Russians Confused by Therapy

When Nikolai Naritsyn opened one of the first private psychotherapy practices in Moscow two years ago, he knew he was in for trouble. It does not help beat your competitors to the market if your customers still do not understand what it is that you are selling.


"So let me get this straight," one potential client recently asked Naritsyn. "I see a girl. I'm interested in marriage, so I come to you, right?" asked the client, expecting to find some potion to make the intended bride fall in love with him.


Another client asked him to lift a spell. "I've had a string of unfortunate events," the client complained -- proof enough for him that he had been cursed. When Naritsyn suggested his own actions might have been triggering the incidents, the client was firm. "No, no. Someone's put a curse on me. My neighbor already read my cards."


Naritsyn, who is patiently trying to change the image of Russian psychotherapy, is not flustered by such requests. It may be as common as 'flu medicine in the West, but Russians still consider psychotherapy to be "exotic," Naritsyn says.


"After all, it wasn't long ago that the only access to psychiatric care was through the police and a straitjacket," says Naritsyn. "People still associate psychiatry with political repression."


In Soviet times, psychiatry was used as a weapon against anti-Soviet behavior. Those who did not comply with the authorities were judged insane and thrown into psychiatric hospitals -- a practice which peaked during the Brezhnev years, when psychiatric hospitals largely took over the role of the gulags of previous decades. "I know doctors who can diagnose just about anyone as schizophrenic," says Naritsyn.


After graduating from medical school in the early 1970s, Naritsyn was on his way to being a part of that system. But his focus shifted early in his career when he enrolled at the Medical Academy of Postgraduate Education for training as a psychotherapist.


Until 1985, when the Health Ministry signed a decree prohibiting doctors from practicing outside their specialization, this training was voluntary for any physician who practiced psychotherapy. It was not until later that same year that the Health Ministry officially established it as a separate field.


"The paradox is that we had been preparing psychotherapists for decades, but the specialty did not exist," said Dr. Alexander Slutsky, head of the academy's psychotherapy department. But for the majority of doctors psychotherapy went no further than giving patients drugs to calm them.


Only in the past few years have doctors started relying less on drugs and more on therapy -- both passive, such as hypnosis, and active, such as psychoanalysis. Although Slutsky is an advocate of active therapy, he admits that most Russian patients prefer to be passive. "People are used to waiting for miracles," he said. Doctors like Slutsky and Naritsyn are trying to convince people that this is pointless. But it is an uphill battle. To gain the trust of would-be clients, Naritsyn's firm, Psitep, has set up a 24-hour free hotline.


While most clients may be call-ins, Psitep already has 100 paying clients -- people who spend upwards of 25,000 rubles ($12.50) for an hour's session.


Some patients suffer from serious depression, having recently experienced divorce or a family death. Others suffer from neuroses or phobias -- one of the most common being a fear of the metro. "People are afraid of getting caught between the doors," Naritsyn says.


Wives of the new Russian businessmen make up another considerable portion of Psitep's clientele. Some complain of sexual problems, and suspect their husbands of fooling around or have trouble with their own lovers. Many are lonely now that their husbands are never at home. "He was great when he was poor," is a common complaint.


While Psitep may be making progress, it still cannot keep up with its main competitors -- sorcerers and spiritual healers. "These people will find their niche -- albeit a small one -- in any society, but in Russia they have influence over the majority," said Naritsyn.