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Healing the scars of asylum confinement

Experts are helping former inmates of the Leros Psychiatric Hospital to recuperate from their time at the notorious facility.

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SPECIAL REPORT 08.04.2019 • REPORTING: YIANNIS PAPADOPOULOSPHOTOGRAPHS: THODORIS NIKOLAOU

Spyros is obviously stressed, beginning a slow whirl as soon as he sees us, strangers, around and around. It's a process. He stops, sighs in obvious relief, and reaches a hand out to each person in the room, one by one, just grazing us. This is his way, a gesture that helps him define his boundaries and people. Once the introductions are made, he sits on a couch, almost cross-legged, clutching two strings of worry beads in his left hand. “What else do they call you?” he asks in a hoarse voice. Now 61, this man lived in almost complete obscurity up until the age of 57. His name had been erased from the municipal register and he didn't even have the mandatory identification card issued to all Greeks by the police.

Psychologists Emmanouela Vintiadi (first left) and Stella Halimourda help Spyros Georgiou with his jacket.

Spyros Georgiou was born in Athens in 1958 to an unknown father and a mother with an intellectual disability. Based on his official records, he was baptized by members of the social services at the Attica Psychiatric Hospital. He was committed to the Leros Psychiatric Hospital at the age of 13, possibly with his mother, and spent a year there before being transferred to other facilities, including back to the Attica facility, which was to serve as his home until 2005. That was when he was transferred to Galini B, a boarding house and rehabilitation facility at Zevgolatio in Corinthia, where he started the slow process of healing the scars of a lifetime spent in asylums.

“When he came to us, he was barely functional and had very frequent outbursts. He couldn't hold a spoon to eat or even sit down properly,” says Sofia Tsesmetzi, a carer at the facility and one of the main people involved in Spyros's gradual recuperation over the past five years.

Such an absence of social skills and behavior like that exhibited by Spyros are not uncommon in patients who have spent a long time in confinement. It is most acute among patients who were sent to Leros in the 1960s, 70s and 80s, where they were entirely shut off from society, exposed to very little in the way of stimuli and doomed to inertia, treated more like a problem that needed to be put away.

Reforms in the country's system of psychiatric care in the 1990s saw these people returned to their place of birth and admitted into more progressive care facilities. Kathimerini traveled to Corinthia and Evia to meet two former patients of the Leros asylum, to study records and to listen to the experts who were at the vanguard of efforts to help these people get their lives back.

‘Colony of Psychopaths’

Founded in an Italian World War II army barracks on the distant eastern Aegean island by royal decree in 1958, the “Colony of Psychopaths” was renamed the Leros Psychiatric Hospital in 1987. For decades, it received boatloads of mentally ill patients from every corner of Greece, who were placed in the care of a mostly untrained and uneducated staff made up of local fishermen and farmers. Records from 1989 show that there were just two psychiatrists and one general medicine practitioner for 1,138 patients.

The Observer's scathing 1989 report on the Leros Psychiatric Hospital.

The horrific conditions at the facility were decried by the Greek medical community, yet it was a scathing expose by British newspaper The Observer in 1989, including photographs of naked and emaciated patients, that prompted the drive for radical reform and a process of deinstitutionalization. In the first phase, more than 100 patients were transferred to boarding houses in Athens, Thessaloniki, Amfissa, Ioannina, Halkida, Larissa and Alexandroupoli, on the basis of where they came from originally, whether they had family in the area, their age and their psychopathological profile. More followed.

Experts dispatched to Leros to put the program in motion were shocked by what they saw. Some of the most revealing testimonies are found in the archives of the Society of Social Psychiatry and Mental Health, a nonprofit organization founded in 1986 by Panagiotis Sakellaropoulos, a professor of psychiatry and child psychiatry hailed as the father of psychiatric reform in Greece. One of its speech therapists remembers patients living like prisoners, urinating on the floor, and being sprayed down, 40 people in the row, every morning with a hose, without soap. They were shorn and shaved in groups and ate with their hands, either standing up or in their beds. There was no individual care. Some had gone decades without seeing their reflection in a mirror.

Equally horrifying stories come from the staff. One expert described a woman who in the early days of working at the facility would come home sick after every shift. “She cried and vomited, and begged her parents not to make her go back. But she was the family's only breadwinner and giving up a steady job in the public sector was unheard of.”

Release

A young man from a village in northwestern Epirus found himself thrust into these sickening conditions on a February day in 1967. His medical records in Leros, seen by Kathimerini, reveal that he had been diagnosed with “mental deficiency-epilepsy.” He was committed because he was being picked on by the village boys, “resulting in numerous problems because of his irritability.”

Asked whether he knew why he was being committed during his first interview upon arrival at the island asylum, he said it was so that he could be “given injections” that would prevent him becoming “upset.” He expressed the desire to return home and work the family land. Instead, he spent the next 24 years at the Leros Psychiatric Hospital.

Pages from the medical file of a patient who spent 24 years on Leros after being diagnosed with epilepsy.

His entire medical file from admission to release is just 11 pages long, an indication of the sparsity of patient examinations and assessments. The man, whose name was not released for publication, did not return to Epirus until 1991, where experts gradually helped him become independent. He was able to visit his village alone and, even though he couldn't tell the time, never missed a bus, according to an expert who knows him and who spoke to Kathimerini on the condition of anonymity. He learned to eat on his own and to handle money by separating bills according to color and size. Today he is 88 years old.

Costis Triandafyllou also returned home, to Evia, in 1991 after spending 25 years at the Leros asylum. According to his medical records, during his time on the island he was described as “listless, unresponsive, disoriented in terms of time and place, and unaware of his condition.”

Local media in Evia covered the reactions of residents in 1991. At right, the press release distributed by the Avlida community center to brief residents.

A small group of the 50 or so residents that made up the village of Avlida in Evia where Costis was being relocated had reacted at the time to the idea of hosting mentally ill individuals. A month before the arrival of the first group from Leros, the community council organized a town meeting where experts tried to address their fears and concerns.

“For some time now our village has been dealing with what is purely a social and humanitarian issue, and which concerns the establishment of a boarding house for 10 Evian people with special psychosocial needs,” the April 1991 announcement by the Avlida community center said. “Yet some people are approaching the matter as though it were some pollution generating industry or a nuclear plant.”

“The patients were quietly brought in at night so as to avoid creating any tension. Costis was among them,” says Foteini Tzaferou, the scientific director at the Halkida Boarding House for Psychosocial Rehabilitation, where Costis, now aged 81, still lives. “With time, the residents of Avlida realized that they only benefited from the facility. Its residents were free to go outside, to buy their bread, fish and fruit, and so the community got to know them."

Costis was not the only patient from Leros to be relocated to Avlida around that time. Heavy medication and hardship at the island asylum had significantly shortened the inmates' life expectancy, yet there was one more patient who lived until his 80s thanks to the help he received at the new facility. During his time on Leros, he had been subjected to as many as 18 electric shock treatments a day. By the time of his release in the 1990s, he could no longer move his arms.

We met Costis at the new facility built by the Association for Regional Development and Mental Health. It was almost lunchtime and the octogenarian was passing out plates, bread and water to the other residents. Tzaferou remembers him in the early years after he left Leros. He would smoke discarded cigarette butts, could only walk up to 10 paces without stopping and would grab at his food impatiently. None of these behaviors are evident anymore.

Costis serves food at the Avlida boarding house.

“They came into a home that had a kitchen, where they could enjoy food served on a table laid out for a family meal. They had curtains and picture frames in their rooms, and a lounge where they could watch television,” says Tzaferou. Extracts from Costis's medical records show that in May 1991 he was trying hard to adapt to life in his new surroundings. “He does not present fictional elements but pieces of his real life. He seems to be getting himself together. In contrast to Leros, where he seemed to struggle to make sense of things, here he becomes distracted but soon gets on track again.”

Costis is seen at left shortly after his release from the Leros facility. At right, he is seen in his room in Avlida at age 81.

With time Costis has managed to do a lot of things on his own. He helps with the gardening, takes walks along the beach and can enjoy a coffee outside without supervision. He also likes to fetch the daily bread and is fastidious about his personal appearance.

“If something pleases him he will express it with a lot of enthusiasm. He does not create problems and we haven't seen any relapses,” says Tzaferou. Even habits that most of us take for granted, like buttoning a shirt or putting on your clothes, had to be taught to many of the former Leros inmates all over again.

Therapeutic farm

The Galini B boarding house at Zevgolatio in Corinthia, in the eastern Peloponnese.

In Zevgolatio, Spyros's rehabilitation has been a slow yet steady process. “He yearns to be caressed, touched. He is not aggressive about it, but it's something he needs,” says Emmanouela Vintiadi, a psychologist at the Galini B guest house, where Spyros, who has been diagnosed with an intellectual disability, lives.

Run by the Promitheas nonprofit organization, Galini B is a boarding house and therapeutic farm located on a 1.7-hectare plot of land and is home to 15 patients and 30 staff. Among other facilities, it has workshops for making soap and traditional “koboloi” worry beads.

The patients “help with all the farm work, from watering and digging to harvesting, supervised by staff,” says Costas Moustakounis, its scientific director, explaining that this is a therapeutic community modeled on similar programs in the United Kingdom.

During our visit, we watched Spyros collect fresh eggs from the hen house, feed Daphne the cow and pet the farm's two horses, Domino and Pinto.

Spyros, 61, helps with the farm work at Galini B.

Galini B runs an innovative therapeutic riding program, which includes a simulator that allows patients to become acquainted with horse riding before engaging in the real thing. There are also two carriages that are used to take the facility's residents on rides around the village. One of them was recently used to transport a local bride to church, while there have been other similar expressions of interests from the villagers. The facility also welcomes school groups, educating youngsters on mental illness.

Galini B has fully rehabilitated seven patients who now live independently, and has another four staying at apartments in the area where they receive daily visits from a psychologist and a nurse. Thanks to its social workers, Spyros was re-registered with the Athens Municipality and issued a birth certificate, while he was also given an identification card in April 2015. According to his records, since the day that he was committed, no one has looked for him, called for him or visited.

Spyros enjoys a hug at the Galini B boarding house.

As we walked around the garden, he stopped for a moment to cut a sprig off a bush. “Rosemary,” he said after inhaling its aroma. The 61-year-old is starting to learn the names of the different plants.

HEALING SCARS

Reporting- video editing: YIANNIS PAPADOPOULOS

Photographs: THODORIS NIKOLAOU

Greek to English translation: CHRISTINE STURMEY

For Kathimerini and eKathimerini.com.

08.04.2019

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