A DAY IN THE LIFE OF A PSYCHOTHERAPIST

A DAY IN THE LIFE OF A PSYCHOTHERAPIST

D-r Ksenia Kisselincheva

It’s the hour of musical therapy - I can hear Vivaldi’s Fours Seasons being played -I think I recognize the string ‘torrents’ of coming spring. For a moment I forget about where I am going and I dare contemplate the March sunset. The gently rippling music that envelops my soul for an instant makes me picture pink and white flamingoes flapping their wings through the sky. It’s only a fleeting instant. The chimneys and satellite dishes seem to have voraciously ‘engulfed’ the city sun and it’s seen no more.

 The musicotherapy seance seems to be over-I can hear the dragging of chairs and the chattering and clattering of the participants in the seance. A knock at the door and I find myself into an empty hall . Chairs are lined by the wall, loudspeakers are attached to the padded walls and a mike is hanging from the middle of the ceiling. The ‘concertgoers’ who appear to be of all ages and colors-from babyboomers to teenagers are all patients of the psychiatric clinic. But instead of being hospitalized they are treated on an outpatients’ regime. Some of them have undergone a short but intensive course of treatment with neuroleptics under the supervision of doctors but after that they can go home and feel like normal human beings. While at the same time they go back to the clinic for half a day to get either supervision from their doctor or some kind of alternative therapy-musicotherapy, calanetics, occupational therapy, art therapy and auto training. Most of the patients suffer from psychosomatic disorders like neurosis, depression, obsessive conditions. The relative ratio of the serious psychic disorders is steady - it is about 30%.

 But it is alarming that the latter ailments are on the increase and what is still more alarming drug addiction has boomed for the last 6-7 years and it is affecting mostly youths from the age of 13 to 18. Now that the patients have left I can have a chat with the psychiatrist, Dr. Zdravka Gerdjikova. She is a small energetic woman in her late fifties , short hair cut and prominent charcoal eyebrows which seem to be perennially questioning what she hears. And as you can guess she hears many stories full of ‘sound and fury’. And she has to solve the puzzle and she can’ t make a mistake because if she does, people may commit suicides or suffer a permanent damage of the brain. But this brave little woman is full of laughs and jokes and she does not show the enormous burden she has to shoulder. She is also a deputy director of the clinic and the telephone in her office is ringing most of the time. She is trying to tell me while she making herbal tea that in 1990 she took on a challenge bigger the ones she is used to-she was invited to the National Consultative Polyclinic where she was supposed to deal with the toughest cases which the local treating therapist cannot crack. ‘I find my work there so exciting and dynamic like nowhere else.  Though I must admit at the end of the day I can just about get home and crash into bed. . . ‘

Thank God her children are grown up and at university and she can devote more of her time to her profession. Because she made her choice against the will of her parents - they expected her to choose a more’ feminine’ profession like German philology, for instance. But her ‘infatuation’ with psychiatry started way back into her college years when her beloved biology teacher took the class to the psychiatry clinic. It’s the same clinic where she is working at the moment. What struck her most of all then was the attitude of the staff towards the patients - they were so kind and considerate and never laughed at the patients’ eccentricities. So soon after she became a medical student she joined the psychiatry circle and she became acquainted with the achievements of the three great figures in Bulgarian psychiatry- Prof. Shipkovensky, Prof. Temkov and Prof. Usunov. First she saw their busts in the clinic’s foyer at the time of her first visit. Later she came to appreciate their contribution to psychiatric practice. In the fourth year Zdravka started taking duties at the clinic learning how to do various manipulations.

After graduation in the ‘socialist manner’ she was ‘directed’ to go to work to Karlukovo, 120 km north of Sofia. This is one of the biggest and oldest psychiatric establishments in the country . Dr. Gergjikova loves to go back to that period in her life because this was the greatest time in her life, both in a professional and personal way. ‘There was a very special atmosphere of being together, doing things together. There was a group of older and younger doctors whose motto was to learn and know and to apply it in practice. What bound us together was a keen interest in our work. Sometimes one of us would wake up all of us to become witness to an interesting case . Then we‘ll stay up all night struggling to work out this case or to connect it to other similar ones. ‘ Then there were the endless gatherings on the verandah which started with conversation about the patients and ended only late at night over a glass of wine. ‘Those were the days . . . we thought they‘ll never end . . .’ It was a jocular interjection on my part but Zdravka recognized the song immediately and added that they used to dance to that hit of the 60’s on the verandah well into the night. . . She stayed there for six years. By the third year she took her specialty . There she met her prospective husband, there she married him and there she had her first daughter. But then the times were ripe for a move. But the only chance for her to return to Sofia was to win a post-graduate competition.

And she certainly made it- in 1972 she won the tough nation-wide competition and was appointed as an assistant at the newly founded clinic for alcoholism and drug addiction. She made it back to Sofia but she had to face to new challenges-the clinic was still under construction, the medical staff was being recruited, and Zdravka had to learn ‘a new trade’. So far she had seen just two drug -addicts in Karlukovo. By 1975 there were 198 drug addicts - it was no longer something you read about in thick medical books. Also there were quite a few patients from Greece since at the time there was no such unit in the country. Zdravka says that what kept going in those hard times was her sense of duty to her patients. In the early 80’s Zdravka suffered a few shattering blows in her personal life. Her elder daughter got seriously ill and she and her husband separated and later divorced. But she never lost her sense of humour and always made people feel better around her. She used to listen to Vissotsky in those days and she used to sing with him-did she gain some moral strength from the magic of the maestro’s electrifying voice? Dr. Gergjikova pours me another cup of tea telling me more stories full of ‘sound and fury’.

 ‘After 1989 , we, the doctors from the clinic warned about the oncoming boom of drug abuse with hard drugs. But nobody believed us then-everybody was too busy shouting at political rallies. Today , in 1998, we are in a state of emergency. Teenagers smoke marijuana at school instead of tobacco and the number of heroin addicts is ever rising. . . ‘ But Dr. Gergjikova cannot sit back and do nothing. And she starts another one of her stories. . . She invited quite informally mothers of drug addicts to a New Year’s party. And they came up with an idea to set up an Association of Victims of Drug Addiction. At present they are in the process of registering it and they have regular weekly gatherings. They educate themselves how to cope with drug addiction, some of them have already lost their beloved sons or daughters. Little by little Zdravka came up with the idea of setting up a Rehabilitation Center for Drug Addicts based outside Sofia. There are such centers all over the world and the Association is trying to establish contacts with such institutions in Germany, Israel, Italy. In some cases they are supported by the church. And the members of the association are on the search of sponsors and supporters. They have already negotiated the opportunity of taking over a neglected monastery and refurbishing it for the purposes of the Rehabilitation Center. One of the mothers who is an architect is ready to make a project for the readjustment of the building.

But there are moments when she wants to escape all her duties and responsibilities and she has found a way to do it. She loves to put together puzzles representing paintings of famous artists. Also she loves to read science fiction and detective stories in her spare time. But most of all Zdravka loves to log into the Internet and to browse through for hours. When I asked her what was the thing she liked best after 1989, she did not hesitate to say it was free access to information. And when I harped on the topic how hard the times were, she reminded me that the Chinese hieroglyph for development meant ‘crisis’. Zdravka answered the phone - she had to consult a colleague of hers on a tricky case of manic depression. She invited me to join her. I was apprehensive but curious to witness the partial revelation of the human psyche in one of its extreme and distorted manifestations. Moreover some of them are intensely happy and pleased with themselves, something which rarely befalls normal humanity. This brings to mind Kurt Vonnegut’s saying: “It’s not necessary to be mad to work for us but it can help a lot”. Isn’t our brave new world of today more like a madhouse than a utopian vision?

Sofia Western News monthly, 1998