"The most important factors in my recovery have been my commitment to my work in a user organization, together with the openness of my doctor to talking therapy without medication. Stigma and self-stigma have been the biggest barriers.
My first
possible move away from normal behaviour, I attach to an incident when I was 7 or 8 years old. It was evening and my two older brothers teased me until I fell asleep. Later that night, I woke up crying. The lights were switched on, my eyes were open
and I was communicating with my parents, but my consciousness was somewhere else. My father calmed me down by reading me stories, my parents told me the next morning. I had no recollection of what had happened.
The first time I encountered
graver mental health problems was during the war, as a soldier in Sarajevo. I am Bosnian by nationality but Catholic by religion, and my fellow soldiers, who were all Bosnian Muslims, had difficulties understanding what someone called Igor (a non-Muslim
name) was doing in an almost solely Muslim army. They treated me as a traitor and would say things like: ‘On the next mission you’ll be the one to die first.’ I was under constant suspicion, and this, together with the permanent
threat from enemy positions in the surrounding hills, insomnia caused by guard duties and my alcohol consumption, all collaborated to strain my sanity. As a result I withdrew into myself, switched from crying to nonsensical talking and would not answer
questions appropriately.
I was hospitalized for two months in a clinic in Sarajevo, where I was given injections of antipsychotic medicine. I was released after the ceasefire in May 1995, with a diagnosis of schizophrenia and psychosis
in progress. Then I was released from military service and went back to my home town, Tuzla. I came home on the day of the biggest tragedy in the history of Tuzla – the killing by grenade fire of around 75 civilians at the Gate, an area in the
city centre where young people hang out. I knew most of the victims.
In the autumn the military authorities declared me unfit for service, with the comment that I had been taken ill while serving in the army of Bosnia and Herzegovina, but
that my illness had been in progress before I joined the army. In less than eight months, I thus went from being a completely capable individual to total disqualification. I was given the status of military war invalid, which I rejected, not wanting
to be associated with people who had lost an arm or a leg in the war. To put it bluntly: who wants to be a cripple at the age of 21?
For the next eight years I worked for several different employers, mostly journalism in the electronic
media. When my father died in 2003, I was unable to show any emotional reaction. I contacted a neuropsychiatrist about this, and was again diagnosed with psychosis in progress and offered some antidepressants. My situation worsened while I was working
as a waiter in a local café for a few months. I suffered from insomnia and had war flashbacks due to my consumption of alcohol and soft drugs, and once again I began withdrawing into myself. In the end my family took me to an acute psychiatric
care ward, where I was hospitalized for 40-odd days, and subsequently released with heavy medication. While I was in hospital, I was four-point restrained and forced to take psychiatric medicine a couple of times. The only compassion I encountered
was the contextual question, ‘Are you suicidal?’
A year ago I changed doctors, since I was fed up with the superficial medical treatment I was receiving, and began looking for work again. I went round to all the private businesses
and radio stations where I used to work, but found nothing. Many of the employers had heard rumours about my hospitalization and therefore refused to hire me. During this period, I joined the ‘Fenix’ Association (the Association for Mutual
Support in Mental Distress) in Tuzla, and began working as a volunteer in its art studio. I was granted the status of 50% war-disabled veteran, and in September 2006 I signed a year-long contract with Fenix to work as a secretary, but in reality I
am a jack of all trades. I act as a spokesperson, translator and project manager for smaller projects, and participate in the art studio and woodwork workshop when needed. In addition, I advocate the rights of mental health service users whenever
I get the chance.
Fenix offers occupational therapy in an art workshop, a woodwork workshop and greenhouse vegetable production. There are a library, an Internet service and a day centre, which we are developing to stimulate the reintegration
of clinically isolated service users into society. Fenix also strives to be, and partially is, a progressive stakeholder in the making of mental health policies, and in the creation of social cooperatives and social tourism.
I have changed
doctors again, since the second one, too, refused to give me talking therapy and insisted on medication. My present doctor responds to my thinking and efforts with support, while giving me some guidelines that are truly effective. Nowadays I rarely
take psychiatric medicine. I have no signs of mental instability and once a month I have a heart-to-heart talk with my new doctor, who is of a younger generation than the previous two.
As a matter of fact, I talk openly about my experiences to
anyone who shows interest and is prepared to listen. I do this in all kinds of forums, from everyday encounters to big meetings with university students, where I go to talk about our association.
Unfortunately, my family has not been overwhelmingly
supportive. I live with my mother, with whom I have quite a difficult relationship. She is overbearing, and denies any link between our family relations and my mental instability. She considers my difficulties banal, only hears what she wants to hear
and plays the victim, which leads to self-stigmatization on my part. I want to improve our relationship with the help of a pedagogue–psychologist, but am somewhat doubtful of the outcome, as my mother is inclined to gossip.
I have
two older brothers, who are married and have children. The older is the more considerate, but he lives in Zagreb with his family. The other one lives here in Tuzla and visits once or twice a month, when he mainly talks about his own successes and
failures.
I believe much can be done to counteract the stigmatization of people with mental health problems: from the creation of affirmative expressions in Bosnian for a person who is recovering from mental distress, through the presentation
to the media of positive examples of people with these problems, to the raising of awareness about the consequences of stigmatization. Having worked as a journalist for many years, I use my knowledge to criticize inappropriate reporting in the press
and electronic media, for example, on suicide. I send memos to both the editors initiating the stories and the journalists writing them, to inform them about the right approach.
My work in Fenix has helped me to become aware that, although
a user of mental health services, I have equal rights and responsibilities in my community. With my experience, I am useful, and there is plenty of work to do.
Today, I encounter my biggest problem with stigmatization when looking for a
life partner. I do not hide who I am or what I am, and I long to fill up the empty space in my emotional life with a person who can appreciate my honesty and directness.
P.S. Since I first wrote this testimony, my life has taken many positive
turns. First, I have now lived with my girlfriend for 10 months. I extended my contract with Fenix for another year, and finished my secondary schooling, which was interrupted by the war. I hope to start studying at university in the autumn."
How can Igor‘s story influence policy-making for mental health?
A central message of every story, although particularly strong in Igor’s narrative, is the split between the rich personal experience and the reductionism imposed by psychiatric treatment. Igor tells a powerful story, full of tragic and impressive experiences of family life, war, religious divide and discrimination by only his 21st birthday. To simplify Igor’s life into a label of mental illness or cripple does not do it justice, and it is doubtful whether any simplistic intervention such as medication could solve the complex consequences of such experiences on a personality. This story makes one reflect about the role of psychiatry.
What saddens me are expressions such as, “although a user of mental health services, I have equal rights“, implying that equal rights must be won, even in one’s own mind, rather than being rights. Nevertheless, Igor shows that people can demand and exercise those rights, including finding a place at university and a girlfriend.
Again, the hero of this story is Igor, who transcends all that has happened, confronting the challenges and applying his talents to great effect. I wonder whether Igor believes that these experiences have given him strength and inspiration, making him a deeper and more effective person than he would have been otherwise. I look forward to receiving a follow-up story in a year or so.
Dr Matt Muijen, Regional Adviser, Mental Health, WHO/Europe.