The Psychiatric Gulag The Misery of Romania's Mentally Ill

Patients in Romanian mental institutions are treated little better than animals. Neither the country's transition to democracy nor its preparations for entry into the European Union can make the government in Bucharest take action.

By Erich Wiedemann in Borsa, Romania


Conditions in the mental institution are rudimentary and patients often have to share beds.
Erich Wiedemann / DER SPIEGEL

Conditions in the mental institution are rudimentary and patients often have to share beds.

Doru discovered the dead man right after breakfast, lying in a meadow behind the lounge. A glass of water stood next to the charred corpse. The man had set himself on fire. Now he'll be examined by the doctors and then maybe he'll go to heaven, his friends say. He's put the worst behind him, they add.

The other patients don't have that option. They have to put up with the stinking gray underworld of the mental asylum in the Romanian town of Borsa. None of them know if they will ever get out again -- most of the patients in Borsa stay there until they die.

Mentally ill people are often seen as unwanted outsiders in Romania. No one wants to have to deal with them, and they're referred to colloquially as "varsa" ("weeds"). In this country, not even doctors believe a disturbed soul can become healthy again -- once crazy, always crazy.

Cursed

Borsa Castle is located in the most idyllic part of Transylvania, 260 kilometers (162 miles) west of Bucharest. It was the summer residence of the Bánffy family until shortly after the end of World War II. When the communists threw the family out, Baroness Bánffy put a curse on the expropriated house, wishing for it to become an asylum. The reality was worse than her curse. Borsa Castle became one of the most monstrous mental institutions in Romania.

The annual death rate here is around 10 percent. Those patients who don't have relatives to bribe the attendants with food parcels and gifts can't afford to become seriously ill. If they do, they may end up rotting in their own feces.

Outside visitors aren't welcome in the castle -- unless they're accompanied by Paul-Otto Schmid-Michel, a professor of psychiatry from Ravensburg in western Germany who has become something of a godparent to the asylum.

Less than rudimentary care

A young man stands in front of the carved wooden gate to the dormitory building, holding an apple and babbling. His gaunt skull has been shaven, and he is wearing gray-striped pajamas and a brown bathrobe. On his right foot is a grubby sneaker, while his bare left foot is almost completely black. He holds the apple out to the visitors, saying "Bun venit" ("Welcome").

Borsa is located in the most idyllic part of Transylvania.
DER SPIEGEL

Borsa is located in the most idyllic part of Transylvania.

Outside the shack used for occupational therapy, patients assigned to the firewood detail are sawing logs. They are also dressed in pajamas and wearing plastic sandals.

Medical care here is as rudimentary as the clothing. During a visit last year, Schmidt-Michel found a patient with a broken pelvis. "He had already been lying in bed, moaning with pain, for three days," he recalls. "No one took any notice of him. They said he was just pretending." The man would have died if Schmidt-Michel hadn't taken him to hospital.

Infested

"This way to the dormitories," says the attendant. He raises his index finger with a wink: Best not to touch anything. The clothes, pillows and mattresses here are infested with fleas and itch mites.

The stench is overwhelming. The asylum has only two showers -- one for women, the other for men. According to regulations, every patient is supposed to shower once a week. But that's only possible when the well that supplies the asylum has enough water. In the summer, when the groundwater level sinks, the well often dries up for long periods. Then the lavatories become covered with excrement and the only washing machine doesn't work any more. At these times the patients often wear the same unwashed clothes for months.

German psychiatirst Paul-Otto Schmidt-Michel is something of a godfather to the asylum.
Erich Wiedemann / DER SPIEGEL

German psychiatirst Paul-Otto Schmidt-Michel is something of a godfather to the asylum.

In the winter, the dormitories with their coal stoves are often not aired for weeks. There's no room to walk around in the dormitories, so many patients only leave their beds to eat or when they have to go to the toilet.

Around 40 patients are forced to share their beds with someone else, sleeping head-to-toe. During the cold season, they no longer see it as a problem, since they can keep each other warm.

There's little hope of the asylum's overcrowding getting better in the foreseeable future, because a bonus is paid for every new patient admitted. Schmidt-Michel tries to show understanding for the corrupt attendants and the director, Radu Ilea. Over the years the staff members have lost their sensitivity to human suffering, he says, pointing out that the employees here are often struggling to survive themselves.

Passive euthanasia

Schmidt-Michel says the conditions in some Romanian asylums have reminded him "of the treatment of mentally ill people under fascism." In Beclean on the Ukrainian border, for example, where in 1990 half of the 130 patients were kept in the cellar like animals. "That was passive euthanasia," he says.

Romania's transition to democracy hasn't changed anything in the country's mental asylums. In early 2004, it was reported that 17 patients in a hospital in Poiana Mare had died, most of them from hypothermia or undernourishment. When the state prosecutor's office investigated, it turned out that the death rate for 2004 was actually below average. More than 80 people had died in the institution the previous year, again mostly from starvation or cold.

Elderly people are sometimes dumped by their children in the institution if there is no room for them in a nursing home.
Erich Wiedemann / DER SPIEGEL

Elderly people are sometimes dumped by their children in the institution if there is no room for them in a nursing home.

The bureaucrats in Bucharest are well informed about the misery in the country's mental asylums, but they're not doing anything about the situation. "That's to do with the state of ethical awareness here," Schmidt-Michel says.

The European Union, which Romania will join on Jan. 1, isn't doing much either -- even though the Romania's EU membership negotiations would have been a good opportunity to remind the government in Bucharest of its obligations towards the mentally ill. Simona Lupo from the department for social affairs at the EU's contact office in Bucharest says an action plan has been developed. "But we have to admit the situation hasn't improved that dramatically," she says. In other words: The situation is as bad as it was three years ago.

No way out

In Romania, the mental institutions are worse than the prisons. At least prison inmates can get a lawyer if they have the money, but for those in the psychiatric gulag there is no way to appeal.

Some patients in Borsa aren't even ill in the clinical sense. They're just being dumped here because they have no family or home, or because their spouses want to get rid of them. Sometimes people put their elderly parents in the asylum if there's no room for them in a nursing home.

Therapy is carried out almost entirely through mediation, with the first tranquilizers already administered at breakfast time. Many of the patients only became ill because of the treatment they received here -- anyone who takes two tranquilizers a day for years on end becomes addicted.

The constant medication diminishes the mental and physical autonomy of the patients -- which is clearly also the intention. The drugs administered in Romania's mental asylums are mostly haloperidol and levomepromazine, neuroleptics whose long-term use can cause movement disorders and damage to the central nervous system.

Losing track

An attendant beats a hammer against a cast iron pipe outside the canteen -- it's lunch time. Today's meal is cabbage and potatoes in a thick sauce. Most patients sit on the grass and stare into space. Mentally handicapped and schizophrenic patients sometimes lose track of everything except their bodily functions and meal times.

The state of Romania pays four lei -- just over €1 ($1.30) -- per patient per day. Borsa has slightly better financial resources at its disposal than other asylums because Schmidt-Michel and a group of supporters from Ravensburg help out when money is tight. They also considered completely renovating the castle, but realized that it wasn't actually possible to repair the building. As a result they are recommending that the mental asylum be moved to another location. Although the current location has few advantages, Schmidt-Michel's recommendations have provoked fierce resistance -- mainly from the mayor and the local council. The clinic, after all, is the main employer in the area.

The farmers in the area also have an interest in the asylum staying in Borsa. They can hire those patients who are capable of work as day laborers to help out on their farms. Payment consists only of alcohol and cigarettes. Of course, alcohol is strictly prohibited in the asylum, but such infractions aren't punished.

"Borsa, what a hell you are," wrote Anja Hellstern, a nurse from the German city of Tübingen, in the diary she kept while she was doing her six months of voluntary social service here. And the attendants aren't the only offenders.

"It was the mute's washing day," she wrote. "Everything got lost in the bath except for his shoes and two ties. All his belongings were stolen by the criminals who were washing him. The poor boy cried and protested. There was nothing I could do, so I gave him a pair of socks. I got a smile in return."

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