PALMIRA RUDALEVIČIENĖ, M.D. 
Lithuania

I believe most psychiatrists would agree that psychiatry is a field of kings – a uniquely fascinating area offering psychiatrists the privilege of exploring the depths of human emotions and relationships. I believe that there can be no true approach to practising psychiatry without true love.

I was involved in a sabbatical programme under the guidance of Prof. Vijoy Varma at the Postgraduate Institute of Medical Education and Research in Chandigarh , India , in 1995. During that time, Prof Varma organised the WPA-TPS Congress in Chandigarh and he asked me to give a lecture on Lithuanian psychiatry, since I was the only person there from Lithuania ; a country that was unfamiliar to most of the participants and did not exist on the world’s map.

This is how my involvement with WPA-TPS and its activities began. I met very interesting and warm people, wonderful psychiatrists whose minds and visions were occupied with something extraordinary, unique and passionate. Their enthusiasm was infectious. In fact, the source of many important things that happened in my life was India , my love for India . People who have been closest to me throughout my life, including my family members (who try to accept and even appreciate the things I feel passionately about) were aware of this source of inspiration in my life and its impact on my work.

This phenomenon of my “love for India ”, which arose when I was 10-11 years old, has a long, rich and treasured history. I went to India for the first time in 1992, searching for similarities between Lithuania and India . I found a lot them and I thought of them as precious jewels.

My mother was a doctor, but she did not support my choice to study medicine. She would tell me that if I became a doctor, I would never be able to have a private life, because other people’s lives, their sufferings would have to take priority. On the other hand, my father was quite happy with my wish to go to medical school.

As for my own career aspirations, I gave myself two alternatives: if I won a gold medal in the secondary school final examinations, I would enter medical school, if did not – I would go to Moscow to study Bengali language and literature.

Both my parents were, and still remain, the main authorities and sources of inspiration in my life. Both of them were a steadfast example of free Lithuania ’s (before the Soviet occupation) intelligentsia, bright and loving. They embodied spreading humanism, optimism, high spiritual qualities and passionate commitment in everything they did. Their convictions ruled the daily life of the family and presented a source of inspiration and a compelling example of how one should remain true to one’s ideals . I was also influenced at home with daily considerations and emotions that one day Lithuania would be a free and independent country again. My parents kept talking about this every day and I was full of these longings, perspectives and prayers. That is why it was so natural for me to accept it when the dream of an independent Lithuania finally became a reality in 1991. During more than forty years Lithuania was under foreign occupation, but at home I was brought up as a free spirit. My parents would say:  “Only people with a free spirit and pure mind could be healthy”.

My mother would open our door to poor people and ask them to sit down at the dinner table beside me. As a child, I was afraid of them and kept silent, but I observed. My mother would tell me after they left; “Never ask for reward: God will reward you if you truly deserve it”.

My close friends were familiar with my dreams: if I were a man I would become a pilot or a priest. As I grew up, I wanted to become a doctor.

My choice of specialising in psychiatry was made during my second year of medical studies – two years before our clinical exposure to psychiatric patients. I aquired my first knowledge about psychiatry when I became a member of the Students’ Psychiatry Circle .

I obtained my MD from Vilnius University in 1979, and completed my psychiatric specialty training in 1980. I have continued to extend my knowledge and skills as a psychiatrist ever since that time.

I have always been surrounded by wonderful people. My internship supervisor, Dr Danutė Požerienė, was a psychiatrist who loved her profession. This was unforgettable and infectious. She also possessed excellent pedagogical skills. I still remember the report she asked me to rewrite ten times, until every detail was perfect, and only then did she invite several colleagues and asked them: “Could anyone of you write such a good report?” Many years have passed since her death, but she is still alive in my heart.

Strict adherence to the prescribed methods and limits of innovative thinking were required during the Soviet times. Any creativity in clinical psychiatric practice was discouraged and ridiculed, and any deviation from standard procedure could become a reason for punishment. My thoughts of visiting India also could be diagnosed as delusional and bizarre (as were anyone’s expressed desire to go to any country abroad). We all had to be very cautious in choosing what to say, how to say it and to whom to say it; or, as the case may be, when it was better to keep silent. This was the case with everyone who valued their lives and did not want to be sent to Siberia or simply “disappear”. We all were expected to think the same way; otherwise “additional questions” and danger could arise.

Expression of true feelings and thoughts could be found only in the theatre and in literature. Nevertheless, Lithuanians were very strong in their spirit and able to preserve their best qualities.

K.P.Dave, Professor of Psychiatry in Bombay , was the person who was best able to explain to me the “pathogenesis” of my appearance in India . “You prayed for this every morning and evening since your childhood. These prayers created strong energy in the universe and the power of it touched my mind. You see, every day I receive many letters from all over the world and have no time even to open them. But your letter was opened and read and I invited you to Bombay – I performed an act which I would never have expected of myself. This was not a coincidence. It is evidence of order in the universe.”

Later I met other psychiatrists in India who told me much the same thing about my visits to India . I was convinced. This was not a delusion. Nor was it a hysterical craving for an unfulfilled need. This was an act of love. I broadened my view of life in India – who wouldn’t do it there? And it contributed a higher philosophical perspective to my interactions with patients. I learned valuable lessons and new responsibilities during the two months I spent in India doing a course in psychiatry at Sion Medical College in Bombay .

I came to Bombay with empty pockets, but was never in any need and was treated as a very special person. At the airport, when I was saying goodbye to Professor K.P. Dave and his wife at the end of my stay, I asked how and when I could repay him for everything he did for me. His answer was: “Do the same for others – the same way. This will be a reward to me and a sign of time not wasted”.

My professional development has also been greatly influenced by Prof Pierre Flor-Henry, in Edmonton , Canada . He showed me the highest standard of practice of psychiatry as a science and an art. I spent three sabbatical leaves, each of six months duration, under his guidance, at Alberta Hospital Edmonton. Presenting cases to Prof Flor-Henry was the most serious examination experience in my life. I never slept during the nights preceding these presentations, as I tried to ensure that my preparation was complete and accurate, down to the last word, and that my English would be sufficiently articulate, if not elegant in expression.

My supervisor at the Forensic Unit of AHE, Dr. Vijay Singh, was also exemplary in dealing with patients. While observing his attitude and behavior with patients I learned a lot about clinical care. One of my colleagues told me that she wanted to educate her six children to be like Dr. Singh. What could be better recognition of his unique abilities?

I continued my quest for learning in different cultures by spending two months in Scotland , under the mentorship of Dr. Joe Bouch. For someone coming from the intellectually stultifying environment of a Soviet-dominated country, locked away for decades from the free exchange of ideas with physicians and scientists in other countries, it was an eye-opening and exhilarating experience to subsequently take courses at University College, London, and then at Harvard University.

My professional life has been further enlivened by participating in a number of WPA-TPS conferences over the past ten years. Discussions at these conferences with Prof Thomas Stompe led to my collaborating with him in his study of religious delusions. Later I joined his research project on suicide.

I have learned a great deal about psychiatric thinking and clinical care, and also about life in general, from my experiences in India , Canada and Britain . I have tried to apply what I learned, to improve the quality of psychiatric care in post-Soviet, independent Lithuania . Our nation is still going through a difficult process of healing from the decades of occupation and intellectual repression. We have to learn how to change past patterns of fear of innovation and change, and learn how we relate to patients as people with innate rights to compassionate care. We need to evolve our own, culturally-sensitive and humanely-based ways of relieving our patients’ fears and enhance their sense of well-being in a free and independent country.

In 2004, several colleagues and I inaugurated the Lithuanian Cultural Psychiatry Association (LCPA ). The Association is unique because it includes psychiatrists, priests, lawyers and social scientists as full members. Most members are academics. Several have degrees in divinity and law, or divinity and medicine. The result is a lively inter-disciplinary discussion on a wide range of topics.

LCPA has organized two international scientific conferences: “Love for One’s Neighbour is the Basis for Mental Health” (2004) and “How Spirituality Affects Mental Health” (2005). Both conferences were held in the Lithuanian Parliament House and attracted a large number of participants.

Our LCPA is an affiliated organization of WPA, as well as of the newly created World Association of Cultural Psychiatry, and is a sponsoring organization of the First World Congress of Cultural Psychiatry, to be held in Beijing in September 2006.

Lastly, a few words about my family. My husband is a psychiatrist. My elder son graduated this year from Vilnius University with a MD degree. My younger son is finishing secondary school. Both sons have accompanied me to WPA-TPS’ conferences and related meetings and are familiar with and admire its staff, ideas, and activities.

October 5, 2006