Seeing Through the Eyes of The Polish : How is mental health approached?
How did we get here? A language of silence and disempowerment
By Margo Dmochowska
Our societies are dependent on language. It gives life to our culture, politics, art and music. It is the medium we use to communicate our shared existence, and express our solidarity with one another. If we do not have the language to express something, we do not allow it to exist. And this is the case with mental health in Poland. Despite the country’s vivid memories of hardship and occupation, mental health remains a facet of Polish life that continues to be stigmatised and persecuted by silence. Therefore, it is important to ask: how did we get here?
In order to answer this question, we will have to delve into the colossal socio-economic and political transformation that Poland went through after the collapse of communism, and which arrived in the form of a two-fold deal.
On one hand, the newly acquired values of democracy and freedom uplifted a nation desperate to reassert itself as an autonomous entity. A short-lived run at independence in 1918, after 123 years of occupation and colonisation by Prussian, Austro-Hungarian, and Russian powers – which itself quickly transpired when Nazi Germany and the Soviet Union occupied Poland from 1939 to 1945, and again from 1947 to 1989, respectively – left a long-neglected identity vacuum in Poland’s institutions. They owed their foundations to external powers - not the Polish populace.
On the other hand, Poland’s second birth as an independent republic was a true moment of social upheaval and proved arduous on the population. The newfound promise of civil liberties eroded previous social safety nets that had protected worker’s rights and resulted in disconcertingly fast ‘growing rates of poverty, unemployment, and crime’ (International Labour Organisation). Pre-pandemic, Poland’s unemployment rate stood at 3.28% in 2019. At its worst, however, this figure had wavered haphazardly between 13.66% in 1991 and 19.9% in 2002 before it finally followed a steady downwards trend (World Bank).
This kind of patchy economic growth, as well as the income inequality and an increased sense of financial vulnerability amongst individuals that came with it, have been shown by numerous studies to lead to increased levels of stress, morbidity, and mental illness (British Medical Journal). And this was not the first time that Poland had gone through such a momentous change in such a short period of time. This volatile socio-economic and political environment has taken a toll on the populace, and made individuals feel powerless to the changes going on around them. Something that can be better described as a sense of obezwładnienia [disempowerment]. A Polish term whose sentiment can be hard to translate, but refers to a loss of freedom over one’s own situation, and a general feeling of inertia and exhaustion at its culmination.
Today, Central and Eastern Europe has become the most rapidly growing tech region in Europe – and Poland leads it by a mile with a 30% total share of the region’s GDP (Dealroom). However, no amount of data based off materialistic metrics can hide the mental anguish that this unrelenting transformation has left on the country.
The status quo – Empty words vs real-world actions
Poland’s heavy focus on bringing its economic development up to speed over the past three decades has neglected its social fabric to such a degree that it may come apart at the seams – and it has witnessed growing social discontent as a result. Most recently, the ongoing protests against the Constitutional Tribunal’s anti-abortion ban that started in 2020, and the growing discourse condemning the government’s crackdown on the LGBTQ community and anti-LGBTQ zones (Margo Dmochowska).
But a social issue that still has not found its voice in Poland is mental health. Poland’s solitary focus on growing its economy has neglected the hardships that often come with it. Mental health continues to be overlooked and characterised by a culture of discrimination – as something that gets in the way of progress. As put by Mateusz Biernat – a therapist, mental crisis consultant, and member of the Ministry of Health’s mental health advisory board – the result is a rapidly evolving society with a ‘mental health care system that has hardly changed in 100 years’ (Notes From Poland).
The mental health care system is still heavily reliant on an institutional approach, rather than on a community-based one. Individuals with mental disorders and learning difficulties are put into social asylums and removed from society, and primary care services are in desperately short supply. The care that is available is extremely disjointed and there is a lack of discourse between mental health services and related programmes such as substance misuse (British Medical Journal). An attempt was made to move mental health services to a more community-based approach in 2008 via the National Mental Health Programme – an amendment to the 1994 Mental Health Protection Act – but a lack of resources and a lack of motivation meant that the programme found itself underfunded and unsuccessful (The Health Systems and Policy Monitor). Mental health may exist as a statute on paper, but actions most certainly speak louder than words, and no significant action has been taken to improve the education and discourse around mental health, nor the services available to address it.
Where do we go from here? – A journey from denial to acceptance
This culture-wide dismissive attitude towards mental health is so deeply embedded that even when mental health care is available, those who need it most do not seek it out. A recent study of Polish migrants in the UK found that despite the fact that mental health care is more readily available in the UK than Poland, and even though ‘migration has been shown to be associated with negative mental health outcomes’, Polish migrants tend to underutilise the services available to them (BMC Health Services Research). The culture of silence around mental health has cultivated a nation-wide internalised stigma around speaking out so strong, that we have become our own policemen. Censoring anything in our minds that deviates from what is considered to be the norm. If only Freud had been alive today – he would be all over this.
So where do we go from here? The pandemic has shown us that the need to address mental health is more important than ever before. Researchers have shown that the mental deterioration caused by it could linger long after the pandemic abates (Nature). In countries like Poland that already struggled with mental health services before the pandemic started, this is a challenge that requires us to move from a discourse of denial to one of acceptance when speaking about issues surrounding mental health as soon as possible.
Children are a particularly vulnerable group in this regard (Balkan Insight). A survey by the Polish NGO Fundacja Dajemy Dzieciom Siłę [The Empowering Children Foundation] found that 1/3 of respondents aged 13 to 17 described their mental state as bad at the start of the pandemic (Fundacja Dajemy Dzieciom Siłę). Despite this growing need, a recent report by the Supreme Audit Office found that nearly a 1/3 of the 16 voivodeships across Poland had not a single mental health ward for youth available. And the statistics gathered by the Kampania Przeciw Homofobii [Campaign Against Homophobia] on LGBT youth are particularly unsettling: 49.6% are displaying symptoms of depression, and 69.4% have suicidal thoughts (Kampania Przeciw Homofobii).
Poland desperately needs to allocate more funding to mental health. Just 6% of the country’s GDP is allocated to public health – well below the European average of 10% (Balkan Insight). But before this can even happen, Poland is in dire need of reform in order to accept mental health as an issue that needs to be addressed in the first place.
The new generation may be more aware of the importance of mental health, but this is still largely due to the influence of Western social media and cultural outputs like films and music. This kind of language and social understanding has still not taken root in Poland itself. Years of neglect have left the soil barren. With more young people being online users, there also exists an intergenerational discrepancy in the knowledge and access to information about mental health. But the online community can only do so much when the community that lives alongside you does not have the tools available to understand and, let alone, help you.
Mental health cannot make a sound until it is provided with a voice with which it can finally tell its story. A policy of silence helps no one. The fact that it is not visible when not talked about makes it all the more inescapable. It is a silence that you live in. A deafening silence that has the potential to dominate its voice over everything else in one’s life.
We need to cultivate a shared language to address it.
If we spoke a different language, we would perceive a somewhat different world.
– Ludwig Wittgenstein