. You can see that this was not just another ordinary class where lectures were the primary teaching method. As an example one student was a manic depressive, one didn’t want do anything but listen to her voices and the third was extremely anxious. They spoke in their own language, Lithuanian. We thought briefly that the ‘therapist’ was loosing control of the situation and when Jack questioned them about this, we found out that the woman who was anxious was being helped by the manic depressive and the young woman, who really didn’t want to be there, was helping as well, by talking to the one student/patient who was so anxious. It was clear that this was a sensitive group the therapist somehow persuaded the other two to have empathy for the student/patient who was anxious.
To continue, Jack kept talking to the students informally, he would always ask if he was being understood and if they needed help understanding he would explain what he meant. He would always suggest that they ask questions, that this is an open forum. This course was meant to be an active one, as you can see.
I believe that these wonderful young students and a young psychiatrist had never had a class quite like this, and perhaps never will.
There was harmony between the staff members and with Jack and I as well. Jack had many papers that he brought to Kaunas, for the staff to copy for the students, not only papers that Jack authored, but of course other professionals as well. A generous gesture, I think, as they do not have access to many books, but are well read with what they have and they should not be underestimated.
Let me insert something that according to the World Health Organization third world countries get better results. Lithuania is a third world country but in our brief experience there the only difference was in the use of medication which was much less than other countries that we had visited.
The next to the last day, Jack showed a tape of a Russian woman (the students understood Russian), in view of the fact that Russia occupied Lithuania and the other countries and for many years and also many Russians lived in the Baltic countries, Russian was a very common language along with English and Lithuanian. So when the Russian tapes were shown, they were very interested and didn’t seem to be able to get enough of them. In fact, we allowed the university to copy all the tapes that we brought with us.
The last day, was test day and as anxious as they were, they all attended class and took the test. Their answers to the questions were very intelligently answered and I think all of them were able to incorporate much of the material that was taught in the class. Students were able to explain in English, which in itself was somewhat difficult for them.
I must confess that in the beginning I was not too sure about how much they could absorb, because of the intensity and shortness of the class. Forty hours in two weeks is very intensive. In the two weeks we were there, the students began to believe more and more how Jack’s method can work for almost anyone, if they adapt their own personalities to the method.
It is with regret that we left this university and these very bright students and this wonderful psychiatrist who participated willingly and with a great deal of knowledge. There was usually a student by her side translating what she didn’t quite understand, which I thought was very kind on the student’s part. Also, which I found interesting was that this young psychiatrist was able to explain many scenarios about her hospital where she worked, which was very important for the students.
In Vilnius there was an audience of students, interns and practicing psychiatrists and psychologists. They seemed to be sensitive and interested in Jack’s work. In a two day period, I believe they gained a different point of view from what they had in the beginning of Jack’s talk and the showing of a few of his video taped treatment sessions. He showed some tapes that were aggressive but very tender as well.
Jack had shown a tape of a treatment session of a young man with his first acute onset and Jack was able to overcome the symptoms of what appeared to have been a young man possessed by demons. He was able to overcome his psychosis in one single session of about half an hour. This patient that he treated at that time was not on any medication.
There was one psychiatrist in the audience who was obviously antagonistic towards Jack he chided him telling him he thought Jack might be the devil himself. We found out later that this psychiatrist was a sadistic person; a cruel person. We were told by one of the psychiatrists who worked with him that he had patients ‘lick their own shoes with their tongues to clean their shoes and many other such acts like hitting them hard ‘punishing the patient’. During the conference he bragged he doesn’t work so hard – ‘I sit and take it easy as much as I can’. This is not a professional this is a cruel man who sees pleasure in cruel treatment.
Conclusion:
Even though this was a very difficult trip the distance and the changes in climate it was well worth all the effort we put into this because I hope that we made a difference in some lives in the way some people treat people with any mental disorder whatever that may be. Jack throughout the course said many times, ‘we are all human beings, just human beings’. With this, I hope that this reaches some people with one thought in mind, that we treat people with respect and give them hope that they can and do get better and recover.
