104 oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania Mental health issues reduce the opportunity of individuals to be independent, to get an education and to work. Those with mental health conditions experience stigma, discrimination and wide-ranging violations which strip them of their dignity.16 In communist Albania, limited resources and isolation from Western treatments and practices negatively impacted the process of rehabilitation of the mentally ill. The Directorate of State Security, commonly called the ‘Sigurimi’, the state security, intelligence and secret police service of the People’s Socialist Republic of Albania, manipulated people, including through pressure and violence, who were obliged to cite unreal ‘facts’ in their testimony to the courts. Anxiety, caused by repeated purges by the secret police and a fear of being reported for some real or perceived misdeed, resulted in distrust and widespread mutual suspicion.17 In combination with frustration arising from a scarcity of consumer goods, this suspicion further contributed to a general decline in civility. The regime also rewarded those who conformed, regardless of their competence or their honesty, which, in turn, led to resentment and envy.18 Historically, former socialist countries have had a slower adaptation process with mental health policies, in comparison to other countries. The socio-political background is evaluated as responsible for framing this context. In general, totalitarian societies produced a `totalitarian syndrome’, a specific pattern of cognition, attitudes, and behaviors developed in order to adapt to life under totalitarian circumstances.19 The communist regime fabricated images of a perfect socialist state, of society and of the virtues of the ‘socialist and Soviet’ man. Although this propaganda was not generally believed, it produced confusion and doubts about reality.20 Post-Communist Syndrome is manifested in these features: 1) Learned helplessness including low self-efficacy and the avoidance of initiative and responsibility, hopelessness and pessimism. This impacts the social security and is evident in a fear of change (the system). 2) Aspects of immorality, including normlessness, disregard for moral values and legal norms in the absence of sanctions. It is expressed in form of corruption, rudeness and violent behaviors. 3) The abuse of civic virtues, such as public mindedness. It is manifested through an anti-civic culture. Post-totalitarian Syndrome offers a theoretical approach to psychological explanation of the post-communist condition of a state. Analysis of the socio-political background and the lens of Post-Communism Syndrome is a helpful approach to understand the application of transitional justice mechanisms. Post-totalitarian syndrome may have broader social and political impacts such as facilitating a return to non-democratic or dictatorial regimes or introducing a degree of social and political anarchy. 16. James D. Livingston, Mental Illness-Related Structural Stigma: The Downward Spiral of Systemic Exclusion Final Report, (Mental Health Commission of Canada, 2013). 17. Martina Klicperova, Ivo K. Feierabend and C. Richard Hofstetter, In the Search for a Post-Communist Syndrome: A Theoretical Framework and Empirical Assessment, (Journal of Community & Applied Social Psychology, 1997). 18. David K. Shipler, Russia Broken Idols, Solemn Dreams, (Penguin Books, 1984). 19. Martina KlicperovaÂ, Moral values in the modern Czech history, (Global Bioethics, 1994). 20. Gabriel A Almond, Communism and Political Culture theory, (Comparative Politics, 1983).