102 oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania The government called for treatment for such persons, as a means to return to “normal” life. But normal life in the communist state meant uncontested service to the country and obedience to their orders even though they didn’t agree with the totalitarian regime. The concept of ‘punitive psychiatry’ or ‘political psychiatry’ is never accepted or used in Soviet documents of this time, because the act of forcing the individuals to undergo treatment in psychiatric medical institutions, was justified under the ‘compulsory medical treatment’, decided by a court. This type of political abuse constituted violations of fundamental human rights when the psychiatric diagnoses were used as a tool to pressure political dissidents. At the end of the 1980s, the World Psychiatric Association admitted that psychiatry had been abused for political purposes. An anti-psychiatric campaign accompanied this statement and mental health professionals faced challenges of trust and integrity, with accusations of misuse by the profession.11 The Soviet Union is not the only country where these abuses took place. Politicization of psychiatry was a common practice in the socialist or communist countries. In recent decades, we have seen a lot of documentation from other countries. In Romania in 1997, the International Association on the Political Use of Psychiatry (IAPUP) organized an investigative committee to research what happened and came to the conclusion that several hundred people had been victims of systematic abuse. As in the Soviet Union, on the eve of Communist festivities, potential ‘‘troublemakers’’ were delivered to psychiatric hospitals by busloads and released when the festivities had passed. In the 1980s, information was shared on cases in Czechoslovakia, Hungary, and Bulgaria, but all these cases were individual, and there was no evidence that a system of abuse was in place. Information on the political abuse of psychiatry in Yugoslavia in the 1980s was inconclusive.12 During the communist regime in Albania, different forms of punishment of political enemies of the system were used. The process of punishment started with the ‘Hetuesia’, part of the Ministry of Intern Affairs. In ‘Hetuesia’ were used violent methods of torture on suspects, to force them to admit to crimes, even though they may have been innocent. Due to such terror, persistent pressure and verbal or non-verbal violence over periods of several months, sometimes even years, some of the victims demonstrated psychological disorders and some were sent to psychiatric hospitals for treatment, while others were imprisoned, without any medication or treatment. However, the application of punitive psychiatry in communist Albania in that period as a measure of punishment of the system’s political enemies, has never been admitted. While imprisonment, deportation, and execution were openly accepted as a form of ‘justice’ for enemies of the system, the use of psychiatry isn’t mentioned in documents as punishment, but only as a form of treatment of the mentally ill, who had committed crimes because of their unstable mental situation. Involuntary, or compulsory, admission to mental health facilities and involuntary treatment are controversial topics in the field of mental health as they impinge on personal liberty and the right to choose, and they carry the risk of abuse for political, social and other reasons.13 11. Michaela Amering, Margit Schmolke, Recovery in Mental Health Reshaping Scientific and Clinical Responsibilities, (A John Wiley & Sons, Ltd., Publication, 2005). 12. Robert van Voren, Political Abuse of Psychiatry—An Historical Overview, (US National Library of Medicine National Institutes of Health, Schizophrenia Buletin, 2010). 13. World Health Organization, Resource book on mental health, human rights and legislation, (ISBN 92 4 156282, 2005).