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You have asked me to comment on the three papers from Eastern Europe on child psychotherapy in Russia and Hungary, which appeared in the previous issue, as I have been working there, mainly in Russia and the Ukraine, on a regular basis over the past eleven years. My experience reflects exactly the themes of the papers, particularly what Kagan calls “the post totalitarian stress syndrome” — the sudden disintegration of a well established way of life, which has generated a high level of anxiety and psychological conflict. It seems to me to be a good phrase to help to explain how different people react so differently to the consequences of the collapse of the Soviet Union, each according to their own degree of resilience and social support as with other traumatised people in different situations. For what else but traumatic is the pain of everyday life in the C.I.S. where there is high inflation, scarce resources, little personal money, (some Civil Servants haven't been paid for years let alone months); high unemployment, a crumbling infrastructure, (including fragmentation of the once unified health system into fifteen new ones, each with reduced resources including equipment and in particular medicines); an old ideology which can no longer cope with current needs and change hampered by rigid, hierarchic and beaurocratic organisational structures. There is deterioration in the diets of most of the population, leading to seventy percent of new born babies having a pathological condition and twenty one out of a thousand teenagers who “enter adult life with an illness” Ryan (1993). Nina Vasilyeva's case history traces in detail the tragic effects of these statistics on one family and the courage and determination needed in trying to work in such a situation. She also shows that using a psychodynamic model of treatment, (regularity, individual work, boundary setting, transference etc) can be helpful, even in such cases.
Kagan's paper outlines the history of psychoanalytic