Growing poverty, downward social mobility and stress are partly to blame for what is a rising incidence of mental illness among Greeks, according to psychiatrist Michalis Madianos. There are already 200,000 people with chronic psychiatric problems in this country, and the number is rising, experts say. More patients «The lower a person’s prestige at work, the more likely it is that a person will manifest psychological disturbances. Poor people take three times as many anti-depressants as the better-off,» Madianos told a recent conference organized by the Psychiatry Files magazine. «In the country’s poorest prefectures, such as Grevena, Kastoria, Florina and Karditsa, there are proportionally more cases of schizophrenia,» he said. Pressure at work, fear of unemployment, overcrowding in urban centers and trying to keep up with a lifestyle model that is out of one’s reach are additional causes for the appearance of mental problems, not only in Greece of course. The problem is a complex one since current conditions not only create these problems but cancel out any attempts at rehabilitation. For example, when unemployment and fear of losing one’s job is the norm, it is very difficult for a person who has undergone psychiatric treatment to find a job. While the main reasons for the development of these conditions are social, there is a tendency in scientific and ideological circles to regard them as a problem for the individual, to be dealt with above all by personal initiative. There is also the view that people’s natures are formed by their genes. Treatment of problems of this kind is then of a chiefly pharmaceutical nature. In the future, gene manipulation may be added to the treatment of mental illness. Naturally, no one can deny the results of biological research and its contribution to decoding human behavior. However, seeking the causes of human disease solely in these areas is to forget that humans are social animals. A recent editorial in a major American psychiatry journal warned of the danger of psychiatry being destroyed as clinical experience is replaced by DNA decoding. Over-prescribing expensive drugs is one aspect of the individual approach to mental illness. Meanwhile, state care is being downgraded to the benefit of private health services. According to data presented by Madianos, all the beds in state hospitals are occupied by permanent patients (who have little hope of being discharged). There are only 37 primary psychiatric care units out of the total 82 required. «Treatment at a state hospital usually means camp beds in halls, and private care is enormously expensive but without any real therapeutic benefit,» said Katerina Matsa, head of the conference and a psychiatrist at the Athens Psychiatric Hospital. «Dealing with less serious cases has out of necessity become the job of private practitioners,» she added Private sector Twenty years ago, the state announced a program of psychiatric reforms. «If we want to be precise,» said Matsa, «these reforms have developed into a process of simply releasing thousands of chronically ill people from large psychiatric hospitals into hundreds of half-way houses in the community.» The vision of an integrated approach to the mentally ill, and their rehabilitation into the main body of society, has not become reality. «At the same time, state psychiatric hospitals continue to suffer the consequences of the social exclusion (of former psychiatric patients), and as patient admissions are high, chronic hospitalization becomes the norm. The psychiatric reform process is at a dead end and that is why it is handing over powers to the private sector, to non-profit and profit-making concerns,» she added. Another major problem is the over-prescribing of drugs. «There are cases where almost entire consultation sessions are taken up with discussing the effects or side-effects of a particular drug. The doctor-patient relationship turns into a drug-symptom relationship,» said Matsa. The role of pharmaceutical companies is crucial. «The ease with which psychotropic drugs are prescribed contributes to the development of dependent behavior,» she added. Commodities Harilaos Varouhakis, a doctor who has worked for many years at the Athens Psychiatric Hospital, is concerned that many firms, often using European Union funds, treat patients as «valuable commodities. «These days, people’s lives are not in danger, as they were in the past for example when the mortality rate at the psychiatric hospital on the island of Leros was 40 percent within the first six months of hospitalization. However, their psychological torment has not lessened. The body is worshipped, but not the soul.» The problem is growing as expenditure on social welfare is reduced, affecting the weakest and most defenseless. It is no coincidence that in the USA, the mortality rate among the mentally ill has tripled in recent years. When current European Union and Greek funds run out, the lack of any new infrastructure means that psychiatric patients could be left to fend for themselves. Drugs are being over-prescribed The discovery by British environmental services this last summer of traces of Prozac in the country’s rivers and groundwater brought home the realization that use of the drug had become so high that it was finding its way into the environment. According to official statistics, doctors’s prescriptions for anti-depressants rose from 9 million to 24 million between 1991 and 2001. In Greece, the Institute for Pharmaceutical Research and Technology (IFET) showed that over the past five years, the consumption of these drugs has risen by 6.5 percent to about 8.7 million packets a year. Between 1999 and 2000, the increase in outlay on psychiatric drugs rose to 24 percent. According to Matsa, the groups most subjected to the over-prescribing of psychotropic drugs are women (where the figures are almost double those for men), the unemployed, the aged and people who have been widowed. Particularly worrying is the trend among teenagers. A recent survey showed that 5 percent of senior high school students in Greece said they had taken anti-depressants at least once, acquired either from a friend or from the household medicine cabinet. They gave stress and anxiety as their main reason for resorting to them. Unfortunately, in Greece as abroad, it is often parents who give the children these drugs, with their doctors’ cooperation.