On Thursday, September 27th, we met Dr. František Krch, a nutrition specialist who treats people with eating disorders such as bulimia and anorexia. After giving us a brief history of psychiatry in the Czech Republic, Dr. Krch invited two of his patients to join us. They shared with us the roots of their disorders and tried to explain the challenges they face each day in their treatment. Although the journals they have to keep show that people with eating disorders tend to eat very little, the patients we met said that their next meal was almost always on their minds. According to Dr. Krch, the best way to address such thoughts varies from patient to patient, but the nation’s health insurance setup means that the patients at Dr. Krch’s clinic must go through group treatment. This gets problematic when one patient’s refusal to eat encourages others to avoid eating, too, which can happen when patients feel that they are competing with one another.
On a lighter note, though, a bit of group work had turned out well for us students before our visit with Dr. Krch. En route to his clinic, we decided to cross a busy street, but doing so was going to be fastest without the help of one of those crosswalks popular among all of the tourists. Instead, most of us ran across the street together, confident that not even the worst of Czech drivers could hit all of us. One of us, however, was momentarily stranded after failing to make it across the street with everyone else. It was Elsa.
Our second clinic visit was on Monday, October 15th, when we met Dr. Petr Weiss, one of the Czech Republic’s foremost sexologists. Dr. Weiss began by pointing out the difference between the Czech and American ways of dealing with sexual deviance: Whereas the US system mainly punishes sexual offense, the Czech system tries to treat sexual deviance. To know what counts as deviant, though, we have to know what counts as normal, and normal sexual behavior is generally characterized by consent, the absence of harm, and—in some cultures—the lack of a familial relationship between participants. By these standards, there are two types of deviance. Deviations in object include pedophilia, fetishism, and transvestism, and deviations in activity include voyeurism, exhibitionism, sexual aggression, sadism, and masochism. After Dr. Weiss gave us an overview of these disorders, one of his colleague spoke to us about gender identity disorders. We were then able to meet two of Dr. Weiss’s patients with gender identity disorder, who told us of how they, their friends, and their families came to terms with their transitions from one gender to another through sex reassignment surgery and therapy.
On Wednesday, October 24th, we met the last of our local clinicians, Dr. Andrej Trojan. Dr. Trojan works with people who have committed sexual offenses to determine whether or not they have a sexual paraphilia such as pedophilia. To do so, he employs the somewhat controversial technique of measuring offenders’ sexual arousal while exposing them to sexually explicit material. If an offender has a paraphilia, he or she is required to receive treatment for that disorder, and this mandatory treatment replaces a prison sentence. Dr. Trojan was the only clinician who wanted a group picture with us.
Our most interesting visit, though, may have been the one on Tuesday, October 16th. On that day, we traveled by subway, by bus, and by foot to reach this place: the entrance of Bohnice Psychiatric Hospital. With more than 1200 patients, Bohnice is the largest psychiatric hospital in the country.
Inside the grounds of Bohnice, we were shown to the unit where patients with sexual paraphilias are treated. There, we met Dr. Martin Holly, the hospital’s director and a specialist in treating sexual paraphilias. We also met his colleague, Dr. Jan Koznar, and six of their patients. Most of these patients had been in treatment for just a matter of months after being diagnosed with pedophilia. One, however, had been at Bohnice for six years, and that was after six years in prison.
The patients were surprisingly open in answering our questions, and the general sentiment seemed to be that the experience was very humanizing. Even though they had committed crimes that we generally think to be inhumane and unacceptable, these were still just people, and as such they were capable of the full range of thought and emotion that we would expect from anyone else. At one point, one of them even challenged us to a soccer match, and, to our surprise, Dr. Koznar encouraged us to accept. So we did. The next week we found ourselves back at Bohnice, playing soccer with sex offenders. Unfortunately, we were no match for them, and this team picture was taken after a crushing defeat of 11 to 0.
