By Anca Vilma Sabau, ESTD representative for Romania
Some days ago I had to finalize some things about a Romanian trauma association in a local bank. The lady who was in charge saw the name…”t rauma” and said -“You know there is lot of trauma in Romania. How can we get some counseling?” Yes – you might say that she does not understand what really trauma means, and partly you will be right. But in a way she has her own right too. Being under a totalitarian communist regime for almost 50 years left a lot of scars in our nation. We learned to obey, to submit to those who humiliate (“A man’s hat in his hand never did him any harm”) to lose the hope that it can be better, to admit that unjust things happen, to make home with abuse, to try survive and live with the bad. A friend use to say- we consider elementary rights as a favor. Even 24 years after the Revolution in ’89 took place, things are not ok. A friend of mine who was gone for more than 15 years in Australia coming back in visit was surprised to see how small the changes in everyday life were.
To understand where trauma work is in my country, first I think you have to take a look into the history of psychotherapy, psychology and of course psychiatry in Romania.
Before the world war period, there was a flourishing interest in psychiatry / psychotherapy in Romania, which was in concordance with the findings of that time. G. Marinescu, MD (neurologist and hypnotherapist) together with Dr I Marcel published the first paper on a clinical case of psychogenic dysphonia („A case of hysterical mutism with spasmodic contracture of glosso laryngeal cured by hypnotic suggestion associated with vocal gym.” (Archives Roumaines de Médicine et Chirurgie, 1888, nr.6, p.391). There were several neurological patients with “motor impairments “who had been helped by hypnosis.
During the communist years psychiatry had ups and downs.
There were some great professors like Prof E. Pamfil, A. Obregia or A. Ogodescu who created a very well trained school of psychiatry here. But also there were places and people who got involved with the Communist Party and unfortunately took part in political oppression. In general our medical school had a strong affinity to French psychiatry. Prof E. Pamfil was a student of Henri Ey, and even my generation read his semiology during our first resident years. Going back in my memories (in the first or second year of residency training – 2001/2002) I remember the emotion of a large book in the office of one doctor from the clinic – H. Ey -I was reading his description of psychic phenomenon and I found it very helpful. At that time I did not realized that Ey was interested in Pierre Janet’s work or that he followed his courses during his residency training in Paris. Regarding trauma and dissociation there was not a specific interest, at least not in known publications. In the ideology of the communist regime everything was “good “– people had to pretend to be happy, without problems. The word “trauma” had no place in a society that denied abuses of any kind (sexual, emotional, maltreatment or neglect). Even after the change of the regime, the procedure to declare a sexual assault or domestic violence was too complicated. People preferred to treat the consequences and not to go further. Nowadays, as all over Europe, we use the ICD 10 in our diagnostic work and you might find reported cases of dissociative amnesia or functional disorders but not DID (MPD). At a recent national congress in child psychiatry, one of the professors presented a case that he had some years ago where he said he used MPD diagnoses. Mostly dissociation is a symptom among other diagnoses so it is very complicated to have a database regarding diagnostic spectrum in trauma patients. The new ICD 11 may improve the criteria for diagnosis in this pathology and the work will be easier. I am thankful to my professors (Dr T. Mircea and Dr V. Stan) for opening my mind to the neurodevelopmental aspects and attachment dynamics as a basis of understanding many psychiatric conditions and creating the basis to understand traumatic processes. In general little is learned in psychiatry or psychology regarding dissociation. The concept of structural dissociation of personality or the neurobiology of traumatic processes is mostly heard at conferences abroad.
Psychology had a worse situation in the 50 years of communism.
The first psychology department at a university was founded in Cluj in 1919, University of Superior Dacia, by F.S. Goanga, a former student of W. Wundt. In the interbelic period the school strongly developed, a development which declined after 1945 and - as in many other places in Romania – closed between 1977- 1989. Regarding the communist period I asked my colleague E. Bolcu who works in the mental health center (former mental lab center) from Timisoara to help Him said: “During 1945-1975/77 psychology existed with the price of obedience to Communist ideology. Romanian psychologists were confronted with obstruction of internal communication and only selective communication with psychologists from other countries. Starting with the law of 1975 in which Ceausescu combined psychology and pedagogy, he gradually closed the faculties and professors were sent to work in different places or if they were obedient they kept their teaching places but in another specialty (eg philosophy). Some hospitals and mainly the psychiatric units kept their psychologists but they survived in isolation.” The punitive government of Ceausescu’s regime had the law of abortion and the law to limit the number of children people could have with the penalty of a cut 10% of their salary. So Romania had a lot of kids in orphanages and special disability institutions where the conditions were very hard. The result was a generation of children maltreated by state employees with of course lot of attachment problems when the maternal leave for a mother was 3 months and people were forced by the situation to leave the children in special kindergartens where educators could not face the crying -they had more than 30 children in a groupand the result was a lot of neglect even for those who had families. These were hard times both physically with poor food, rationed heat or warm water and so on and emotionally with control and torture for those who did not obey the rules. Having in mind the atrocities of the Second World War and the darkness ofcommunism that followed t my nation has been exposed to a “chronic psychological trauma” which can explain our “paralyses” in changing the mentality of our people and the little progress that we made in these years even if Romania is a beautiful and resourceful country.
A report of the Child protection services from 2013 shows that 38,709 children were in a type of family services and 22,532 children in residential care units (official report June 2013). The situation has improved from ’89 but it is still not satisfactory.
After December 1989, the University for Psychology and Social work was re-borne but the administrative structures remained rigid. It was a time of hope and enthusiasm in ’90 but people were not prepared to use the freedom. In many places things changed at surface but the mentality remained the old one. Regarding psychological services, they tend to be centralized and controlled by a new institution called Psychological College which is nominally in line with European norms but unfortunately some rigid characteristics of the old regime can be seen here too (centralizing personal data of patients and reporting them to the central head and other internal decisions that seem to be questionable). Psychotherapy in Romania is very often confused with psychological counseling. Many times you can hear in the media about rape, traumatic incidents or other forms of possible trauma – that the solution is the “psychologist who will do counseling”. The fact is that, in general, psychologists are not trained to deal with trauma or to make a special assessment. They are poorly paid and the state institutions do not invest in specific training so the result is that people try to do their best but with not very good results. Even in these difficult circumstances, different psychotherapy schools have developed in Romania including psychoanalysis, hypnosis, and psychodrama as the older ones and nowadays family therapy and cognitive therapies..
In trauma training there are some trauma organizations which provide therapies for different emotional disturbances related to traumatic events but they do not have a specific “trauma training”. They mostly adapt the form of therapy that they practice to a specific type of pathology. There is also a “trauma module “included in the masters program of psychology but the information there has little in common with the actual international trauma work.
In recent years there have been several lectures and workshops (at least in the Western part of Romania) about assessment and treatment of trauma patients and the word dissociation is not so uncommon for Romanians. But there were just a few attendees from those who work in the mental health system so more has to be done to reach mental health professionals.
In the spring of 2015 in Timisoara ESTD will hold a one day European event which will be organized by the joint effort of Romanian NGO’s and will have as target professionals from the mental health system and of course all who are interested to learn about trauma.
Doresti sa-ti asisti clientul in acest proces de stabilizare?
Daca da, tu si clientul tau ati putea fi interesati de Reteaua de Studiu al Tratamentului Pacientilor cu Disociatie Severa (TOP DD)!
Echipa TOP DD a dezvoltat un program video educational, disponibil online pentru clientii cu DD si terapeutii lor, care se focalizeaza pe imbunatatirea sigurantei clientilor si abilitatea lor de a-si controla disocierea si emotiile.
Pentru a fi eligibili pentru participare, pacientii trebuie:
- sa aiba cel putin 18 ani;
- sa se angajeze sa lucreze aproximativ 2 ½ ore pe saptamana, presupunand: urmarirea unor scurte inregistrari video educationale (intre 5-15 minute in fiecare saptamana), efectuand saptamanal exercitii scrise, si practicand zilnic exercitii de formare a abilitatilor;
- sa fie diagnosticati cu o tulburare din spectrul Disociativ
- sa se afle in tratament la un specialist care este la randul sau dispus sa participe, urmarind inregistrari video si completand chestionare
Echipa TOP DD nu va colecta exercitiile scrise reflexive ale pacientilor.
Reflectiile scrise sunt destinate dezvoltarii pacientului, desi incurajam pacientii sa impartaseasca cu terapeutii lor ceea ce afla cu privire la ei insisi. Terapeutii vor urmari aceleasi scurte inregistrari video pe care le vor viziona si pacientii, astfel ca trebuie sa se angajeze sa investeasca aproximativ 10-15 minute in fiecare saptamana pentru a putea participa la studiu. Pacientii trebuie sa poata citi si intelege engleza la nivel de clasa a opta. Participantii vor primi un cod de acces care le va permite sa intre pe un site securizat creat de echipa TOP DD, care va gazdui inregistrarile video educationale, exercitiile scrise si exercitiile practice. Participantii nu vor trebui sa plateasca pentru accesarea acestor materiale, create de catre echipa TOP DD specific pentru a ajuta pacientii disociativi sa invete cum sa-si imbunatateasca siguranta si sa-si dezvolte abilitatile de a controla disociatia si sentimentele. Participantii trebuie sa aiba o conexiune de internet rapida si stabila. Daca un potential pacient foloseste un telefon mobil pentru a accesa internetul, el sau ea trebuie sa aiba un plan tarifar cu acces nelimitat la date pentru a putea viziona inregistrarile video. Ca parte a participarii, pacientii vor completa saptamanal scurte intrebari cu privire la simptomele lor si progresul in insusirea abilitatilor invatate din inregistrarile video. Pacientii si terapeutii vor completa de mai multe ori pe parcursul anului chestionare pentru cercetare, precum si in anul urmator, ca follow-up. Completarea acestor chestionare va dura aproximativ 1-2 ore. Pacientii si terapeutii vor evalua, de asemenea, in cateva intrebari scurte, materialele saptamanale, ceea ce va permite echipei TOP DD sa imbunatateasca programul pentru viitori participanti. Echipa TOP DD crede ca participantii vor invata noi moduri de imbunatatire a sigurantei, si de controlare a emotiilor si simptomelor in maniere sanatoase. In plus, viitori pacienti si terapeutii lor vor beneficia de feedback-ul participantilor cu privire la materialele educationale ale acestui studiu, precum si de cercetarea care va fi bazata pe acest studiu. Echipa TOP DD nu va putea oferi consultari, tratament sau feedback niciunui participant, nici nu va putea oferi informatii referitoare la progresul niciunui participant, nici nu va putea raspunde vreunei solicitari clinice telefonice sau prin email.
Programul retelei TOP DD va fi lansat in iunie, 2014. Participantii nu vor putea vedea adresele de email ale celorlalti participanti, astfel incat nimeni nu va putea vedea cine altcineva mai primeste emailuri, sau alte adrese de email. Pacientii participanti la studiu pot alege daca sa se logheze cu numele lor sau utilizand numele terapeutului lor (de ex., pacientul doctorului Sue Smith). Pentru mai multe informatii, vizitati
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Va multumim pentru interes si pentru sustinerea studiilor TOP DD!
Bethany Brand, Ph.D., investigator principal, studiul TOP DD
Echipa de consultanta TOP DD:
Frank Putnam, M.D., Chapel Hill, North Carolina, USA
Ruth Lanius, Ph.D., M.D. si Paul Frewen, Ph.D., London, Ontario, Canada
Richard Loewenstein, M.D., Hugo Schielke, Ph.D., Gregory Chasson, Ph.D, si Amie
Myrick L.C.P.C., Baltimore, Maryland, USA
Claire Pain, M.D. si Catherine Classen, Ph.D., Toronto, Ontario, Canada
Kathy Steele, M.N, C.S., Atlanta, Georgia
Suzette Boon, Ph.D., The Netherlands
Ellen Jepsen, M.D., Ph.D., Modum Bad, Norway
Vittoria Ardino, Ph.D. si Martin Knapp, Ph.D., London School of Economics, England