What do you know about the Eastern and Central Europe (abbreviated CEE)? The region consists of 23 countries, excluding Austria and including the Eastern part of Germany. All of them are connected through their history of being in the former communist block. Are their citizens still affected almost 30 years after the fall of the Soviet Union?
Imagine living under the totalitarian regime. All of the things you know and like would be severely restricted – forget about new fashion trends and even fresh meat and vegetables. Unless you’re a friend of the butcher or someone of great importance, you have to learn to live without these “luxuries.” Your health, not only physical, would also deteriorate from the lack of accessible basic necessities and culture stimulation. Now imagine the government spending only 3% to 4% (roughly) of the nation’s gross domestic product on healthcare, with the funding of mental health care being even less.
The situation has of course improved in the last 26 years, with the help from the European Union, the World Health Organization (WHO) and non-governmental organizations like Open the Doors and Open Your Heart. Mental care patients have more rights and can choose their care provider, but everything comes with a downside – psychology professionals are underpaid and the whole subject is still encompassed in stigma. While the younger generations are generally more open, the older ones were not well informed about the basics of mental health in school, so their perception of the mentally ill is heavily influenced by the negative image of them painted in the media and the news. The impossibility of talking about problems even with close family members is reflected on the general happiness of the population – in the World Values Study Survey (1999) Latvia, Estonia and Slovakia have scored the lowest. This has two common consequences, listed below.
Depression and suicide
In a socialist system, it is practically impossible to lose your job even by trying to. Also, competition in industries is almost non-existent, as one company has the monopoly for the entire state. This means that the quality of goods lowers and there’s a shortage of them due to the government’s five-year plan. This leads to less satisfaction at work and life in general, so it’s easy to see why people were depressed back then.
But what is the situation like today?
The burden of the region’s totalitarian history still lingers over the states, especially in the social and economic lives of their citizens. Risk factors for developing mental health issues later in life include deprivation, bad relationships with parents, poor prenatal nutrition, unemployment, job insecurity (and stress) and alcohol/drug consumption. Unemployment and job stress are especially prevalent in the average CEE citizen due to the rise of capitalism. The system brings many positives, like free will and open borders, but work security has decreased, so holding a job now means being competitive and always knowing you can be replaced. Prices of goods (excluding consumables, such as electronics) have risen and so have rental costs. All of these factors add up and there is no escaping. This also explains a prevalent nostalgia for communism, particularly among people 50 years old and up, who want to go back to their prime years, to the age where the system cared more for the average person, at least according to them.
Work culture also differs from that of western countries – workers aren’t supposed to identify with the company that employs them and nobody expects them to be loyal or go beyond their comfort level. At the same time, pursuing one’s hobbies also isn’t encouraged, so what should citizens do other than await an existential crisis?
Suicide rates in Europe are the highest in the eastern and central region, with Lithuania on the top with the rate per 100,000 coming up to 28.9 (Eurostat, 2005). This can be attributed to the taboo and stigmatization of mental health discussion, with the government’s unwillingness to open the topic due to its controversiality. With the inability to talk about their obstacles freely, people seek other ways to deal with their emotions, such as alcohol use.
Eastern Europe is quite famous for its rather generous consumption of alcoholic beverages, where social drinking isn’t only expected, it’s the norm. Research on this subject is poor, as people tend to either under- or mis-report their amount of alcohol consumption. With a lot of myths surrounding alcoholism, people tend not to recognize binge drinking and consumption of lower quality alcohol as problems.
In the last century, the life expectancy gap between men and women has significantly risen up to 14.3 and 11 years in countries like Russia and Ukraine respectively (WHO). This is associated with alcoholism, stress and unhealthy living in general. These beverages, mostly beer and wine, are cheaper than water and sodas in most bars and restaurants in CEE, and nobody questions if you routinely order two beers with your lunch.
Despite all of these factors that contribute to mental issues, including anxiety disorders, the situation is improving overall – CEE countries have put in place national policies (e.g National Program on Mental Health for 2007–2011 in Moldova), community programs and more funds towards the psychiatric field. Patients can and will receive proper care (with maybe small exceptions in the more rural areas). Unfortunately, they might still have to deal with prejudice and bias from their family and friends, but even the stigma is slowly disappearing.
DLOUHY, Martin, Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems [online]. [cit. 2017-01-28]. Accesible: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908346/
Mental Health in the EU – Key Facts, Figures, and Activities A Background Paper [online]. [cit. 2017-01-28].
COCKERHAM, William C. Health and social change in Russia and Eastern Europe. New York: Routledge, 1999.
KYMLICKA, Will a Magda OPALSKI, ed. Can liberal pluralism be exported?: western political theory and ethnic relations in Eastern Europe. Oxford: Oxford University Press, c2001. ISBN 0-19-924815-X.