Therapy Still Taboo in Germany

At a World Health Organisation conference on mental health last week, EU Commissioner Markos Kyprianou described psychological illness as Europe's "unseen killer."

"More Europeans die from suicide each year than are killed in car accidents or as a result of murder. Yet mental health receives surprisingly little attention," Kyprianou said.

The figures certainly add up. Some 58,000 people in the EU die each year as a result of suicide or self-inflicted injury, which compares with around 50,700 traffic deaths and around 5,350 as a result of murder or homicide. Most suicides are linked to mental illness, and in particular depression.

Therapy still plagued by stigma

Although it is impossible to say exactly how many people in Germany are currently in therapy, there are almost 6,000 psychotherapists across the country who work with health insurance companies, and in addition, an undetermined number of private and alternative therapists touting their wares to patients in need. And there are no rumours of a slump in business.

In keeping with the generosity of the German health service, those who stump up their monthly fee can take their psychological problems -- be they phobias or depression -- to a therapist of their choice at no additional cost.

Compared to the palette of opportunities in countries like Britain and the US, it's a great deal. But then again, there are other comparisons which show that Germany is less advanced in terms of shaking off the old taboos and stigmas attached to opting to talk through problems with a professional.

Ongoing taboo

"It's still not easy in Germany. People react with reservation and some social groups perceive the need for psychological help as a weakness," Timo Harfst, Academic Advisor at the German Chamber of Psychotherapists said.

But that is not all. Harfst believes that the therapy taboo runs so deep in the veins of German society that a kind of self-stigmatism kicks in, with those in need of outside help refusing to go and find it for fear that they will be acquiring a stain that will stick.

Steffi Buchal confirmed it. "I was going through a really bad time, and I felt like I needed to go and talk to someone," Buchal said. "But when I told my friends, they were all horrified. They tried to persuade me that I didn't need to see anyone, insisting they could help me through my rough patch."

In the end, Steffi ignored the advice of her friends and started therapy, but several months later she quit.

"People think that if you go for therapy that you have no family or friends to talk to, but the reality is that there are situations in which it is better to talk to a therapist than to a family member," said Recha Drews, Business Economist with Prenzl Komm, a non-profit organization. "Germans don't take depression very seriously, they prefer to sweep it under the carpet."

The trials of re-integration

Prenzl Komm aims to help people who have been out of work as a result of psychological problems to find a way back into a more independent existence. But as the government gradually chips away at the welfare state, there is less money available to ease their plight.

"These days people have other problems. They're worrying about Hartz IV (the latest slew of labor reforms) and unemployment rather than about the disabled or those with psychological problems," Klaus Leonhard, Manager of Lankwitz Disabled Workshop said.

Recha Drews believes that although patients in Germany have relatively easy access to therapy, the system no longer provides those who have had to give up their jobs, with the necessary support for a return to regularity. "What we are seeing now is a system in which people with psychological problems are told to go to workshops for disabled people, and that's pretty much the last stop," Drews said.

And although there are a number of small workshop initiatives which promote reintegration and rehabilitation, Klaus Leonhard says that of the people who enter such protected working environments, no more than 20 percent of them make it back out into the free labor market.

Prevention is better than a cure

In view of such statistics, at least part of the solution has to lie in preventative measures. "We have to move away from just providing information, we have to change our behaviour," Timo Harfst said.

He welcomes the introduction of a prevention law which is due to be passed this spring, and sees it as an opportunity to teach Germans that factors such as stress, lack of physical exercise, too much television and inadequate social activity can all lead to some form of depression. "It's time to take a look at the bigger picture," Harfst said.