Ann Faerden MD PhD; Oslo, Norway
I have been fortunate in having had the opportunity to visit Armenia and specially Armenian psychiatry for two weeks. I am a Norwegian psychiatrist who for the first time visited Armenia in April of this year when I attended the World psychiatric association meeting in Yerevan. During this first visit I was charmed by your people and the friendliness you showed towards me as a visitor. I was also impressed by the psychiatric standard that was presented at the meeting. My specialty within psychiatry is directed towards patients who experience their first episode of psychosis. Since Armenia also has a special clinic for these patients in Yerevan; I asked the president of the Armenian psychiatric association, Armen Soghoyan, to come back for a study visit. He immediately welcomed me!
My two visits gave rise to many thoughts about our two countries which were not on my mind when I first arrived. Surprisingly, at least to me, our two countries have many things in common. We are both small in population, 4.9 mill vs. 3 mill, education and scientific knowledge is highly valued, as is freedom for the individual. Both countries have Christianity as a state religion and a culture that appreciate music, theater and literature. This I think contributed to the ease of merging into daily life during my visit. I did not feel like a tourist, but as one of you, this despite me not being able to understand one word of Armenian! Some of the ease might also be contributed to Nansen; for Armenians being a Norwegian was associated with something good!
According to the WHO Norway is one of the best countries in the world to live in. I love my country, but despite this “well-being” we also have problems which affect daily life and that I did not find or see to the same extent in Armenia. This is what made me think and that I want to address:
As a small nation you have experienced more tragedy than most other countries. Despite the experience of a genocide with extinction of more than 1.5 million people affecting the history of every family, a devastating earthquake with the loss of more than 80.000 people and a recent war with your neighbors’ at the cost of more than 20.000 young men I met an optimistic future-looking people. Never did I get the feeling that you looked upon yourself as victims. Norway experienced a massacre last summer with the killing of 77 young people. Norway is still struggling with this attack. I am sure Norway can have a lot to learn from Armenians in how to carry on with life after such terrible experiences.
At the time of my visit the daily discussion in the newspapers in Norway was about an alarming increase in the rape of young women walking home at night. Before I left my friends and family told me to be cautious and not walk by my self at night in a foreign country. I was determined to sit inside at my hotel every night and not take any risks. But already the first night I found my self walking outside. Many other people were also out walking and it felt safe. I asked several of my Armenian friends about my safety and they confirmed my perception. For the rest of my stay I walked every where which I cannot do at home at night. Yerevan is even a three times bigger city than Oslo with its 1.5 million inhabitants. Why this difference in safety and behavior? I do not have the answer, but some people suggested that you have an internal “pride code” for your city and that all inhabitants took part in protecting the “rumour” of the city. Norway definitly have something to learn from you!
Another problem we have in Norway is that people drink too much and get drunk in public leading to problematic behavior; often with violence. Also very visible in the heart of most big cities are groups of people using and selling drugs. Armenia has lots of alcohol. You produce wine and cognac and Armenia is a passing through of illegal drugs on the way to Europe. But I did not see drunk people in the streets, nor did I see drug-addicts down town. I might have been only in the “right place”– so as not to notice. But again I asked my friends: Why? Nobody could give a full explanation. Again the strong code for good behavior was part of the explanation. What is the code and how do you manage to have young people live according to it? Why do young people in Yerevan have a more safe night walk home and healthier life style with less alcohol and illegal drugs?
As I have already stated, my main aim while in Armenia was to visit your “First episode psychosis clinic” in Yerevan. The clinic has been operating since 2005; which is impressive! At this time in Norway, very few clinics were operating with this focus. The focus on first episode psychosis is a world wide program and tells that Armenian psychiatry, despite its limited resources; manage to make the best out of it. I visited many different psychiatric institutions. Everywhere I found a high professional standard and a deep dedication from all people involved. I met psychiatrists who had been working for more than 50 years and were still full of passion for the patients. I can also find such colleagues in Norway. This tells of a universal experience among psychiatrists and how also personally stimulating this work is. But Armenia needs more psychiatrists: Armenia has 103; Norway 1300. I really admire all my colleagues who work in psychiatry in Armenia under such a difference in resources!
But despite this difference in resources our two countries have about the same incidence of suicide. In Armenia about 300 people committed suicide in 2010 and in Norway the number was 550. For both countries too many, but in the lower range compared to many other countries and neighboring countries of Armenia have much higher rates. Something in the Armenians society must protect and what is that? If we understood this better it could be of benefit for both countries may be?
Another problem for Norway is young woman in such mental pain and instability that they cut themselves into bleeding and so deep that they are left with scars. I was told that this was hardly ever seen in Armenia. Again: why this difference in behavior? I wish somebody could tell me.
Another big difference between our two nations seemed to be time spent with family. Armenian life I was told was centered around the family. Despite modern life in Yerevan, you have managed to protect family life. In the families I visited members of all ages came passing through and filled the rooms with joy and laughter. I am well aware that this also has its back-sides, with family rules that can be too strict and hidden domestic violence. In Norway friends and activities takes up most of the time after work. I brought my running shoes to Yerevan, but realized I would be nearly alone in this activity! So why do we live such different lives at one level and yet have so many similarities? The answer may be simple, but I also think there may be some interesting answers to be found if we explored them more.
Also I was told there is a lot of shame and stigma concerning mental illness in Armenian society. But despite this, family followed their member to the doctor and contributed with concern and thoughts in a very straight forward and surprisingly opens way. In Norway patients with mental illness often come alone and it is often hard to involve the family.
I did not know what my stay would be like. I am very thankful for the openness I was met with. This gave me a unique opportunity to get to know Armenian way of life and psychiatry, but also reflect upon my own society. I feel our two countries are “made for each other” by having many things in common as well as differences. I am very sure that more contact between our two societies can give rise to meaningful exchange of ideas that will be of help to both nations and that the geographical distance contributes to this with more clarity of similarities and differences.