WESTERN SKYSCRAPERS COMPETE WITH STALIN’S “GIFT”
Do Europeans look at mental illnesses differently from us?
I’m posing this question because last week I was in Warsaw, Poland, delivering a speech to an international group. Its members seemed genuinely surprised when I told them my personal story about how I was turned away from a hospital emergency room when I took my son, who was psychotic, there for help. The audience appeared even more shocked when I said there were 360,000 persons in the U.S. with severe mental disorders currently incarcerated in U.S. jails and prisons. When I also mentioned that the largest public mental facility in the U.S. is a jail and that the chances of a individual in the midst of a mental break ending up in a hospital versus a jail are three-to-one in favor of a jail — well, let me just say that I saw lots of jaw dropping.
Before I continue writing about mental health, however, I have to digress.
When the international group that I was addressing wasn’t discussing mental health, the conversation was about the crisis in Ukraine and I found my Polish hosts especially anxious about Russia and Vladimir Putin.
During World War 2, the Nazis destroyed 80 to 90 percent of Warsaw and stories about Jews in the Warsaw ghetto and how they were later slaughtered haven’t been forgotten. However, my hosts told me that most Polish citizens have made peace with Germany. (The Mercedes Benz emblem is proudly displayed on one of the city’s skyscrapers.) That sense of forgiveness is not true about Russia.
Stalin wanted control of Poland so badly that he cut a deal with the Nazis and invaded it in 1939. He kept control, with the blessing of the Allies, in 1945 and Poland remained a nation under the Kremlin’s heavy hand until the collapse of Communism and break up of the Soviet empire. Today, visitors walking en route to the rebuilt Royal Castle stroll by banners that proudly declare that Poland is a member of NATO.
One relic of its Soviet past is the Palace of Culture and Science, a structure inspired by the Empire State Building in New York. It was a “gift from the Soviet people” to Warsaw ordered by Stalin. Containing 3,288 rooms, it is one of the tallest buildings in the city. Without a doubt, it also is the most hated.
Ask older Warsaw residents and you’ll be told that only tourists visit it. I was one of them. A tour guide told me the observation deck on its 30th floor is the best place to look out over Warsaw because it is the only place in the entire city where you can’t see the Palace of Culture and Science.
My Polish hosts didn’t like Stalin’s gift and they made it clear that they felt Putin was as dangerous as Stalin. Few of them felt Hillary Clinton needed to apologize for comparing Putin’s antics and Hitler’s.
Now back to mental health, which was the focus of this conference.
I’m always curious about the way that other nation’s balance involuntary commitment and civil rights. When I checked, I discovered that Poland had adopted the World Health Organizations’ standards. Heavily influenced by the U.S., those standards declare that an individual with a severe mental disorder cannot be committed into a hospital against their will unless they pose:
A. an imminent danger to oneself or others, or
B. Helplessness, i.e., inability to cope with the basic needs of everyday living
C. Substantial harm to that person’s health as a result of deterioration of his or her mental condition if that person is not given psychiatric care.
Poland adopted A and B, but not C.
Given that the WHO criteria mirrors some of the same language as commitment standards in the U.S., which are set by each state, I wondered why my European audience was so shocked by my personal struggle to get my son help and my statistics about incarceration.
Here is a sampling of what I was told.
“In the U.S.,” a psychiatrist told me, “you think everyone must pull themselves up by their own bootstraps. We recognize that the weakest among us often need help. This is why many commitments are not based on if someone is or is not dangerous, but on if a person is clearly ill and needs help. If so, then they are helpless and we intervene.”
Put simply, while imminent danger is a criterial, it often is not the overriding one.
“The U.S. has always been hyper focused on individualism, especially personal liberty,” another doctor said. “A citizen can do whatever he wants if he is not interfering with another person in the U.S.. That is engrained in Americans. We Europeans are an older culture and we believe citizens have certain rights but if an individual becomes mentally impaired, then his individual rights should and can be abrogated for his own betterment and also for the overall good of society. We do not believe in letting someone who is crazy roam our streets.”
Clearly, a more paternalistic view.
Here is the last quote: “Most of our countries — especially the former Soviet republics — have not closed all of our hospitals like the U.S. did. In Poland, if you need mental health services, you go to a hospital and get help. We don’t try to treat people who are severely ill in our local clinics — just like you wouldn’t try to do a heart transplant in a neighborhood clinic.”
I suspect as Americans, we do feel more strongly than many Europeans about individuals pulling themselves up by their own bootstraps. We also may believe in individual freedom more than some other nations, especially Eastern European ones that under communism were taught that the collective always overruled the individual. These differences might explain why Europeans are more comfortable with a “need for treatment” commitment standard (as observed in England and France) or focusing on “helplessness” rather than only dangerousness.
It’s hard to draw conclusions because my limited Qs and As are exactly that: a collection of opinions. Nothing more.
One conclusion that I have reached during my limited travels, however, is that we Americans distrust mental hospitals more than most other nations, even those in Poland where asylums were misused by the Nazis and Russians. In Iceland, Portugal, and in Brazil, I found that people simply were not as terrified of going to a mental hospital for help as we are. In Portugal, the mental hospitals were run by the Roman Catholic Church and were seen as places of refuge. In Iceland, people said, “Well of course you go to the mental hospital. Where else would you go?”
During my travels, I have yet to find a country that locks up more persons with severe mental illnesses than we do. Whether this is because it is easier for persons to be involuntarily committed to hospitals in other countries so they don’t end up acting dangerously and getting arrested, or because other nation’s are more paternalistic, or because other nations still operate large mental hospitals, I cannot say.
What I can say is that every foreign crowd who hears me talk about how our jails and prisons have become our new asylums are stunned. How can a nation that values individual freedom so highly take away the freedom of individuals who are ill and need help?
They expect more of us.