Moscow's Tragic, Absurd Mad House

The sturdy red-brick buildings of Moscow's Alexeyev Psychiatric Hospital are home to about 1,500 mental patients whose lives are a mixture of the tragic and absurd.

Margarita, 44, believes that when she was 5 somebody implanted a radio sensor inside her body. Since then, she has received signals that hurt her heart. Her suffering grew so unbearable in early August that one night she swallowed 50 sedatives in a suicide attempt. She was saved by doctors and brought to the Alexeyev hospital.

"I don't know what happened and even if I did, there would be no use in knowing," Margarita mumbled indistinctly in an interview this week, her lips barely moving and her eyelids heavy.

In another case, a male patient thought that his neighbors wanted to destroy his mind by beaming electromagnetic signals at him. The man lived in a tent of aluminum foil he constructed in his room and walked the streets in an oversized military hat, also wrapped in foil. This innocent oddity eventually developed into a murder attempt, however, when the man tried to stab his wife for plotting with his neighbors against him.

From the Oscar-winning "One Flew Over the Cuckoo's Nest" in 1975 to Andrei Konchalovsky's "Dom Durakov," or "Mad House," which won the runner-up prize at the Venice Film Festival this week, mental patients have proved an enduringly fascinating subject, both to filmmakers and the wider public.

But for the doctors and nurses of the Alexeyev hospital, watching, treating and caring for mentally ill people is all in a day's work -- a 24-hour a day job that nets them a maximum of just $200 per month.

The hospital, which for many years bore the name of Soviet psychiatrist and apparatchik Pyotr Kashchenko, was the most famous mental institution in the Soviet Union. Its mere name sounded an ominous note, one associated with repressed dissidents who were often diagnosed as insane by the KGB and packed off to prison-like mental institutions.

Alexander Podrabinek, a civil activist who was imprisoned for five years in the late 1970s for writing a book about how the Soviet psychiatric profession served the KGB, said the Kashchenko hospital was used to detain relatively minor dissidents. In the later years of the Soviet Union, Muscovites risked being sent there for misdemeanors such as telling a joke about Communist Party leaders or staging an unauthorized rally, he said.

"I remember times when many patients who had criminal records or who could be dangerous when their condition worsened were forcibly taken to the hospital ahead of public holidays or visits by important foreign leaders," said Arkady Shmilovich, the deputy head of the hospital, who has worked there since 1977. "But only a few of them should have been hospitalized; the others did not have acute conditions and were not dangerous."

After the collapse of the Soviet Union, the hospital returned to its pre-Soviet name of Alexeyev, after former Moscow Mayor Nikolai Alexeyev, who started building the hospital in 1886 with money donated by philanthropists. In an ironic twist of fate, Alexeyev was shot and killed by a mentally disturbed man in 1893, one year before the hospital was completed.

Today, the Alexeyev hospital is an oasis of tranquility in a busy suburb of southwestern Moscow.

The women's wards of the hospital look very homey, decorated lavishly with colorful self-made knick-knacks, from wall paintings to teddy bears.

"Our task is to create a therapeutic environment for the patients," Shmilovich said. "Patients spend a lot of time here and the hospital may be their only healthy social environment."

He said the main emphasis in treating patients at the hospital was not on medical therapy but on social rehabilitation.

A good example is the hospital's sewing workshop, set up by two female patients in 1988. The women came up with the idea of a workshop to make teddy bears and clothing for children who survived the disastrous earthquake in the Armenian town of Spitak that year.

Today, this tiny workshop is a center of attraction for hospital patients, who cram into the room waiting for their turn to sit behind one of eight sewing machines. The women, many of them in homemade clothes and fresh makeup, talk little among themselves, preferring to concentrate on their work.

Igor Tabakov / MT One of the hospital's wards for violent patients, who are supervised 24 hours a day..

They were reluctant to answer questions from outsiders, but most of what they did say was in praise of the doctors at the hospital. One woman sobbed as she recounted how in 1985 she had attempted suicide, since when she has checked into the hospital nine times for months of treatment.

The women refused to be photographed, saying they didn't want people to know about their illnesses. Others denied that there was anything wrong with them.

"I am not ill at all but I am not against any assistance the doctors want to provide for me," said Polina, 54, whose gray hair was arranged smartly into two short braids behind her ears. "I just don't want to traumatize the doctors, so I permit them to treat me."

The stuffed toys sewn by the patients are sold outside the hospital, and the women receive 60 percent of the proceeds. The rest is reinvested in the workshop, said Irina Akopdzhanova, head of one of the hospital's several women's sections.

The hospital boasts several other workshops and even a greenhouse where patients who do not require constant surveillance can work or learn new skills. The wards also have rooms where patients can play board games, listen to music or watch television during the day.

The men's wards of the hospital look much grimmer and shabbier than the women's, and they have steel bars on the windows. Although hospital staff said it was a requirement of any Moscow hospital to have bars on the ground floor, it seemed that the additional security here was sometimes justified.

Last year, a patient went berserk and attacked a doctor, Natalia Lazina, breaking her nose and knocking out two of her teeth.

"Such things happen," Lazina said. "We have only two elderly nurses to watch over patients with acute conditions, and in emergency cases they call me."

Each of the hospital's sections has a ward where violent patients are watched 24 hours a day, even when they go to the toilet, for fear that they might commit suicide or attack another patient. All 12 beds in one of these wards were occupied one lunchtime this week.

"No comment!" the male patients screamed in English, sawing the air with their hands, when they were approached with questions.

Patients in other wards were much friendlier. Vladimir, a 33-year-old musician, recited elegiac verses that he had scribbled on random slips of paper.

"I am not sick, I come here to find solitude and rest," he said, stroking his long hair.

Doctors said that for the past nine years, Vladimir has checked in for two months every year.

Vladimir belongs to the largest group of the Alexeyev hospital's patients: people who check themselves in for treatment and who can leave at any time unaccompanied by medical personnel.

Shmilovich said the hospital's psychiatrists try not to tear mentally ill people out of their social environments. In many cases, he said, patients are permitted to go home at night after being given medication during the day. At the same time, students who have to study during the day are allowed to spend the night at the hospital to be treated for their psychological disorders.

The cost of medicines for the hospital is covered by the state, which also pays 43 rubles ($1.40) for each patient's daily food ration. This is a lot compared with other hospitals across Russia, the hospital administration said.

Other than that, the hospital has to fend for itself, Shmilovich said. For example, the patients have to sweep the lanes and clean snow on the hospital's 30-hectare compound themselves.

In pre-Soviet times, the hospital was supported solely by charitable donations, while under communism the state took total control of it, Shmilovich said.

With the decline of the Soviet Union in the late 1980s, however, the hospital became strapped for cash and decided to apply for help from the country's newly formed business elite.

"We sent 90 letters to the country's richest people and companies and received only six replies, all negative," Shmilovich recalled.

Only the Russian Orthodox Church donated money at the time, along with a descendant of Pyotr Smirnov, the famous Russian vodka producer who supported the hospital's creation more than 100 years ago. The descendant pledged to pay for the cost of treating three patients annually for the rest of his life, Shmilovich said.