text Klára Říhová photo Martin Zeman (Innova Healthcare)

In his case, psychiatry. He is the "father" of the National Institute of Mental Health in Klecany, approaching patients very differently than in the early days forty years ago. At the same time, he writes books and articles, appears in the media, gives lectures, and is a member of numerous institutions. His background is supported by his wife, painter Jitka Štenclová, with whom he has four children – and eleven grandchildren! How does he view the current situation, what advice does he have for others, and how is he doing with a healthy lifestyle?

What has made you happy recently?

Unlike the pre-COVID times, a person has to search hard in their memory to recall what makes them happy. The greatest source of joy remains the grandchildren. They do not yet understand the situation with adult hypocrisy and behave completely authentically, even in environments that are not normal for them and are essentially pathological. The contact with them is immediate, sincere, and free from any negative impacts of the restrictions in which we live.

Another source of joy is art, but we have had little of that lately – concerts, exhibitions, and theatre have stopped. Books and screens remain. But when the screen becomes the only source of cultural experience, it is like consuming pickled vegetables instead of fresh ones – after a while, it becomes tiresome.

Once in a while, students bring joy, even though contact with them remains limited to distance education. You lecture into an anonymous monitor, without feedback, without sharing the moment.

Of course, personal friendships and bonds with friends also bring joy, at least within the permitted small social bubbles. Sharing opinions, enjoying something good, and reassuring each other that we are not alone in this is exceedingly therapeutic.

Humour is also therapeutic. What is your favourite kind?

I appreciate good jokes, but even those are scarce right now. Recently, I was amused by a bonmot: My mask protects you, your mask protects me, so why don’t we swap?!

Are you naturally an optimist, or did you have to learn it?

We are born either as pessimists or optimists. It cannot be completely learned, rather just slightly adjusted. A person's basic setting manifests itself in how they read the emotions on others' faces. We are coded with that assessment – according to it, we react, and likewise, the environment reacts to us. When someone smiles, a positively inclined person notices it sooner than a negatively inclined one who perhaps doesn’t want to see it at all. Conversely – when there is only a hint of fear on a face, the optimist notices it later, while the pessimist notices it immediately. To summarize: a happy person does not want to see anything negative, and a pessimist does not want to see anything positive.

This implies that in everyday life, it is not so important what happens to us, but how we read it. Of course – this does not apply to extreme situations, such as disasters or deaths.

For example?

When a pessimist steps in dog waste, they take it as confirmation that life is worthless, while an optimist says it is a nice day, that they didn’t forget to wear shoes, and that they are lucky. When two of our patients look out the window into the park in autumn, one says with a smile: what beauty, that colourful foliage and sun! The other responds: that’s true, but it will be All Souls' Day and my parents have died. The first one's outlook brightens, while the second is brought to depression. I had a colleague whose mouth was set in a smile, making him look approachable. As a result, most people smiled at him, and thus he behaved kindly. That’s where the causal chain leading to positivity began. So, I answer yes, I am a natural optimist, I try to see the better side of everything, and I believe until the last moment that it will turn out well. I only rarely fall into deep despair.

What did you take away from your family background?

A lot of labels that we assign to what we perceive and which help us create a hierarchy of values. In our family, for example, it was hiking on long trips, the awareness that at home one should always speak the truth, and also a relationship to art. My father loved classical music and often took me (in Liberec) to concerts. When he bought a vinyl record, I would play it as well; I knew some of Beethoven’s symphonies almost backwards. I formed a bond with classical music that endures to this day.

However, the path to becoming a psychiatrist was winding, wasn’t it?

I was undecided for a long time, and to postpone my decision about what I was suited for, I went to high school. My innermost, but not particularly pronounced desire was to try film directing. With the money I earned from collecting paper, I bought an 8mm camera and made amateur films. I imagined that once I had acquired professional skills and learned to write scripts and edit, I would fulfil my inner desire to express myself through a film novel. However, at FAMU, it was necessary to submit your work and attend talent exams, which I missed. Out of desperation, I applied to three schools: the Czech Technical University, Charles University – Faculty of Philosophy and Arts, studying psychology, and medicine. I was accepted to the latter and did not attend further exams.

At medical school, I enjoyed dynamic subjects like physiology, biochemistry, and pharmacology. After graduation, I wanted to intern in pulmonary or internal medicine, but there were no places available. So, I tried psychiatry. When I honestly admitted to Professor Hanzlíček in Bohnice that this was not my first choice and that I found it interesting to read about Freud as a cultural supplementary material, he told me to start in September, adding that there was a queue at the door of those who had problems, and he needed someone normal.

Have you ever regretted your choice?

That field soon completely won me over, and if I had to choose again today, at the close of my career, I would do so without hesitation with psychiatry.

What has changed in psychiatry since then?

A lot. Many things once regarded as disorders have been reclassified, including homosexuality, which I learned was a sexual deviation, whereas today it is considered a normal part of sexual behaviour. Our understanding of certain disorders has changed; in the neurosis department, there was only the diagnosis of anxiety-depressive syndrome plus psychopathy. Now, we call them personality disorders, and instead of neuroses, we differentiate between anxiety, depressive, and bipolar disorders. Some diagnoses or symptoms have disappeared (hysterical arch), while others remain the same (schizophrenia), and more are increasing: instead of card players, there is a growing group of gamblers, and internet and social media addiction has emerged. The profile of substance addiction is also changing. In the 70s and 80s, prescription medications were misused, while hard drugs like cocaine, heroin, and club drugs only came with free trade.

Thanks to advancements in somatic medicine, the proportion of mental illnesses in the population has also changed. Mortality from cardiovascular and oncological diseases has decreased, and people are living longer. Our grandfathers died at sixty from heart attacks, our fathers at seventy from cancer, and today they die at ninety from Alzheimer's, etc.

The public attitude has also changed...

Certainly. There has been some destigmatisation – in the past, having anything to do with psychiatry was a huge shame, today some even boast that they are depressed and on medication.

This is reflected in the language: in the past, people would say lazy, now they say depressed; instead of stupid, they say dyslexic; instead of brat, they say ADHD. Deviations from the norm were understood as failures of upbringing and morality, while today we can classify and treat them. New treatment options have emerged, both pharmacological and others (psychotherapy, magnetic stimulation...), helping to manage even obsessive-compulsive disorders or anxiety. Moreover, they are much more user-friendly. Certainly, in some diagnoses, stigma persists; few people boast that they have a schizophrenic, demented, or paranoid patient at home.

Is it still true that we live in the best possible time?

I am absolutely convinced that yes. Even if it seems curious under the influence of COVID. If we discount the months of lockdown, we objectively live in the best time in history. However we measure it by any parameters, such as life expectancy, child mortality (a hundred years ago, half of children did not survive to school age, look at the biographies of Smetana, Dvořák, Janáček). Physical work has diminished, as has the time we must work for a loaf of bread, healthcare, water, shelter, warmth, etc., have become more accessible, in short, the quality of life has improved. Subjectively, though, it is difficult to define the feeling of happiness. It can be viewed as an experience of pleasure, well-being, relaxation, joy. In that case, the happiest person might be a cocaine addict taking a line or a maniac in a mild state (laughs). Happiness is not related to wealth either. A poor person from a shack can feel happy, while a yacht and plane owner, who is currently getting divorced and suffers from insomnia, is subjectively in a much worse position.

To what extent has the pandemic situation affected this?

There is a schema of causes and effects regarding what is happening in the pandemic. It starts with the coronavirus, which affects the brain directly or through systemic changes (which result in cognitive function decline, delirium). At the same time, the constant exposure to negative news, which is not balanced by positive, has a tremendous impact. Endless press conferences, data on the number of deaths, inducing fear of infection... All of this increases the level of anxiety as an uncertain expectation of something dire. Or even fear of death. Added to this is the restrictive stress from lockdown, isolation, and the inability to meet. All of this is fertile ground for the development of depression, domestic drinking, and domestic violence. Calls to various helplines have soared, and their content has shifted: concerns about health and survival.

Which group is most affected?

Those not sustained by the state, namely entrepreneurs in tourism, hospitality, and services. The state is trying to rescue them through grant programs, which cannot be sustained indefinitely, resulting in businesses beginning to fail – and another rise in mental illnesses. Our institute conducted research on a representative sample (young-old, rural-urban, men-women) about the prevalence of mental disorders in the population. The first wave in 2017, the second in 2020. The results are brutal: depression has tripled, suicidal thoughts have tripled, anxiety and domestic drinking have doubled. Many effects will manifest in the longer term. Besides those who have lost their livelihoods and are on forced leave (mostly younger and middle-aged people), low-income individuals with basic education are at risk. They have poorer access to information, prevention, and awareness. And then the oldest, who remain isolated.

Are "deniers" or "alarmists" more at risk?

Currently, we do not have up-to-date data, only older studies from the intensive care department, where life-threatening patients lie. They are divided into large and small deniers. Large ones do not acknowledge the seriousness of the situation and jeopardize their health, fail to adhere to protocols, smoke in the restroom, and sneak in beer, running up and down the stairs. Meanwhile, the small deniers are consumed by anxiety, watching monitors, and being frightened by every negative piece of information, the events behind the curtain. It is proven that they have a higher mortality rate with the same diagnoses. So, anxiety kills more than small breaches of rules. Troublemakers tend to experience a bit of luck in life. Similar results can be expected even today: the more frightened alarmists are at greater risk.

Do you personally have more fear of illness or the disintegration of society?

I am probably not entirely representative because, for some peculiar reason, I do not fear that illness. Many accuse me of being somewhat careless, but I cannot force myself to scare myself. I’ll die, so what? I experienced this during an emergency landing in an airplane when I imagined that we would all be dead in half an hour. A profound peace settled over me, arising from the awareness that I had not existed throughout eternity, that now I exist for a while, and then I will cease to exist again. So what? What I fear are agony, suffering, torture, living on tubes and machines. But not being, I am not bothered by that. Thus, much more than COVID itself bothers me the lockdown and the associated restrictions. The loss of freedom and democratic principles, changes in lifestyle, forced limitations.

However, there are people who view it differently, and their fear is justified. Just because I do not have it does not mean it is good. My inclination towards unruliness and disrespect for what I see as overly constraining contradicts the fact that I acknowledge on a rational level that many of those measures are necessary to cope with the pandemic.

What advice do you have for maintaining a healthy mind and body in this situation?

For basic mental hygiene, it is essential to change the subject at all costs, to put another disk in the brain, and not to keep focusing solely on COVID. Secondly – communicate, communicate, communicate – if not directly, then at least over the fence, by phone, in the family. Do not keep all emotions to oneself. Thirdly, when things get really bad, seek medical help – psychological, psychotherapeutic, or even spiritual. Be cautious with alcohol as a false problem-solver, and instead of sitting in front of the television, get moving. Recreational aerobic movement has a documented antidepressant effect. Anyone who has climbed a mountain, exhausted while surveying the horizon and then descended knows what "released endorphins" means. All of this provides the basic mosaic of what can be done to prevent the effects of coronavirus on mental health. And also to adhere to necessary measures solidarily, more from one's own will than from mandates, in a sensible manner. The aim is for their negative impacts not to be worse than the infection itself.

How are you doing in adhering to a healthy lifestyle?

Like all preachers who preach water and drink wine. I adhered to it quite a bit in the dawn of life, spontaneously and more or less unconsciously. With advancing age, laziness, and a certain dullness regarding original principles, I adhere to it less and less. But I generally try not to overeat fats and sweets, to exercise occasionally, and not to smoke. Until the age of twenty-seven, I was a complete abstainer; now I drink wine, life has spoiled me. But for that, I do not have a partner. My wife rarely sips half a glass, only for social reasons.

You once said: The pandemic will change the world as much as the invention of the printing press. How will that be?

The pandemic has dramatically pushed the use of information technology and social media. From a worrying hobby that we tried to deny to children, it has become a necessity; suddenly, all teachers and children know what Zoom and streaming are. An absurd paradox, but there is no other choice. And this drives further development of 5G networks, accelerating transmission, and increasing data volume capacity. Thus, the pandemic significantly participates in changing the world, much like the invention of the printing press. In the Middle Ages, wisdom and information were disseminated only orally and by copying in monasteries. After the invention of printing, everyone could suddenly have a Bible at home, making it worthwhile to learn to read – and many areas of knowledge became widely accessible.

Is there a chance that due to COVID, people will reassess their priorities, value life more, and take care of their health?

Definitely. We can almost say with certainty that the hierarchy of values will change and many aspects of our lives. We just do not know precisely how yet. In complex systems like nature or human society, things never move in the direction they are pushed but corrective and rescue mechanisms are activated to balance the swings. For example, as the level of stress increases, so does the resilience to it. The saying goes: What doesn’t kill you makes you stronger. What will emerge from today’s reality in twenty or a hundred years cannot be predicted. Futurists in the mid-20th century believed that elevated trains on magnetic cushions would run in Holešovice and that the moon would be colonized. Conversely, no one thought that everyone would have a mobile phone. But even now, for instance, we see that more people have started running and hiking in nature. They are taking the first step in caring for their health.

What is your first step after coming home from work?

I bring work home. I turn on the computer and continue; I clear hundreds of emails. I am an unrepentant workaholic, that’s my diagnosis. But as long as you enjoy your work, it is not harmful. The worst is the stress associated with powerlessness. Naturally, I am trying to slow down a bit since reaching seventy. My wife is a painter and she attempts to draw me into her world, into the studio. When I am there, I enjoy it. It is a well-known fact that many doctors perceive art as a counterbalance to the higher concentration of human misfortune and discomfort that they encounter in medicine. Many find compensation in amateur musicianship, painting, and writing. This intersection of medicine and art works. I admire classical music, as I mentioned. When possible, we would play music with friends. And here at the institute, we organize events called Art: A Journey into the Soul, where we invite top artists and both the general public and patients.

What are you most proud of – professionally and privately?

Professionally, I am proud of establishing the National Institute of Mental Health, although its birth was extremely difficult and painful. It is not entirely anchored in the institutional funding system for science like the Academy of Sciences or universities, which ties it down. On the other hand, it has allowed many talented young people to develop promising projects.

Privately, it is my family, four children who have turned out well, each in their own way. Number one, Karolina, has graduated from three universities, but does not use any of them because she has seven children and is now overseeing distance education for six. She is a somewhat saintly figure. Number two, Kristina, has the greatest need for adrenaline – she is a paramedic, on missions with Doctors Without Borders, experienced war in Yemen or Afghanistan, and climbs mountains. Number three, Cyril, is a mathematician and a successful software developer, number four, Patrik, has followed in my desired footsteps – he studied at FAMU but then switched gears and now creates mobile games. I have already raved about the grandchildren (aged 2 to 18)...

Do you still have an unfulfilled dream?

I had many dreams. I have abandoned many because I found them unnecessary or trivial. I have fulfilled many – for example, seeing America, Israel, South Africa..., having a little piece of heaven in Greece where I can retreat. Dreams like skiing in the Jizerské Mountains I have given up, but I still enjoy swimming and biking. Otherwise, I live a relatively aimless life.

Nice bonmot. Do you regret anything?

If by that we mean that we should have done something differently, I don’t regret anything. If it is regret over something that happened, I deeply regret the death of my brother. He was four years younger, a really great person. He died in a helicopter crash in the Krkonoš mountains while working as a geophysicist. He left behind four children. That was a significant blow. Then there were cases of serious illness..., but every family has something.

Yet it seems that you are a happy person.

I think so. The source of happiness for me is the circle of close ones, friends, good relationships, positive thinking, and work. To some extent, everyone can create their own happiness.