“There is a study that demonstrated that the stigma of psychiatric patients is constant. Stigmatization is a constant trait of history, we are branded and this will not change. But this does not mean that we don’t have to strive to change it, because stigma is made of the prejudices people have”. Dragan Jugović is the first psychiatric patient in Serbia who came out publicly in 2009 to speak about his illness and his experiences. He is the founder and the first president of The Soul, an association of users of psychiatric services, established in 2000. He had been the Association’s president until 2011 when he, as he says, ceded his place to others. He remains active in the Association, although not as much as before, and appears frequently in the public – participates in public discussions and meets the students of psychology, philosophy and political science of the University of Belgrade. He also gave a number of interviews in various media. “I became ill when I was eighteen and a half, that’s when I was treated for the first time, now I’m fifty-eight, meaning that I have been under treatment for forty years. During those forty years, I have witnessed many changes of the treatment of psychiatric patients in Serbia”, says Jugović. Experiences from ‘Laza’: His first therapeutic experience took place in February 1979. “I had the first outbreak of disease then, I fell ill and after two days I made a scene. I was in the ‘Moscow’ hotel when I fainted, people called the ambulance, they realized I was a psychiatric patient so they took me for a night in the ‘Laza Lazarević’ hospital. Afterwards, I was released, and then I underwent therapy in ‘Palmotićeva’ for ten to fifteen years, and after that twenty or so years in ‘Laza’. All my negative experiences are from ‘Laza Lazarević’. Not from ‘Palmotićeva’, I didn’t have a single bad experience there. It’s a ‘gentlemen’s’ hospital so to say, very well organized; they chose less serious patients, people who are younger. If someone is a long-term patient, if he’s more seriously ill, they send him further on; those cases mainly end up in ‘Laza’. ‘Laza’ is an emergency institution; they deal with situations when the police or the ambulance bring patients in, so they must react pretty rough”. When talking about his bad experiences from ‘Laza’, Dragan Jugović classifies them into four types. “First, it’s physical sedation, when you’re tied to a bed. Then comes chemical sedation, when you are given dosages so heavy that you are completely lost. Then there is that thing in ‘Laza’ that they don’t ask you anything or don’t take anything into account. If an incident occurs, a doctor consults an orderly or a nurse, but nobody asks the patient: ‘What did you do or how?’, they are not interested in that at all. And fourth, there is punishment by injections; I experienced that, as some other patients did. For example, I take three pills of Bensedin per day, but the orderly makes a change himself and gives me a shot. That is a very stressful experience. However, there was another thing that was even more difficult. A patient, older than me, was in my ward and we were once invited for a lecture. The hospital director gave a lecture on alcoholism. Our patient said: ‘Doctor, how can you lecture us on alcoholism when you are an alcoholic yourself?’ The doctor remained silent, and what happened? From that day on, the doctor ordered that the patient be given three injections per day; he was in bed during the next three months and three times a day was given injections of Bensedin, or whatever, until his bottom became like a watermelon”. Physical restraint as destiny: Jugović also talks about the manner and the rationale of changes of “physical sedation” to which he was exposed many times. “Doctors and orderlies act according to rules. Nobody hates you there, nobody abuses you because he wants it”, he thinks. “For example, I fall ill and go to the hospital. As soon as I’m admitted, I feel terrible, my head is in chaos, and they tie me until the next morning. That is the procedure. Later on, I came to know that every patient who has more than 100 kg is mandatorily restrained and if he has less than 80 kg he is not restrained. I have 120 kg, which means that whenever I’m admitted I’m restrained until the next morning and on that particular day they treat me like a very serious patient. Twice I was restrained in ‘Laza’ for three days. If you have to go to WC, you do it on the spot. When I’m restrained, I can’t sleep. I am admitted to the ward in the worst possible condition, and those ten or more hours that I spend restrained, that’s real hell. The protocol is the same for all, and the psychiatric personnel do not think who did what but they apply it automatically. The police or the ambulance bring you in, they don’t know who you are, and they restrain you. These are the rules, nobody has anything against me. However, since the law changed, a couple of years ago, this practice has been abolished. In fact, you are restrained immediately after reception, but only for an hour. If the restraint needs to be prolonged, a doctor must come, inspect the situation and sign for another hour. So, a doctor must give permission for every additional hour. This year precisely, in January and February, I was treated in ‘Laza’. They restrained me for an hour and then released me. The situation ameliorated mainly because the cooperation between our doctors, IAN and us, members of The Soul association, helped change the law a couple of years ago. Without legal changes, no change was possible. This is just an example that I mentioned, the thing that one can remain under restraint for an hour only, after which a doctor must decide on prolongation. Well, you can only imagine my previous experiences, being restrained in any hour of the day until the next morning, or being restrained twice for three days! Imagine that experience! Nevertheless, being tied to a bed is a humane thing. In what sense? Prior to that mode of restraint, in the history of psychiatry, several decades ago, a patient was made to wear the so-called ‘straitjacket’. He could get up, stumble, fall and hurt his head, because he could not use his hands. In relation to the straitjacket, being tied to a bed is a humane thing”. The beginning in the ‘Miloš’s stables’: Forty years ago, Jugović began his treatment in inhuman conditions. “In the beginning, I was hospitalised when ‘Laza’ was still in the old premises. Much later on, the hospital moved into a new building that is so nicely organized. Way back then, it was called ‘Guberevac’, and those were the so-called ‘Miloš’s stables’, that’s where Miloš Obrenović had kept his horses. That’s where I was during the first ten years. It was terrible, terrible conditions; it was a hospital during 150 years. And there you could find anything, lice, fleas, you name it… The conditions are much better now, but in the old days you could not avoid lice. Way back then, they would shave men and women alike and that was a traumatic experience, they had some powder to put on your head. It was really sad way back then”. Among big changes for the better, Dragan Jugović singles out the arrival of young doctors. “The old doctors belonged to the old school of psychiatry, it was all very rigid. I’m not a psychiatrist, but I know that the old doctors were very rough and rigid, while with the young doctors you can nicely talk. This is a new school”, says he. Treatment: When comparing today’s experiences in ‘Laza’ to those from several decades ago, Dragan notices that the old manner of treatment used to take from six to twelve months, later on about three months, while now it takes a month or a month and a half. “Probably the situation itself also changed for the better, there are better drugs or something”, he thinks. “What could also change perhaps in ‘Laza’ is that a person is first given a horse dosage of drugs, chemical sedation, but it perhaps must be that way. Belgrade has about seven psychiatric hospitals. The other six hospitals have much better treatment conditions. However, as far as I’ve heard, ‘Laza’ applies behavioural therapy, which is very rough, and I wonder why? That kind of therapy produces results more quickly and that’s what they need. When someone is brought in a very difficult condition, they need to recover him quickly and release him quickly. Other hospitals, for example ‘Pasteur’, take patients for several months. In fact, that ‘Pasteur’ looks like a hotel. And in ‘Palmotićeva’ as well, everything is nice and mild. But here, they need quick results. If anything happens, you’re immediately tied down to a bed and given strong injections, and those methods are rough. But they indeed produce quick results. I’m not blaming them, that’s how they must act. When you are released, you then proceed to individual treatment elsewhere, you go to a day hospital or to a community health center. What they in ‘Laza’ are trying to achieve is to fix a patient as quickly as possible when the ambulance or the police bring him in. As for the other hospitals, you apply for a treatment yourself and they admit you immediately or say to come back in two weeks, for example. You’re a patient there as well, but not so drastically. Well, ‘Laza’ is an emergency institution, patients are brought there by the police or the ambulance service. One of the problems of psychiatric patients is that after their release they need a program of life. “And when a patient is released, he has no program at all. We mainly tend to stay at home, friends abandon us, neighbours don’t give a damn about us, and we are usually marginalized even within our families. And a patient needs psychotherapy”, testifies Jugović. “Then a patient reports to a day hospital. They have a psychiatric service, social skills, psychotherapy, lectures, health education; the day hospital is a great thing. In the morning, you also have a social life with other patients, various educational sections, you can learn a lot, English language, computers, chess, there is a library, a drama section, a literature section”. Stigma and stigmatisation: Dragan Jugović gave several interviews to the press (“Politika”; “Vreme”; “Blic”) and he also appeared in a number of TV programs. “One should talk to the media. Many patients are not capable of it”, he comments on his public appearances. “Another problem is that many media spread prejudices. A couple of years ago, there was a crime in Jabukovac – a psychiatric patient killed several people. The next day, the front page of ‘Kurir’ bore a huge title: ‘Diagnosis – schizophrenia’. An exclamation mark and a photograph. By the same token, they branded all people with that diagnosis, while the statistics demonstrate that we, patients, have the same or a smaller crime rate than the healthy population”. Jugović believes that the environmental reaction towards psychiatric patients has not maybe changed much and that it is still necessary to persistently work in order to dispel the stigma of psychiatric patients. “There is a study that demonstrated that the stigma of psychiatric patients is constant. Stigmatisation is a constant trait of history, we are branded and this will not change. But this does not mean that we don’t have to strive to change it, because stigma is made of the prejudices people have. We can do a lot to improve our situation in institutions, in society. But the stigma remains, and it is not attached only to patients. Psychiatrists themselves are stigmatised by other doctors. The majority of doctors think that cardiologists, pulmonologists and other doctors represent medicine, while psychiatry is not quite medicine in their eyes”, thinks Jugović. He also says that he did not have any problems for being the first one in Serbia to publicly come forward and speak about his illness, his treatment and institutional problems. “Doors were even open to me because of my public appearances”, says he. “I criticize ‘Laza’ but I’m their patient. My criticism is not misplaced. I didn’t lie at all, everything is sincere, why should I have problems? All doctors know me, I am called there the ‘doyen of psychiatry’, I even have some benefits there, precisely because of that”. A fragmented life: Dragan Jugović had studied electrical engineering, specializing in technical physics, had passed five exams in the third year and then he, as he says, stopped because of his illness. From the age of seventeen to forty-seven, thirty years, he gave private lessons in mathematics and physics and thus earned some money, but stopped doing that when he had obtained the right to family pension. He says he was lucky because, according to the law, that kind of pension could be given only to those who fell ill before they were eighteen and who never worked. Jugović says that all patients like him are retired because psychiatric patients, due to their illness, cannot work long and are quickly retired, but 90% of them have a minimal pension, 15,800 dinars, which is not enough to pay the bills and live on. “But, that’s the law”, he shrugs. “In comparison to my friends, brothers in suffering, I am a happy man, and I must thank God for that. I’m provided for, I have a wife whom I love, we don’t have children but we have a good marriage and we get along well. My wife is being treated for psychosis. Because we had both been ill before we started our relationship, everything is alright, we know that illness”. Momir Turudić
