The socio-economic crisis affects mental health in two mutually sustaining ways: First, it undermines the protective factors contributing to and sustaining development; and second, it increases and enhances the risk factors for the emergence of mental disorders. Situations of the current reality that fall into the above categories include: employment insecurity, income instability, unemployment, flexible employment, exorbitant debts, homelessness, home insecurity, increase in social inequalities, poverty, social exclusion (especially of vulnerable groups), inability of the individual to control his/her life, and uncertainty for the future. All this contributes to a significant increase in psychiatric morbidity overall and has been sufficiently researched and documented by the scientific community during the long-term study of crises. Specifically, there is evidence of a significant increase in depression, suicide attempts, and suicide, as well as their association with unemployment and employment insecurity,1–4 in addition, there is a direct link between a country’s wealth and the population’s mental health level.5,6
In times of crisis, an unacceptable –but also counterproductive, in the long run– phenomenon has been observed: while the demand for mental health care services increases, their supply decreases due to cutbacks in social spending. As a result, a vicious circle of perpetual deterioration in mental health is put in motion.7
One of the major mental products of the crisis is a general feeling of uncertainty and insecurity. This affects individual and group social behaviours in adults, creating a negative environment for the psycho-emotional development of the most vulnerable social groups, namely children and young people.8
A child is born within a mental and cultural background, while at the same time establishes behavioural, emotional and fantasy relations with his/her mother, father, and siblings, while his/her way of living is largely defined by the society (s)he belongs. When society is in crisis, the family as a carrier of this situation is saturated by feelings of despair and helplessness.
The family is a system comprising multiple cyclic interactions. At the present time, the specific events that the Greek society must deal with cause a crisis to the family as a whole, regardless of how many of its members seem to be affected.
Parent-child relations are being reshaped. A parent suffering from an anxiety disorder is unable to absorb his/her child’s anxieties; a depressive parent cannot contain his/her agonies and provide stability and caring feelings, leading the child to role confusion, mental inhibitions regarding his/her needs, and the formation of a “false self”. The guilt-ridden parent will transfer his/her own unresolved conflict issues to the child with inconsistent and contradictory messages. Changes in the socio-economic situation, cultural particularities, dismissal of institutions, constant negation, lack of boundaries, role confusion, as well as various family secrets, serious conflicts, and the disharmony of the parental couple in general – all are known risk factors leading the child to either experience a traumatic situation, due to the nature of stimuli (s)he receives, or lose the enabling/supportive role of the family framework.
As a result, children become neglected or overprotected and immature; psyche is suspended/immobilized in order to survive mentally; or is expressed violently, acting out silent feelings of pain and anger.
For teenagers, processes seem more difficult, since identifications constitute an urgent need as a defence mechanism supporting their narcissistic and ideological reconfiguration in order to form their identity. However, identifications are proven unsound; models are toppled; parents turn out to be weak and unable to accept the aggressiveness of independence-gaining; and fantasies that help the transition process cease to exist.
As far as models are concerned, we are living in a period that puts us face-to-face with pseudo-dilemmas which create feelings of despair, helplessness, abandonment, and deadlock, while at the same time urge us to accept and identify ourselves with messages that oppose and ridicule all former moral values and promote individualism and the pursuit of individual solutions. We live in an era lacking the models and idols able to stimulate the healthy processes of identification and idealization.
Personality is shaped through a series of identifications, first with the parents and then with other important figures. Therefore, it is self-evident that, with healthy models, the child will make satisfactory identifications.
Currently, however, the emphasis is on individual characteristics, not on the whole; consequently, only some sides of the children’s personalities are accentuated and developed, like sexuality or aggressiveness.
School, the other major social institution, is constantly degraded and devalued, both at material level, with the lack of necessary funds and the impact this has on school function, and with the nihilistic criticism towards teachers. Therefore, educators as idealization and authority models, as Masters, as symbolic carriers of power and the Law, as parent substitutes invested through displacement, become weak, underestimated, often scared and straining to put signifiers into words.
At the same time, cutbacks in general health and welfare spending have contributed to the shrinking of the – already insufficient – child psychiatric services of the NHS and to the elimination or downgrading of major child health care policies for vulnerable child groups, such as those with mental disabilities or developmental disorders.
If we are truly interested in finding a way out of the crisis for the sake of our country and its people, then we must claim and follow a course of action quite different from the one followed now, which involves cutbacks in social spending that, in the case of Greek Psychiatry, will lead to the eventual collapse of the greatest social endeavour in our field, i.e. “psychiatric reform”. Instead, we should side up with those who state that, in order for the country and the European Union to come out of the crisis, we should invest in human capital, whose main constituent is the mental capital.
Dimitris K. Anagnostopoulos
Assistant Professor of Child Psychiatry, University of Athens, Athens
Child Psychiatrist, Athens