The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Pavel Katchalov
[Pavel’s first language is Russian and I believe that his second language is French. I have not tried to turn his responses into “perfect English” for fear that I would lose some of his meaning. I’m guessing that he has much better English than most of us have Russian or French!]
EM: Most of the readers of this blog will have zero sense of what “Russian mental health services provision” consists of. Is it primarily traditional talk therapy, primarily medically oriented psychopharmacology, a combination of the two, or something else?
PK: Actually, in 2016, the Russian mental health services are geographically sectorialized public health facilities, with administratively independent in-patient (hospitals with day-hospitals) and out-patient (dispensaries with day-hospital) branches.
The services are mostly free of charges for the patients. Private mental clinics are forbidden in the law. Private psychiatric practice is marginal, with no rights either to prescribe psychotropic drugs, nor to deliver sick-leave certificates.
Private clinical psychology is equally marginal. There is no cooperation between the public and private services. Public mental health is explicitly medically oriented psychopharmacological psychiatry. There are no traditions of psychodynamic talk therapy in Russia. A bit of psychotherapy, if it is sometimes integrated in the public mental health services, is extremely eclectic, provided by mostly very poorly, if at all, trained therapists (psychiatrists or clinical psychologists), and considered as a superfluous adjunct treatment by their psychiatric peers.
EM: What changes have you seen in recent years? Has the current, dominant paradigm of “diagnosing mental disorders and treating them with medication” been taking ever greater hold in Russia?
PK: In the recent years the Russian public mental health services remain organizationally intact, but endure drastic financial cutbacks, with yearly redundancies, hospital beds and out-patient facilities reductions. The paradigm of diagnosing mental disorders (according to the last ICD) and treating them with psychopharmacological drugs remains unrivalled in the public psychiatry.
The resulting worsening of psychiatric care and subsequent disappearance of the free public psychotherapy, motivate patients to seek better help in private psychiatric and psychological practitioners, and motivate the latter to seek for better training in at least dynamic psychotherapy, in Russia and abroad.
EM: Who do you tend to see and what sort of work do you do?
PK: As an almost full-time psychiatrist-psychoanalyst in the country, where everything and everybody related to mental disorder is severely stigmatized, and psychoanalysis is not at all popular in the mass culture, I see at my office mostly middle-class patients with real psychic sufferings, that hinder their life functioning in many domains, i.e., severe incapacitating neuroses, borderline patients, the most intelligent of psychotic and psychosomatic patients (clever enough to seek, and to find a psychoanalyst).
My theoretical and practical inspiration I find mostly in the late André Green’s works. I practice three-to-five times a week 45-minute sessions on the couch, from three to eleven years long. Much more rare are face-to-face once-a-week psychotherapy cases with adolescents, usually not longer than one year. Sometimes I make short (three-to-five sessions) family consultations. Only exceptionally I dare to council my analysands on psychopharmacological drugs. If necessary, if have some cooperative psychiatric colleagues, whom I may entrust with such task.
EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders” and the use of so-called “psychiatric medication” to “treat mental disorders” in children, teens and adults?
PK: This is the cheapest paradigm for public health administrations, and the most profitable paradigm for big psychopharmacological businesses. Mental patients themselves are negligible for politicians and for governmental bureaucracies, as unable to any self-organizing or lobbying their interests. Personally I find this state of affairs deplorable and scandalous.
What is the most promising (though the more expensive, though yet affordable for rich countries) psychodynamic therapy for children and adolescents is largely unavailable. Children and adolescents are at the same time the most defenseless and the least able to escape from precocious stigmatizing diagnoses — more and more multiple and fanciful ones with every DSM (and subsequent ICD) revisions — and from exclusively psychopharmacological treatment.
Here I rely only on the public opinion evolution. In the most enlightened country of the world — in France — it was the public opinion that suddenly revolted, and thus unpleasantly surprised its public authorities some years ago, when the Government tried to chase psychotherapy (and first of all — psychoanalytic therapy) from the French public mental health care.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
PK: In the case of evidently emotional distress, I would suggest, of course, that he or she try to meet some psychoanalytic colleagues, whom I trust. Only in the case if such a demand is actually absent, or precluded by the patient’s acute mental state, would I want to address that distress with psychiatric psychopharmacological care as a measure of emergency.
Psychotherapeutic approach may be postponed for the later aftercare, in order to help a person dear to me avoid falling into the rôle of mentally ill. Of course, no psychotherapy is a panacea. Sometimes, in the cases of severe psychoses, me too, would feel obliged to reconcile with inevitable joined psychotherapeutic and psychiatric follow-up care.
And sometimes, in mental distress, resulting, e.g., from diagnosis of some organic disorder, such as epilepsy in a young person, only supportive psychotherapy would be necessary in the beginning, that will lead further to more intense psychotherapy or not. And, of course, there is Alzheimer disease, when I would suggest nothing more than occupational therapy.
Pavel V. Katchalov, M.D., Ph.D., Moscow, Russia, trained at the Paris Institute of Psychoanalysis (SPP), worked at the Federal Research Centre for Social and Forensic Psychiatry in Moscow, Serbsky V.P., the First Medical University I. M. Sechenov in Moscow, and Saint Maurice Hospitals (Old Hospital Esquirol), and is currently at the Federal Medical Centre of psychiatry and neurology research V.P. Serbsky in Moscow.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
To learn more about and/or to purchase The Future of Mental Health visit here
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