oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania PSYCHIATRY AS A TOOL OF REPRESSION The major concern of the Minister of Internal Affairs was the uncontrolled activity of those people who according to him: “…showed violence and acted aggressively in families. They walked in the street, spoke against institutions of the communist party and government/state. They insulted the others, caused conflicts, beat and wounded the people until death and they commit other ugly crimes.” Although the insufficient number of beds and limited resources in psychiatric hospitals, the organs of the state were determined to find a solution about this problem. Meanwhile, there were shared lists of named mentally ill people, who suffered from schizophrenia and were considered a political threat to their community. Furthermore, a specific danger for the communist regime was the increased number of compulsory treatments driven by a court decision. Interviewees claimed that most of the healthy people who were sent to psychiatric hospitals by court decision were part of the Albanian elite and intellectuals. The purpose of choosing such political enemies as victims of punitive psychiatry was to destroy their credibility and to reduce their popularity among Albanian citizens. The apparatus of the communist regime was especially vigilant in such cases and has followed them systematically – often until their death, either a natural one or caused by torture and physiological degradation. Interviewees stated that the mental health of political enemies was endangered during the investigation (Albanian word ‘Hetuesia’), in prison as well as in psychiatric hospitals. Investigation at Hetuesia lasted from days to years, depending on the resistance of the victim. One of those interviewed, a victim of punitive psychiatry, testified that “they beat him so hard for one month until he lost consciousness several times during the day and at night.” However, he was mentally capable, but one month later the doctor decided to use these weak moments as proof of the need for compulsory treatment. He still doesn’t know the diagnosis that sent him to hospitalization for 5 months. His crime against the socialist state was an attempt to escape the country on 25th December 1989. He explained that even though he spent only five months in the hospital, for five years he had severe headaches and fainted: “I don’t know what they did to me in psychiatry. Maybe the drugs or injections have damaged my brain, who knows…” The uncle of one of the interviewees was a professional electrical engineer who, after a discussion with his Chinese colleagues, was sent to Hetuesia for six months, where they performed intensive electroshock on him until he became mentally ill. He was sent to the psychiatric hospital, where he died. A former mental health physician, who had worked in Elbasan during the communist regime added that besides their presence, there were specified medical staff dedicated to these patients delivered by Hetuesia or the Ministry of Internal Affairs. They served as both medics and guards at the same time: in a room of two patients, one member of staff was responsible for looking after them. In this way, these political enemies wouldn’t be able to create plots or to mobilize real patients against the medical staff. In 1968, the minister of internal affairs Kadri Hazbiu delivered a secret directive to the institutions that reported to him about the execution of court decisions that appoint medical proceedings, such as hospitalization in a psychiatric hospital. He was concerned because “in some cases after their healing or improvement, they (patients with court decision) are released from the health institutions where they have been hospitalized. This was prohibited by the regime laws.” 109