When Life Is a Downer, Serbs Turn to ... Downers

That familiar feeling was back, the same choking mix of helplessness, depression and uncertainty. It had hit her when NATO bombed this city in 1999, and it came barreling back last week when Serbian Prime Minister Zoran Djindjic was assassinated by sharpshooters.

But this time, Emina Cano-Tomic has an extra bit of support at hand: the sedatives she has been taking for the last year.

“They’re a great help,” Cano-Tomic said candidly as she sat smoking in her cozy Belgrade living room.

And not just to her. The people of this war-torn country are among the most heavily tranquilized in the world, with a habit picked up during a dozen years of civil strife, ethnic violence and dictatorial rule. Countless Serbs both young and old have turned to anti-anxiety drugs, antidepressants and even marijuana to help cope with the misery born of their recent history.

Wednesday’s ambush of Djindjic, gunned down as he went to work, confirmed fears that that misery is not over. The attack jolted many residents out of the sense of security and hopefulness they had slowly allowed themselves to feel, and reawakened the depression and dread of the past.

“It’s become clear to all of us what kind of society we live in,” said Cano-Tomic, “and that society hasn’t changed too much.”

A 36-year-old electrical engineer, Cano-Tomic had never thought to seek solace through medication, preferring to soldier on on her own, until her therapist finally suggested she try some kind of anti-anxiety drug or antidepressant.

In agreeing, she chose a well-trod path in Serbia -- the dominant republic in this country that is all that remains of the old Yugoslav federation. In 2001, Serbia’s three most popular brands of sedatives alone sold an estimated 144 million pills in the republic of about 8 million (excluding the people of Kosovo province). In 2002, the manufacturers of those pills ordered enough raw materials to manufacture 200 million of them, a top health official said last fall.

At the time, all such medication was cheap and plentiful and, surprisingly, available over the counter. Virtually any adult could walk into a pharmacy, plunk down small bills and emerge with a packet of Valium-like pills to ease the many stresses of life that are commonplace here.

But in September, the government -- alarmed about rising addiction -- decided to require prescriptions for tranquilizers and other anti-stress drugs, as health experts worried about what the statistics portended.

“Such a big and uncontrolled use of sedatives suggests that something is deeply wrong here,” Zarko Trebjesanin, a prominent psychologist and professor, told the newsmagazine NIN. “We are facing a massive neurosis.”

For many, the cause is not hard to pinpoint.

For more than a decade, the people of Serbia have careered from one crisis to another, living under the strain of the Yugoslav civil wars, the coercive regime of former President Slobodan Milosevic, the bombardment of Belgrade by North Atlantic Treaty Organization forces, the October 2000 revolution that brought Milosevic down and, most recently, the assassination of their prime minister.

During that time, residents accustomed to relatively comfortable European lifestyles found themselves struggling to find work, lining up to buy bread and milk and, if they were men, looking over their shoulders wondering when they might be drafted.

Survival was the name of the game, and the ability to adapt to constantly changing circumstances marked off the strong from the weak.

“Psychologically, it was a period of prolonged stress,” said Dragan Ilic, a psychologist by training who is host of a radio and television show. “Usually, with stress, you deal with an accident ... and it lasts six months or so. But here, you had 10 years of constant stress, day after day.”

Mundane Escapes

To cope, some turned to mundane escapes such as the Hollywood movies and Latin American soap operas that began filling up the TV schedule.

Many others turned to drugs as an additional source of stress reduction. For the young, marijuana -- which could be bought for about 50 cents a gram -- was plentiful; even elementary school students could occasionally be found lighting joints.

Among older residents, who clung to memories of better times as their standard of living plunged, the drug of choice was a sedative called Bensedin.

“It was cheaper than aspirin. You could pick it up without a prescription,” said Ilic. “We were becoming a Bensedin state.”

Older women would go on the radio to talk about how they popped a pill after waking up, took another over lunch with friends, then had one more while watching the afternoon news.

“It was an addiction people started to accept,” Ilic said.

The problem was that users were self-medicating, without guidance from doctors. Among Serbs who take sedatives regularly, as many as 80% do so without consulting a physician, according to an estimate in NIN. Private psychiatric care remains extremely expensive here; in state hospitals, mental health workers are overburdened and underpaid.

Plus, there is the stigma still attached to seeking professional help, though not to taking mood-altering drugs.

Only after she started seeing a therapist did Cano-Tomic realize that she was not alone in struggling with depression. She now takes a sedative in combination with the antidepressant Prozac. Because her therapist is not registered with the government, Cano-Tomic does not have a prescription, but she gets around the restrictions by buying her pills from an online vendor.

Ironically, Cano-Tomic believes, Milosevic’s downfall -- which ushered in an atmosphere of hope -- may have precipitated a rise in people’s recognition of themselves as anxious or depressed.

Before, Serbia was too preoccupied with basic survival, operating too much out of sheer instinct to pay attention to more complex issues of mental well-being. Only since the Milosevic era ended, she said, have she and many of her friends begun to see the unhealthy grooves that that time in their lives carved on their psyches -- how it left a pool of pent-up emotion and anxiety.

Djindjic’s assassination tapped into that reservoir.

“I feel terrible,” said 67-year-old Danica Smudja. “Terrible.”

A retired teacher, Smudja saw in Djindjic someone who might finally bring Serbia out of the political and economic wilderness with his pro-Western policies and reforms. Now, “whenever I see his photo, I start to cry,” she said.

Slew of Arrests

The government has blamed the Djindjic slaying on a criminal gang that includes former paramilitary fighters who may have wanted the Serbian leader dead to avoid being turned over to the international war crimes tribunal at The Hague. Scores of people have been detained in connection with the slaying, held under the government’s declared state of emergency.

But all the arrests will not wash away the old fears, the dejection, the anxious emotion that the assassination brought bubbling back to the surface for residents like Cano-Tomic.

“All these changes we’ve experienced -- you have to admit to yourself that you once envisioned the world completely differently,” she said. “And then you have to deal with that.”