Russia slow in fighting suicides


Deaths: Despite improving economic conditions, many researchers believe high rates persist because of an inattention to mental health.

September 26, 2004|By Douglas Birch | Douglas Birch,SUN FOREIGN STAFF

MOSCOW - Natasha Terk sat cradling a cup of coffee in a Moscow restaurant, her sky-blue eyes pregnant with tears.

She recalled how her 43-year-old mother took her life in Natasha's presence. Years later, after a bitter quarrel, Natasha's brother killed himself at the age of 25.

Now 31 and the mother of two, she thinks she has learned to forgive her family, even if she can't completely forget the pain. " I have my children," she says. "They're my responsibility. I know I have to carry on, no matter what."

The collapse of the Soviet Union 13 years ago led to a sharp rise in suicide rates that has not yet returned to Soviet levels. Suicides now number 38.6 for every 100,000 people - the second highest rate worldwide, after the small Baltic state of Lithuania - at an annual cost of about 70,000 lives.

That's nearly double the rate the World Health Organization considers a "crisis." It's triple the global average, and 3 1/2 times the figure for the United States.

The social chaos and economic collapse of the 1990s, experts here say, tore people from their social and psychological moorings. The Soviet public health care system eroded. Drug addiction and alcohol consumption soared. And many people found themselves unable to cope.

Researchers also blame the limited spending on health care, especially on stigmatized diseases and disorders.

The Russian Federation's chief suicide research institute, occupies an old building the weedy, ramshackle campus of the Ganushkina Psychiatric Hospital on the banks of Moscow's Yauza River, and includes a hot line, hospital, social services office and ambulance.

On a recent afternoon there, three patients stood outside a dormitory in their pajamas, smoking, while a drunken attendant gave directions to a visitor. Inside, the center's parquet floors were bleached and buckled, the walls and windows covered with a fine grit. Visitors must walk up five flights of stairs to the office of the director, Dr. Vladimir F. Voitsekh.

Voitsekh described the daunting financial obstacles faced by suicide prevention programs. "The system is slowly getting better in terms of funding," he said. "But we have to admit the process is very slow."

In 1995, the health ministry issued an edict calling for the creation of anti-suicide hot lines and counseling centers in all 89 Russian regions. But local authorities don't always fully fund these services. Some are understaffed, mental health professionals say, others scarcely operate at all.

In Poland and Hungary, two other countries with high suicide rates, government officials have reduced deaths through a variety of social and health programs. But even with the recent growth in Russia's economy, the Kremlin is trimming, not increasing, social services. Russia's safety net of free medical care and other services used to help compensate for low wages. That's not true anymore. "We don't have social support for the population, real social support," Voitsekh said.

The specter of suicide has long haunted Russian folk culture. Villagers once believed that because suicides died before their appointed hour they were doomed to wander the earth. They were called the "devil's horses" and Lucifer was said to ride them at night. From Tolstoy's Anna Karenina to the hero of Chekov's The Seagull, Russian literature is salted with characters who kill themselves.

Soviet statistics were not always accurate and prone to manipulation for political reasons. But if Russian State Statistics Committee figures can be relied on, suicide rates in Russia have been rising since the mid-1950s - with a brief, sharp dip in the late 1980s, when the Kremlin launched an anti-alcohol campaign.

People who adapted to survival in an authoritarian society struggle when given responsibility for making their own choices, says Aleksandr B. Khavin, dean of the faculty of the Institute of Psychology and Pedagogy in Moscow.

Capitalism demands "more initiative, more flexibility" than socialism, and many Russians feel unable to cope with the new, less restrictive Russia, he says.

Researchers here also point out that some ethnic groups seem to have a far higher risk of suicide: People at the greatest risk are those with ancestors who spoke one of the Finno-Ugrian languages, including Finnish, Hungarian, Latvian and Karelian.

Finno-Ugrian ethnic communities are spread across northwest Russia, and in some of their villages, suicide rates may reach above 200 for every 100,000 - about 14 times the global average.

Dr. Boris S. Polozhy, a psychiatrist with Moscow's Serbsky Institute, believes that some ethnic groups never completely absorbed the taboo against suicide. In some northern communities, he points out, a man might take revenge on a neighbor who has slighted him by hanging himself in his enemy's barn. The rope is then cut up in pieces that are used as good luck charms.

The victim, Polozhy says, "is considered worthy of respect, and the man who offended him is isolated and disapproved of by his neighbors."

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