Is there a greater tolerance towards psychic patients in Switzerland?
Yes, but not everywhere. If we compare the current treatments with the ones from twenty years ago, there is a big difference. Now in hospitals and clinics, there are organised groups for family members of the patient explaining the illness and how they should behave. This shows an increased tolerance towards the psychic sicknesses and the sick ones. There are so called „groups for self help“ and organisations that share experience especially in difficult cases where people simply do not know what to do anymore. Some of these operate around hospitals or clinics others are independent or are being spontaneously organised. There are also organisations such as „Alcoholic Anonymous“ which are very helpful and operate all over the world.
Switzerland has an average of 20% foreigners in the population. Did you notice any psychological problem characteristic to an ethnical group?
As I mentioned, the percentage of psychic illnesses is the same all over the world. What has been noticed here, are psychosomatic symptoms characteristic to some emigrants coming from ex-Yugoslavia. At some of these people the body reacts in a „somatic“ way. Such patients do not „act“; they really suffer pains that cannot be explained. Of course, there are also people who simulate, pretending imaginary pains and hoping to get attention and financial support for their incapacity. But such situations are rare. For the genuine patients suffering „somatic“ pains one cannot find a scientific or medical explanation. In psychiatry we call them „repeated and permanent pains“ or „tendency to somatic reactions“. This means that once a psychic pressure comes up for some reason (usually unknown to the patient) the body reacts with pain. I noticed such reactions mostly in people who came here in their youth, worked and lived „between two worlds“, their family remained in the country of origin where sometimes they built a house that later was destroyed by the war. Such people reach a certain age while their life problems remain unsolved and their body is exhausted. During medical analysis and investigations nothing can be found although they have serious pains.
Did you experience situations with „no way out“?
Many psychic diseases can be classified as „no way out“. A psychiatric patient often lives in another world: he thinks he is Jesus, he hears voices that tell him what to say and do, he has hallucinations or he believes he is being followed. In such cases we give patients anti-psychotic medication and must wait to see if afterwards we can build a „bridge“ to communicate with them. These medicines represented a big turn in psychiatry. They have been discovered in the last 50 years. The first one – „Clorpromazin“ – was created in 1952 and used first against allergies. Eventually, it had been noticed that the patients with schizophrenia who took this medicine against allergy, had a better psychotic state. Until the `50s there were no real treatments against psychosis. There were hot or warm baths, patients were tied up, layed down, let scream. These were just attempts without long term results. The anti-psychotic medicine („neuroleptica“) marked a big step forward in psychiatry.
Regarding „no way out“ situations I can recall a case when I could not talk to the patient as a psychotherapist and was forced to give him just medication. I would call this a „no way out“ case. Another example is a young man who has a psychosis at 18 years of age, another one at 20 and a third one at 22. When this happens - even though he regularly took his medicine, had psychotherapy and support from family and friends - it is also a „no way out“ case. Statistics show that one third of the patients with schizophrenia suffer only once in their lifetime of a psychosis and can treat it with no other consequences. Another third suffer every few years a psychotic episode but between these „crisis“ have no other symptoms, are socially integrated, they work and can have a family. The last third are the chronic patients, the „problematic“ ones, who permanently need medication and psychiatric treatment. These usually do not accept their illness, refuse medicine and spend long periods in the hospital, sometimes several times a year. In such cases the doctor can be overwhelmed and does not know what to do to convince the patients to let themselves be helped. Working with relatives of such patients is also cumbersome because you must help them to accept a destiny that cannot be improved. Psychiatrists are sometimes helpless and this can lead to „no way out“ situations.