Η Ψυχή. Study of the Soul and Its Feminine Side

Η Ψυχή.¹ Study of the Soul and its feminine side

Professor of Mental Health Care (Unit for Social and Community Psychiatry) Queen Mary University of London: London, London, GB

Author "Cognitive behavioural therapy in virtual reality treatments across mental health conditions: a systematic review"

DOI: https://doi.org/10.17650/2712-7672-2020-1-1-30-46

Maya Kulygina

PhD (psychological sciences), Senior Researcher, Department on International Collaboration, Scientific and Clinical Research Center of Neuropsychiatry

Editorial board member

Author "Impact of COVID-19 pandemic on anxiety, depression and distress — online survey results amid the pandemic in Russia" DOI: https://doi.org/10.17650/2712-7672-2020-1-1-8-20;

"Engagement of Russian Mental Health Professionals in the Development of WHO’s ICD-11"

DOI: https://doi.org/10.17816/CP79; "Toward ICD-11 Implementation: Attitudes and Expectations of the Russian Psychiatric Community" DOI: https://doi.org/10.17816/CP80

Elena Molchanova

MD (Psychiatry), Professor, Division of Social Sciences, Department of Psychology

American University of Central Asia, Bishkek, Kyrgyzstan.

Editorial Board member

Author Outpatient Services for People with Mental Disorders in the Kyrgyz Republic: What Is Next?

DOI: https://doi.org/10.17816/CP133

Natalia Petrova

Doctor of Medical Sciences, Professor, Head of the Department of Psychiatry and Narcology, St. Petersburg State University.

Author "Long-Acting Injectable Drugs in the Maintenance Therapy of Patients with Schizophrenia"

DOI: https://doi.org/10.17650/2712-7672-2020-1-2-53-62

Mariana Pinto da Costa

MD, MSc, PhD, Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust; Senior Lecturer, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Professor Auxiliar, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Chair of the Early Career Psychiatrists Section of the World Psychiatric Association

Author "Community psychiatry in Portugal: a critical review"

DOI: https://doi.org/10.17650/2712-7672-2020-1-1-49-59

Denise Razzouk

MD., PhD, Affiliated Professor, Department of Psychiatry, Universidade Federal de São Paulo Coordenadora do Centro de Economia em Saúde Mental (CESM)

Author "Community-based mental health services in Brazil"

DOI: https://doi.org/10.17650/2712-7672-2020-1-1-60-70

Anita Riecher-Rössler

MD, Professor em. of Psychiatry and former Head of the Center for Gender Research and Early Detection at the Psychiatric University Clinics in Basel, Switzerland

Editorial Board member

Natalia Semenova

Associate Professor, PhD (psychological sciences), Senior Researcher, Moscow Research Institute of Psychiatry, a branch of V. Serbsky Federal Medical Research Centre of Psychiatry and Narcology of the Ministry of Health of the Russian Federation

Editorial board member

Why did you choose the mental health career?

Victoria Bird: I have always been interested in people, and in particular social interactions. I have a drive to understand and am always wanting to know more. I wanted to have a career that followed my interests and would be fast paced and energetic. With mental health, everything is unique and about the person, no two days are the same. I work in mental health research, where I get to interact with really interesting people. One thing that drives me is the stories of the people who use our services.

Maya Kulygina: For me it was somehow predestined. As a friend of mine used to say, I was lucky to be born in a room with a bookcase. So, in our bookcase between Lermontov and Chekhov there were works by P. Gannushkin, G. Sukhareva, B. Zeigarnik, S. Rubinstein: my mom was a psychiatrist. I remember coming to her hospital, her conversations with colleagues, reading those books, all that created an environment in which poor mental health and a mentally sick person were perceived as something natural and deserving sympathy. While I was still a child I wondered what people thought about, why they acted the way the acted, what helped them to overcome difficulties and achieve success. In school I had a passion for biology, mathematics and literature which led me to the Faculty of Psychology of Moscow State University named after M. Lomonosov. And there the choice was clear — the Department of Neuro- and Pathopsychology. And so it went.

Elena Molchanova: Ever since school I’ve been interested in mental health. Initially I wanted to become a psychologist, but after attending lectures at several universities in Frunze (that’s how Bishkek was called at the time) I was disappointed. Once I happened to be at a seminar taught by V. Solozhenkin after which I immediately made my choice. So I found a Master rather than a profession.

Natalia Petrova: For me there were no alternatives. Back in school I got fascinated by higher nervous activity, since the 1st year I had been a member of a student scientific society for psychiatry. If I tried to rationally look back at my choice I’d say psychiatry is really intriguing, it challenges an inquiring mind.

Mariana Pinto da Costa: When I was studying medicine, I soon realised that many specialities are very specific (and too narrow) in their focus and in their care towards patients, as if one could become the expert of the little finger of a patient, not being concerned with the rest.

Being interested in supporting 'the person as a whole', beyond any specific organ or body part, I decided in my medical studies that I wanted to train in psychiatry, and pursue a career in mental health.

Denise Razzouk: Before starting my course in Medicine I was in doubt between Psychiatry and Psychology because I was very interested in human behavior and all human dimensions, including anthropological, historical and philosophical issues. In summary, I was interested in human beings.

Anita Riecher-Rössler: When I was 16 years old I read Sigmund Freud and was very impressed by his thoughts on the unconscious and all these psychological processes driving human beings. Later, after having finished my psychoanalytic training, I stayed in psychiatry, as I got more interested in scientific evidence. For example I got very interested in sex and gender differences of mental disorders or in the development of psychosis.

Natalia Semenova: I studied at the Faculty of Psychology at Lomonosov Moscow State University and my choice to become a "psychologist working in psychiatry, in collaboration and close contact with psychiatrists" was influenced by two professors, namely Bluma Wolfovna Zeigarnik and Yuri Fedorovich Polyakov.

B. Zeigarnik was teaching a course on pathopsychology, and I always tried to sit as close to the podium as possible so as not to miss anything. I even bought a very cute notebook specifically for my notes on pathopsychology. And among them were some very important notes — on psychic pathologies in mental diseases, on the key role of social environment and the cultural space for the patient, on the importance of the patient's own activity, on psychological correction and rehabilitation as necessary conditions for the return of an ill person to normal social life.

Y. Polyakov (who was my Ph.D. thesis supervisor later on) gave a course of lectures on the pathology of cognitive activity in schizophrenia (covering, in particular, various types of motivational and personality disorders). In terms of career choice, as it turned out, I was not the only one who was influenced by him. The well-known German psychiatrist Manfred Spitzer once admitted in our personal conversation that if he hadn't come across a little book "Schizophrenie und Erkenntnistatigkeit" (a work of J. Polyakov translated into German and published in Stuttgart in 1972) at the time, he probably would not have chosen this field of medicine for himself.

What is most important to you in your job?

Victoria Bird: Having supportive colleagues and a stimulating work environment is essential for mental health research. You cannot do research on your own, rather you need others. Having a supportive environment allows ideas to flourish and grow, it also promotes creativity. Within this, it is important to ensure a range of perspectives are heard, importantly including people with lived experience in the discourse.

Maya Kulygina: I could say that it is important to feel needed, to be able to see the result of your work, whether it is research or clinical practice. But there is always more: craving for knowledge, the opportunity to explore on your own, feeling of commitment to an important common cause, and of course that basic interest to human beings.

Elena Molchanova: To understand what I’m doing, what the purpose is, and what my patient will receive as a result. To retain the ability to empathize at least at the level that I have so far. It’s important to remain empathetic, at least as much as I already am so far.

Natalia Petrova: Helping people who are suffering.

Mariana Pinto da Costa: I am driven to make a positive and meaningful change in people’s lives. This can be on a one-to-one individual level, or more globally at organisations level. It is extremely rewarding every time I receive a message of a patient or a colleague and knowing that I was able to help that person.

Denise Razzouk: Mental health is about how human beings feel and react while facing life challenges, individual limitation and expectations. Ultimately, suffering is a consequence of our ability failure of dealing with the imbalance between how society supports/threaten us and how our biological and psychological skills are appropriate to survive and to pursue happiness and well-being. Then, poor mental health represents a lack of individual freedom to decide and to choose his/her best possible trajectory in life. A psychiatrist should be able to keep in mind that a mentally ill person is someone that needs support to restore his/her life in all dimensions and not only receive “interventions” focused exclusively on symptoms and claims. Therefore, a psychiatrist should be interested in all human beings aspects and have empathy regarding human suffering.

Anita Riecher-Rössler: For me psychiatry is the most interesting discipline, because it deals with the most important subject, the human being, and in all its aspects from biology to psychology, sociology, etc.

Natalia Semenova: There are probably two things that are worth mentioning. The first one can be described by the expression "need-induced immunity". It’s when you as a professional are really needed. My work mostly involves psychosocial support for the sick. In terms of the experimental component, I have always been more into experiments that help with personal growth and development rather than just detect certain disorders in the patient. "Need-induced immunity " goes hand in hand with increased resilience to life's challenges (and diseases!). This is due to the specialist's experience of being needed by others to successfully carry out an activity that is significant both to them and to the society.

The latter consideration also concerns psychosocial help for the mentally ill. Personally, I call it “protecting” or “saving”. One way or another, from different theoretical perspectives and using different conceptual languages, many have mentioned this common idea which is important for our work. I mean the connection between such phenomena and statements as, for example, once proposed by Solzhenitsyn expression of the national idea, namely "saving the people" and my teacher and doctorate thesis supervisor Isaak Yakovlevich Gurovich's concept of psychosocial rehabilitation in psychiatry.

The pandemic-related crisis is still tough for the whole world. What would you recommend to strengthen one’s mental health?

Victoria Bird: I think we need to focus on our youth people, their mental health and wellbeing. Young people have really had a tough time over the last year, with the closure of schools and the loss of normal social interaction. However, I do not think it is about diagnosing and putting people in treatment, rather we need to focus on giving young people the skills and resources to overcome mental distress. In particular, we need to strengthen community resources, such as those provided by sports and arts groups to enable young people to interact and express their feelings.

Maya Kulygina: The advice would be quite common and even simple actually, but it should be followed: keep in contact with people, and not only with the loved ones, but also on other social levels; take care of your body, in terms of a healthy diet or regular physical exercise, learn something new. What is particularly important in the context of the restrictions and distancing, fill your daily schedule with activities in order to avoid routine, monotony and lack of will. Finally, I guess, it is imperative to create your own meanings and stick to them, i.e. find something that inspires you, brings satisfaction and answers the questions: why am I doing this? For what purpose?

Elena Molchanova: My profession is not about offering advice. Evidence-based medicine believes that regular physical exercise boosts neuronogenesis and lowers cortisol levels. So I would say any type of sport that feels good will do. There’s a lovely book by Robert Sapolsky that is called “Why zebras do not have ulcers”. There's nothing to add to this.

Natalia Petrova: Work hard.

Mariana Pinto da Costa: The current COVID-19 pandemic has led to social isolation blocking people from their usual face-to-face interactions with their family and friends. This led to many feeling helpless, anxious and depressed.

Therefore, there should be an increased capacity to support individuals in their local communities, including through the use of technology. This should be at the services level, facilitating access to mental health services when required to provide treatment, but equally through initiatives that provide volunteering support in the community, and promote social cohesion and support, focusing on (new symptoms or their relapse) prevention.

Technology has been fundamental to provide care and support to patients during the ongoing pandemic. On several occasions it allowed to address social isolation and overcome distances, but also to contribute to patients’ recovery and their social integration. It has not only been an alternative available or a preference for some but for many and on many occasions the only choice available.

In my PhD research I developed a new intervention called ‘Phone Pal’ to overcome social isolation in people with mental illness, connecting community volunteers with patients with psychosis remotely through smart-phones (Pinto da Costa M, 2020), with encouraging findings.

To strengthen mental health I would recommend self-care interventions, the utilisation of resources in the community that provide support, particularly to socially isolated individuals, and that the access to mental health services to those who require it is facilitated through the use of technology.

Denise Razzouk: There are potential actions according to two levels: national level (public health policy) and individual level.

I think that public health policies must address mental health issues together with COVID-19 control strategies. Mental health cannot be apart from it. Mental health is everybody's business and all sectors of society should be involved to strengthen mental health. Regarding public health policies, it is important to address the main triggering factors of poor mental health: financial insecurity, poverty, unemployment, grief, social isolation, anxiety, depression, burnout, suicide risk, lack of social support and alcohol use. It is important to deliver public psychoeducation about signs of poor mental health and to promote a healthier lifestyle. Of course, primary care should be prepared to assist and identify not only the first signs of COVID-19 but also mental health needs. Other actors such as teachers and entrepreneurs should be trained and involved to identify signs of mental health needs as well as to guarantee a supportive environment for students and workers.

Regarding the individual level, it is very important to avoid alcohol and to acquire healthier habits and lifestyle, including exercises as well as keeping in contact with friends and family members. Also, it is important to avoid being several hours on the Internet or using mobile apps. It is important to schedule daily activities, and balance self-care, rest, leisure and work activities. It is good to learn something new or to do something that promotes motivation such as an old or new hobby. Don´t answer emails/WhatsApp 24 hours per day! If all measures are not enough and anxiety and depressive symptoms became dysfunctional, then, is better to have a consultation with psychiatrists.

Anita Riecher-Rössler: Strengthen body and soul. For example by doing lots of sports and outdoor activities, cultivate all the creative work and hobbies you always wanted to, but never found the time for. And most importantly: keep in contact with people using all possibilities like telephone, online or outdoor meetings or social media.

Natalia Semenova: Leading experts in domestic and foreign psychiatry and clinical psychology have already given valuable advice on preservation and promotion of mental health in the context of COVID-19. I can only add a few things. It is about the willingness to act in a situation of anxiety and uncertainty, about the important role of action in general (Fais ce que dois, advienne, que pourra — Do what you must, come what may) and "search activity", as understood by our physiologists V. Arshavsky and V. Rotenberg. The common ground here is continue searching in conditions, when one cannot be sure of the consequences of one’s behavior, when there is no certain prediction of the outcome of the whole COVID-19 situation and despite of that the person continues to act consciously and meaningfully, which helps to restore the peace of mind.

What advice would you give to young women who have chosen the mental health career?

Victoria Bird: You can do this — you are strong, confident and have an opinion to be heard. There is nothing you cannot do. Empowered women, empower women.

Maya Kulygina: If we are talking about the profession of a psychologist or psychiatrist, about someone who combines science and practice, my first advice will be gender neutral and rather standard for those who are just beginning their journey to carreer: read, think, write, learn, grow. And for women specifically, it might be useful not to forget to maintain a balance between professional and personal life, which includes relationships, family, hobbies, without going to any of poles, since both these domains can be mutually enriched if you distribute your attention, time, mental and physical energy equally and create harmony.

Elena Molchanova: Think twice. And then think for the third time. Make a checklist of occupation burnout symptoms and as soon as the diagnosis becomes obvious, take a break. Otherwise you will not be able to guarantee individual approach anymore, which can be harmful for the patients. And then again, think carefully.

Natalia Petrova: To remember that there’s more to life than your profession.

Mariana Pinto da Costa: Follow your dreams. Challenge and improve the “status quo” and do it in a way that you will feel proud of, and that inspires others. Be a good listener and show empathy. Speak your mind, and advocate for what you believe. Never tolerate any kind of abuse. Demand respect and to have your voice heard. Say ‘Thank You’ and show your appreciation. After a while you will see that you were able to build and nurture long-term professional relationships and a successful mental health career.

Denise Razzouk: A high level of professionalism and competence are always desirable and essential, but being women requires much more than that. One important issue is about having good self-esteem and self-confidence because the path for success is much harder and longer for women than for men. Hostility, lack of opportunity, unfair critical and judgemental comments addressed to women´s behaviour and ideas are very common. Being persistent and catching all opportunities (even the small ones) to show the excellence of your work is important too. Don´t expect recognition, instead use actively the media to enhance the visibility of work because this opens new opportunities and it gives you a voice to show your ideas. Developing good professional and public network are worthwhile strategies. Also, it is important to balance work and personal life, especially pursuing positive experience because psychiatry practice is hard in terms of dealing with suffering and high emotional demand. It is important to take care of your mental health.

Anita Riecher-Rössler: Set your own goals and work on them. Question gender stereotypes in others and in yourself. If you don't dare to do something/to claim something, do it/claim it nevertheless! Make your dreams come true. Be self-confident! Self confidence in my experience is the key for women — they often do not dare to…

Natalia Semenova: I would advise women who have chosen this profession to «be seen». I first heard this expression at an international psychiatric forum from Sophia Frangou, who was teaching a course there. To understand what "to be seen" means for a female professional, I recommend the book edited by Frangou “Women in Academic Psychiatry” [Frangou, S. (Ed.). (2016). Women in Academic Psychiatry: A Mind to Succeed. Springer. — the book is the public domain]. In particular, it includes first-person accounts from some of the most influential women in psychiatry about why they chose the field, what challenges they faced and how they managed to succeed. Among these stories there is that of Danuta Wasserman, who will head the World Psychiatric Association in the foreseeable future.

¹ ancient Greek — soul. Feminine.