oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania TRANSITIONAL JUSTICE AND MENTAL HEALTH A mental health approach to transitional justice links to both victims and other citizens, who have been under pressure, terror and violence. Victims include those whose mental condition is damaged because of inappropriate practices of the state towards them, such as physical and psychic violence, injection of harmful drugs, torture, etc. In a dictatorial state, repression is a tool to ensure absolute power : a population living under propaganda and violence is more at risk of mental health disorders, including after transition to a new political system. The collapse of the totalitarian state is related to massive political, economic, and social changes that create conditions of instability and stress, which are associated with troubling trends in health. For example, a study conducted in 2013 in Romania stated that the transition from communism to democracy caused changes in the pathology of psychiatric. A comparison of mental health disorders in 1990 and 1995 showed that affective disorders and depression were the top psychiatric diseases in 1995 while in 1990 they were only in fourth place. This is an indication about the morbidity during communism, where psychoses such as schizophrenia dominated statistics of the mental health disorders. Furthermore, these diseases predominantly occurred in those between the ages of 40 and 55 years, representing exactly that segment of the population that was too old for adaptation to the new capitalist system that the democratic state promotes. During communism people had been dependent on the communist state for all elements of their existence and during the transition, this source of dependence was suddenly destroyed and brought illness and depression as an immediate and long-term consequence.8 PUNITIVE PSYCHIATRY According to the Global Initiative on Psychiatry (GIP), ‘‘political abuse of psychiatry refers to the misuse of psychiatric diagnosis, treatment, and detention to obstruct the fundamental human rights of certain individuals and groups in a given society. The practice is common too but not exclusive to countries governed by totalitarian regimes. In these regimes abuses of the human rights of those politically opposed to the state are often hidden under the guise of psychiatric treatment. In democratic societies ‘whistleblowers’ on covertly illegal practices by major corporations have been subjected to the political misuse of psychiatry.’’ In the Soviet Union, after the death of Stalin in the 1950s and beginning of the Khrushchev era a campaign began to pronounce political opponents mentally ill and to incarcerate them in psychiatric hospitals. In a speech published in the state newspaper Pravda in May 1959, Khrushchev proclaimed: “Of those who might start calling for opposition to Communism… we can say that clearly, their mental state is not normal (Olga Shek 2010-11). Furthermore, Snezhnevsky, a Soviet psychiatrist close to the Party, had invented “sluggish schizophrenia” as a political tool for oppressing anti-Soviet dissenters.9 Symptoms of sluggish schizophrenia came in the form of “reform delusions,” “struggles for the truth,” “a heightened sense of self-esteem,” and “perseverance.” People with sluggish schizophrenia often seemed functional or experienced only slight neuroses, but Snezhnevsky argued that was the very nature of the disease: its mild symptoms only progressed with time.10 8. Martin McKee,  Ellen Nolte, Lessons from health during the transition from communism, (US National Library of Medicine National Institutes of Health, BMJ 2004). 9. Ian Henry Spencer, An investigation of the relationship of Soviet psychiatry to the State, (Glasgow Theses Service, 1997). 10. Stephanie Buck, The totalitarian government in Soviet Russia invented a mental illness to lock up resisters, (Timeline, 2017). 101