Soviet Psychiatry Research Articles

Outsider Art and Psychiatry in the Late Soviet Period

This article examines the discourse surrounding the Soviet Outsider Art of the 1970s–1980s. The author analyses the characteristics of scientific and scholarly approaches to, and definitions of, Soviet Оutsider Аrt, and the relationship of this phenomena to the contemporary political situation. The research methodology relies on the theory of discourse and discourse analysis, which makes it possible to examine texts and events from highly different fields as parts of an interconnected system. The innovative character of the study lies in the fact that, for the first time, the author considers the discourse of Soviet Оutsider Аrt from the perspective of Soviet policy and international affairs. The lack of specialized works that study Soviet Оutsider Аrt makes the article relevant and innovative. Researchers have not previously considered the connection between Soviet foreign policy, ideology, punitive psychiatry, and the discourse surrounding Outsider Art. In the 1970s, the creative process of the mentally ill became a topic of interest for Soviet psychiatry. The drawings of psychiatric patients were treated as vehicles of their creative impulses and utilized in psychiatric research for diagnostic purposes. Soviet psychiatrists compared the creative abilities of the mentally ill with various artistic movements, primarily surrealism; however, their vocabulary and analytic approach remained strictly psychiatric in nature. The 1980s gave rise to significant interest in this topic by a larger audience, in connection with a rethinking of artistic languages and the creative process. There was a dual attempt to dispel the reputation of “punitive psychiatry” and a growing understanding of the importance of “otherness” in art. Orienting to the discourse of key texts, this article reveals a gradual shift from the language of psychiatry to art in academic and journalistic texts devoted to Outsider Art in the 1970s–1980s.

Treatment organization of disabled veterans with mental illnesses in the post-war years (1945–1950) (based on the materials of the Tambov Psychiatric Hospital)

Importance. Studying the treatment features of participants and disabled veterans of the Great Patriotic War of 1941–1945, who were in regional psychiatric hospitals, allows not only to clarify the levels of medical care for such military veterans, but also to evaluate the results of public health organization in the postwar years through the prism of Soviet psychiatry development in the 20th century, as well as the results of medical care for war veterans. A detailed study of the situation of disabled veterans in psychiatric clinics in the post-war period is very useful, which will clarify many little-studied aspects not only of the history of medicine, but also of the development of interpersonal, group, and regional relations in socialist society.Research Methods. The methodological features of the study of the stated problems are based on the author’s concept of involving the works of contemporaries, primarily specialists in the field of psychiatry, practitioners of the Tambov region, as well as the actual case histories and anamnesis of mental illness. Materials from state and party archives of the Tambov region and memoirs of contemporaries were used, many of which were introduced into scientific circulation for the first time.Results and Discussion. In fact, patients of psychiatric hospitals in the post-war period received almost the entire necessary complex of therapeutic and preventive procedures and rehabilitation measures. At the same time, it must be borne in mind that the post-war devastation, lack of food, clothing, and a number of medicines seriously complicated the capabilities of medical organizations, which often did not have the necessary resources to fully organize the treatment of war veterans suffering from mental illness. In addition, there are often problems with heating, the supply of necessary equipment and supplies for the psychiatric hospital, which left an imprint on practical health care at the regional level. Nevertheless, Tambov psychiatrists used the full range of medical procedures and medicines available to them, both traditional and new, which gave a tangible therapeutic effect. It is important to note that in the post-war years there is a complete rejection of the elements of “punitive” psychiatry due to the cessation of placing patients in isolation, as well as wet wraps. In addition, the use of intensive treatment methods required coordination with the chief physician.Conclusion. The results of the study of the problem made it possible to assess these processes, viewed through the prism of the development of regional health care, to identify trends in the development of Soviet psychiatry in the first post-war decade. The development of an outpatient network for the provision of medical care to war invalids suffering from mental disorders and diseases is clarified. The assessment of the placement of military veterans in labor unions, enterprises and homes for the disabled is given. It is concluded that, in general, regional psychiatry has shown its capacity and effectiveness in terms of treatment and rehabilitation of military invalids who had mental illnesses.

Features of cultural work and ideological education of disabled people of the Great Patriotic War in 1945–1955 (based on materials from the Tambov Psychiatric Hospital)

Importance. The study of certain aspects of cultural work among disabled people of the Great Patriotic War who are being treated in psychiatric hospitals allows not only to clarify the features of the treatment process in medical organizations, but also to carry out a systematic detail of the socialization and rehabilitation of military veterans in the 40–50s of the twentieth century.Materials and Methods. The methodological features of the study of the stated problems are based on the author’s concept of involving the works of contemporaries, primarily specialists in the field of psychiatry, practitioners of the Tambov region, as well as the actual case histories and anamnesis of mental illness. Materials from state and party archives of the Tambov region and memoirs of contemporaries were used, many of which were introduced into scientific circulation for the first time.Results and Discussion. In fact, patients in psychiatric hospitals, to one degree or another, were involved in mass cultural events, ideologically verified political and cultural activities, which reflected the mentality of not only the party elite and nomenklatura, but also completely coexisted in the perception and understanding of the overwhelming majority of the population of the Soviet Union. The results of studying the problem made it possible to assess these processes, viewed through the prism of the development of regional healthcare, to identify not only the vectors and trends in the formation of Soviet psychiatry in the first post-war decade, but also to clarify the features of the relationship between government and society, the individual and the state, individual consciousness and the collective Soviet (“communist”) worldview.Conclusion. The results of the study allow us to draw a very obvious conclusion that cultural work, as well as political education in general, was not only an integral part of the ideological concept of the era of socialism, which lowered the entire structure of Soviet society, but also an important component of the treatment and preventive work of medical institutions of various profiles. These medical and social work activities were carried out very successfully in the Tambov region. However, in general, it should be noted that the lack of trained personnel and resources, including logistics, musical instruments, etc., often contributed to the formation of a superficial approach in organizing cultural work in psychiatric clinics. It is important to note that these shortcomings are fully preserved in the modern healthcare system in the Russian Federation. In fact, the traditions of budgetary residual financing of medical institutions are stable in the worldview of officials from different historical eras. But it is still worth noting that the general messages of ideological education consistently covered the entire population of the country, including patients in psychiatric hospitals. For these war veterans, political information, reading newspapers, and watching movies were quite common, which inevitably helped their rapid socialization, inclusion in normal communication, and ensured stable remissions during mental disorders.

Gannushkin P. B. Clinic of psychopathies, their statics, dynamics, systematics. VII + 142. Moscow. Cooperative company "North", 1933

Gannushkin begins with the fact that clinical psychiatry is going through a crisis. Speaking without making absolutely any distinction between Soviet psychiatry and bourgeois psychiatry, referring the so-called crisis to Soviet psychiatry, G. is definitely making a mistake. psychiatry at a time when it is freeing itself from the slavish dependence in which it was previously in bourgeois psychiatry, when we have outlined and are pursuing our own paths for the further development of theoretical and practical psychiatry, and when we successfully apply in psychiatry the Marxo-Leninist methodology, which is outside doubts do not know the crisis and resolves any crisis situation.G. until the last moment of his life could not free himself from the influence of bourgeois psychiatry, he entirely stands under the banner of the old, Kraepelin psychiatry and he speaks openly about this in his book.

Cold War Psychiatry, Extremism, and Expertise: The “Special Committee on the Political Abuse of Psychiatry”

Abstract Throughout the history of psychiatric ethical professionalization, the question of the “extremist” contextualizes and frames the limits of medical practice. Using archival research at the Royal College of Psychiatrists, the article explores how professional committees debated medical ethics after evidence of psychiatric participation in national security measures against dissidents. British, American, and global professional associations organized a prominent struggle against Soviet membership of the World Psychiatric Association in the 1970s and 1980s—reconstituting the field of professional expertise through Cold War geopolitics. The Special Committee on the Political Abuse of Psychiatry was formed in 1978 at the British Royal College of Psychiatry to publicize the medical detention of dissidents in the USSR and to pursue the expulsion of the USSR delegation from global professional fora. In doing so, it constituted an identity for Global Mental Health (vis-à-vis Soviet abusive practice) as impartial, objective, and uncompromised. However, this article explores the many ambiguities that complicate the performative constitution of Western psychiatry as good, and Soviet psychiatry as bad—reflecting on the political dynamics, and philosophy of science, which underwrote the struggle for global expertise.

Power in psychiatry. Soviet peer and lay hierarchies in the context of political abuse of psychiatry.

Soviet political abuse of psychiatry in the Brezhnevite era offers a rich case study of entanglement between various layers, impact spaces, and actors of power. This article discusses two types of discursive power in Soviet psychiatry. One sprang from the madness-affirmative cultural canon, in which dissidents sought their self-legitimation. More prominently, there was the power of psychiatrists within their own hierarchic system. I analyse how the action scopes for psychiatric power varied, depending on whether the recipient was a patient or fellow professional. Here, the inherent hierarchy structured and regulated the peer community and secured the stability of medical practices – and of the political entanglement of these practices and actors with the state-owned places of power.

Peripheral Nerve: Health and Medicine in Cold War Latin America

Peripheral Nerve: Health and Medicine in Cold War Latin America

Psychiatry in Vilnius in 16th–20th Centuries: Review on Social Transformations

There issue of Psychiatry in Vilnius is unexplored field especially in a terms of its social aspects. Most of the former papers devoted to psychiatry in Vilnius were written in descriptive manner or they were uncritical case studies of one or another hospital. One of the first successful studies that was constructed by using modern methodology was a monograph of Dr. Tomas Vaisėta that described a social features of Vilnius psychiatry. However, the study is devoted to a late period – Soviet psychiatry only. Therefore the modern analysis of earlier periods and other Vilnius hospitals was still missing. In our article, we set us a goal, namely, to find the most important features, the so‑called paradigm fractures in the social history of Vilnius psychiatry. The main tendency which should be emphasized was uneven development of Vilnius psychiatry, especially in a terms of attitude towards the patient. In most cases that could be interpreted in a light of a broader Global context. In Vilnius hospitals just like in other countries mentally ill were discriminated because of their unclear social and economic status. In the earliest period the mentally ill as an outcast of society is being locked in a jail‑like mental hospitals or fall into complete favor of the monastery hospices. The 19th century positivism at least theoretically brought humane paradigm to Lithuanian psychiatry. However, because of the limited medical measures as well as economic reasons the later period was marked by the realism or even negativism of semi‑modern interwar psychiatry. Mentally ill again falls into a status of outcast or a burden to the society. The question of responsibility towards mentally ill is avoided by the community as well as by state. Nevertheless, some original solutions were found in Vilnius district. The mentally ill were employed in local farms that at‑least partly solved the issues of economic burden. Moreover, there were some more tendencies that do not fit in the global narrative. Despite the technical advance in treatment that gradually enabled the psychiatrists to help the patient, in the Soviet period we observe the opposite tendency that was to restrain and harm the mentally ill patient. In many cases even totally healthy people were misdiagnosed to be mentally ill and received harsh chemical treatment and isolation because of their personal criticism towards totalitarian Soviet system.

State of Madness: Psychiatry, Literature, and Dissent After Stalin by Reich Rebecca (review)

REVIEWS 165 series of acquaintances the author interviewed to frame his representation of the Gulag (Grossman was never arrested himself), helping this text to become both his most ambitious stylistic work and the clearest crystallization of his political-philosophical views. A question arises from Popoff’s references to the poet Semen Lipkin’s memoir about Grossman, Zhizn´ i sud´ba Vasiliia Grossmana (Moscow, 1990). Lipkin was Grossman’s confidant in the post-war years and his text formed an important basis for early scholarship on the author. However, recent research by Iurii Bit-Iunan and David M. Fel´dman, published in Russian as Vasilii Grossman v zerkale literaturnykh intrig (Moscow, 2015) and Vasilii Grossman: literaturnaia biografiia v istoriko-politicheskom kontekste (Moscow, 2016), has questioned some of the detail of Lipkin’s account. Popoff likely decided that, as the memoir of Grossman’s closest friend, Lipkin’s text could not be dismissed. Furthermore, her analysis does not rely too heavily on any one particular source. However, it would have been helpful to note the potential problems of memory and subjectivity inherent to using this, or indeed any, memoir as a source for biography. Nonetheless, Popoff’s work is an engaging contribution to Grossman scholarship likely to appeal to general and expert readers alike. Its contextual approach provides a useful framework with which to introduce Grossman’s work within the historical developments that shaped his writing and ideas. Her readings of the author’s early novels and identification of new source material in regard to the later works are very helpful for those wishing to understand his thought and narrative style in detail. University College, University of Oxford O. T. Jones Reich, Rebecca. State of Madness: Psychiatry, Literature, and Dissent After Stalin. Northern Illinois University Press, Dekalb, IL, 2018. xi + 283 pp. Illustrations. Notes. Bibliography. Index. $60.00. A literary study is only as good as its villain. In the case of Rebecca Reich’s analysis of Soviet punitive psychiatry, dissident writing, and their intersections, the author has found an excellent antagonist in Andrei Snezhnevskii, who ‘at the time of his death in 1987 […] had been memorialized as a consummate clinician’, but ‘just two years later […] was being remembered as the architect of a diagnostic system that facilitated the pathologization of inakomyslie’ (p. 24). Through a series of multifaceted close readings of writings by psychiatrists including Snezhnevskii, Reich demonstrates in her first chapter how ‘the business of a psychiatrist was making accurate diagnoses based on SEER, 98, 1, JANUARY 2020 166 objective facts and methods. Yet within that context was room for a subjective skill that ultimately amounted to an ‘“art [of diagnosis]”’ (p. 27). Starting from this opposition, Reich explores how the state and its psychiatrists, on the one hand, and political dissidents and dissenting writers, on the other, engaged in a rhetorical war from the 1950s to the 1980s. Doctors could hospitalize those ‘inakomyslie’ for expressing beliefs that contradicted Sovietideology,leadingdissentersintoa‘discursivetrap’(p.5).Thepsychiatrists regarded their diagnoses as objectively pure, despite the fact that they were constructed from interviews, as well as from other evidence that required interpretation; indeed, their psychiatric reports betrayed a subjective approach to describing patients’ life histories, symptoms, attitudes toward the state, or even their art. Any arguments that dissenters would make against their own diagnosis could then be deployed as evidence of insanity. The vicious circle of Soviet psychiatry grew tighter around them as the very question of what it meant to be mad was addressed in these various realms of society. But such rhetoric cuts both ways, of course. Dissenters of assorted stripes fought back, as Reich shows in the remaining chapters, by ‘depathologiz[ing] themselves and pathologiz[ing] the state’, by arguing through their writings (artistic or otherwise) that it was society that had taken the dive into madness (p. 60). In chapter two, Reich focuses on political dissidents (Aleksandr Vol´pin, Vladimir Bukovskii, Semen Gluzman) and the strategies they developed to combat the discursive trap. For instance, Vol´pin promoted appealing to legalese and the alleged rights of Soviet citizens over the psychiatric discourse. Reich afterward turns her attention elsewhere, taking up literary figures rather than explicitly political ones. Joseph Brodsky...

Power unto Sickness, Sickness unto Power in the Periphery of Soviet Psychiatry

The three most important processes in psychiatric hospitals of the Lithuanian SSR (1944–1990) have been analysed in terms of the centre-periphery relation. Two of them are named “power unto sickness”, that is, the Soviet state’s efforts to influence people with deviant behaviours who were considered to have “mental diseases”. The first process could be considered external: institutionalisation of psychiatric system in the Lithuanian SSR that was meant to create the conditions, forms and means to exercise the said influence. The main outcome of the process is said to be the so-called “institution addiction” where problems arising from institutionalisation are tackled with more institutionalisation. The second process in the “power unto sickness” category is internal. The Soviet psychiatric model used in the Lithuanian SSR has been analysed and the question whether there has ever been a homogenous and unique model of Soviet psychiatry has been raised. The third process is the symbolic inverse of the “power unto sickness” processes, but determined by them – “sickness unto power”. It shows the “power” itself to be deviant, transgressing formal limits, exposes the consequences and cracks of its exercise. The third process in psychiatric hospitals of the Lithuanian SSR, “parallelisation”, in which the modern hospital, alongside its formal therapeutic function, acquired parallel, non-formal functions, has been described.

The Psychopharmacological Revolution in the USSR: Schizophrenia Treatment and the Thaw in Soviet Psychiatry, 1954-64.

Twentieth-century psychiatry was transformed in the 1950s and 1960s by the introduction of powerful psychopharmaceuticals, particularly Chlorpromazine (Thorazine). This paper examines the reception of Chlorpromazine in the Soviet Union and its effect on the Soviet practice of psychiatry. The drug, known in the USSR by the name Aminazine, was first used in Moscow in 1954 and was officially approved in 1955. I argue that Soviet psychiatrists initially embraced it because Aminazine enabled them to successfully challenge the Stalin-era dogma in their field (Ivan Pavlov's 'theory of higher nervous activity'). Unlike in the West, however, the new psychopharmaceuticals did not lead to deinstitutionalisation. I argue that the new drugs did not disrupt the existing Soviet system because, unlike the system in the West, the Soviets were already dedicated, at least in theory, to a model which paired psychiatric hospitals with community-based 'neuropsychiatric dispensaries.' Chlorpromazine gave this system a new lease on life, encouraging Soviet psychiatrists to more rapidly move patients from in-patient treatment to 'supporting' treatment in the community.

Soviet psychiatry and the origins of the sluggish schizophrenia concept, 1912–1936

This article seeks to understand the origins of the Soviet concept of ‘sluggish schizophrenia’, a diagnostic category that was used to imprison political dissidents in the post-WWII era. It focuses on the 1920s and 1930s, a period when Soviet psychiatrists attempted to find ways to diagnose schizophrenia at its earliest stages. The new Soviet state supported these efforts, funding new institutions where clinicians encountered types of patients they had not previously studied. Conceptual disagreements arose about what symptoms could be used to diagnose schizophrenia, and how it could be differentiated from other ‘borderline’ mental disorders such as neurosis and psychopathy. Several research groups used their findings to propose new clinical concepts, including ‘mild schizophrenia’ and sluggish schizophrenia. By the early 1930s Soviet psychiatrists no longer shared a basic consensus about schizophrenia. At the same time, the priorities of the Soviet government under Joseph Stalin ceased to support preventative psychiatry. The result was a 1936 ‘discussion’ at which the concept of mild schizophrenia was criticized and sluggish schizophrenia was held up as a model for how the discipline should develop in the future.

Общественная психиатрия — возрождение наследия земских психиатров

The purpose of the study : to analyze the reforms of the Russian psychiatry beginning in the zemsky period of public administration, to establish the role in these reforms of public psychiatrists, to determine the purpose and objectives of the special direction of scientific and practical psychiatry called «public psychiatry». Materials and methods : the material for this work was a set of scientific publications on the problems of formation of mental health care in its various historical periods. The analysis of materials is based on the methodology of qualitative research. Results : the analysis of the evolutionary development of the direction of «Public psychiatry» in the period of Zemsky and Soviet psychiatry, as well as in the post-Soviet period. The assessment of the role of public organizations of users of psychiatric care in the new Russia, which are considered as an important additional link of the state system of psychiatric care. Conclusion : is supposed important to use the traditions of the zemsky psychiatry for the further development of public psychiatry.

Liberating Madness – Punishing Insanity: Soviet Hippies and the Politics of Craziness

This article looks at an important interface between the small community of Soviet hippies and Soviet authorities: the politics of madness. Like dissidents, hippies often found themselves forcefully sequestered in psychiatric institutions. Yet an account of state repression against colourful, innocent flower children does not give justice to the complicated power games that were fought on the battlefield of craziness. Hippies used the ease with which diagnoses of schizophrenia were handed out to obtain exemption from the army. They embraced and fostered the label ‘crazy', subverting official actions through absolute acceptance rather than resistance. At the same time, they feared the loss of control that came with psychiatric treatment, yet re-invented their often traumatic experiences into a marker of their identity. The relationship between hippies and Soviet psychiatry reflects the multi-layered entanglement, which bound the Soviet system with one of its most unruly subjects. Hippie politics of craziness defy easy classification in conformism and dissent, instead highlighting the way in which a group at the margins of society made use of the political environment they lived in, subverting and succumbing to it at the same time.

Excavating the Psyche: A Social History of Soviet Psychiatry in Bulgaria.

This article investigates how an imported Soviet psychiatric model affected Bulgarians who experienced psychological crisis by examining therapeutic possibilities that were available and foreclosed in the People's Republic of Bulgaria. Bulgarians struggling with psychological disorders in the present day experience polar forms of marginalization: non-recognition on one extreme, and chronic medicalization on the other. Both tendencies can be traced to the Communist-period remodeling of mental healthcare, which outlawed private practice and individual-centered therapy, which reified empirically observable, physiological underpinnings of pathology while suppressing therapies that engaged with the existential context of mental illness. I argue that the reproduction of a Soviet psychiatric model instigated a modernization process but failed to anticipate the idiosyncrasy of economic and social conditions within the country. Furthermore, that this model rejected a therapeutic focus on the individual but developed no effective alternative for identifying and treating subjective characteristics of mental illness. Bulgaria's history of psychiatry has received little scholarly attention beyond Bulgarian psychiatrists who documented the development of their field. This article presents archival, literary and oral history footholds towards the development of a social history of Bulgarian psychiatry-a perspective that is especially and problematically missing.

Emil Kraepelin's time in Dorpat - Did this stay made marks in Russian and Soviet psychiatry?

In Russia, German psychiatrist Emil Kraepelin (1856-1926) is regarded as an influential and famous personality in the history of the field. This study discusses whether it was his period in the Russian Empire in the years 1886 to 1891 when he worked at Dorpat University (today Tartu, Estonia) that raised his popularity in Russia. Our research shows that all of his writings which had been translated into Russian language derive from a period much later than Dorpat. Moreover, none of his students has ever reached a scientific position which would have enabled him to become a proponent of Kraepelin's ideas in Russia. Despite his stay at Dorpat was important for Kraepelin's scientific development, it had no major impact on Russian psychiatry.The later perception of Kraepelin in Russia and in the Soviet Union is quite inconsistent. At some point of time, his works on experimental psychology were appreciated, which was probably connected with the rise of reflexology in Russian and, especially, Soviet psychiatry. On the other hand, it was Kraepelin's merits in the classification of psychiatric diseases that have mainly been acknowledged.

Mental health and human rights in Russia—a flawed relationship

When the Soviet Union disintegrated in 1991, new independent psychiatric associations were established in many of the former Soviet republics, and groups of reform-minded psychiatrists initiated projects to discard the old Soviet psychiatric system, a system notorious for its political abuse of psychiatry and characterised by an almost exclusively biological orientation and institutional form of care. Russia was no exception and even boasted some of the most prominent mental health reformers, such as psychiatrist Yuri Nuller in St Petersburg 1 Van Voren R Yuri L Nuller. BJPsych Bull. 2004; 28: 269 Crossref Google Scholar and the Moscow-based lawyer Svetlana Polubinskaya, an associate of the Institute of State and Law who formulated the Soviet Union's last law on psychiatric help and Russia's first law on psychiatric care, which was adopted in 1992. 2 Bonnie R Polubinskaya S Unravelling Soviet psychiatry. J Contemp Legal Issues. 1999; 279: 292-293 Google Scholar Health of Russian people after 100 years of turbulent historyTo mark the centenary of the 1917 Russian October Revolution (Nov 7–8 by the Gregorian calendar, which Russia adopted on Feb 14, 1918), we publish eight essays1–8 that examine the current state of health and the health system in light of Russia's key historical events (panel). The essays largely paint a grim picture of current approaches and health outcomes with a glimmer of hope that some enlightened politicians and health professionals in the country and some in the Russian population itself could be ready for change. Full-Text PDF

Banning the Soviet Lobotomy: Psychiatry, Ethics, and Professional Politics during Late Stalinism.

This article examines how lobotomy came to be banned in the Soviet Union in 1950. The author finds that Soviet psychiatrists viewed lobotomy as a treatment of "last resort," and justified its use on the grounds that it helped make patients more manageable in hospitals and allowed some to return to work. Lobotomy was challenged by psychiatrists who saw mental illness as a "whole body" process and believed that injuries caused by lobotomy were therefore more significant than changes to behavior. Between 1947 and 1949, these theoretical and ethical debates within Soviet psychiatry became politicized. Psychiatrists competing for institutional control attacked their rivals' ideas using slogans drawn from Communist Party ideological campaigns. Party authorities intervened in psychiatry in 1949 and 1950, persecuting Jewish psychiatrists and demanding adherence to Ivan Pavlov's theories. Psychiatrists' existing conflict over lobotomy was adopted as part of the party's own campaign against harmful Western influence in Soviet society.

The Limits for Deinstitutionalization of Psychiatry in Russia: Perspectives of Professionals Working in Outpatient Mental Health Services

:The purpose of this study was to explore the views of mental health professionals on deinstitutionalization reforms in Russia. Qualitative interviews were conducted with 33 specialists from outpatient mental health clinics. The data were analyzed using thematic analysis. The results revealed that the professionals appeared very restrained in supporting the reforms. They argued for the preservation of the existing mental health care system rather than its transformation. Their lines of argumentation were organized around four key themes as follows: 1) critiques of state policies and a suspicion of reforms, 2) tradition instead of innovation: reclaiming the image of Soviet psychiatry, 3) hospitals as a means of social control, and 4) reform as a threat to the protection of people with mental health problems. The findings suggest that practitioner resistance to deinstitutionalization is a complex phenomenon, demonstrating how various political, economic, social, and cultural factors are intertwined in the construction of professional discourse on the reforms.

Soviet Psychiatry through the Prism of Circulation: The Case of Outpatient Psychiatry in the Interwar Period

Soviet Psychiatry through the Prism of CirculationThe Case of Outpatient Psychiatry in the Interwar Period Grégory Dufaud (bio) and Lara Rzesnitzek (bio) The whole mental hygiene movement in Russia has completely revolutionized the concept of psychiatry in the direction of medical, biological, and social hygiene disciplines. —Lev Rozenshtein, First International Congress on Mental Hygiene, 19301 This article examines the transnational dimension of Soviet psychiatry by focusing on outpatient psychiatry. By “outpatient psychiatry,” we mean the policy of care and prevention that took place beyond the walls of psychiatric hospitals and the structures that supported them. This policy was formulated in opposition to the asylum tradition, which had advocated confining patients to help them regain their sanity.2 We use this syntagma less narrowly in reference to the Russian expression to which it corresponds—vnebol´nichnaia psikhiatriia or vnebol´nichnaia psikhiatricheskaia pomoshch´, and more broadly to encompass the various terms most heavily used during the interwar years, [End Page 781] such as “mental hygiene” (psikhogigiena) and “psychiatric assistance” (psikhiatricheskaia pomoshch´). Competing with one another in usage, these terms evolved semantically, as occurred with “psychiatric assistance,” which had by the early 1930s come to designate psychiatric policy in general. In choosing the term “outpatient psychiatry,” we wanted not only to avoid lexicographic difficulties but also to use a fairly neutral expression that allows for establishing equivalency with words that, in languages other than Russian, refer to closely related ideas and similar approaches. Soon after the revolution, psychiatrists developed outpatient psychiatry with the support of officials at the Commissariat of Health (Narkomzdrav), who prioritized the new approach in the late 1920s, once collectivization and forced industrialization began. Through outpatient psychiatry, psychiatrists sought to reduce overcrowding in hospitals, counter the development of chronic symptoms in patients, and attend to pathologies that lacked acute psychotic symptoms but nonetheless required appropriate care. To what extent and in what ways were Soviet psychiatrists’ initiatives inspired by the ideas of their foreign colleagues? Did outpatient psychiatry, as it was implemented in the Soviet Union, generate interest abroad? How were exchanges carried out in practice? In taking up these questions, our investigation draws on the historiography on circulation of knowledge and practices. As Yves Cohen points out, the study of circulation entails resetting global phenomena in a local context. This literature is concerned with the successive transformations of ideas, practices, and objects and with the potential effects of their movement on the original situation. Cohen emphasizes the necessity of identifying “who” and “what” was being displaced, and of studying the discourses that accompany circulation and borrowings.3 For the USSR, this effort raises, of course, the question of the reflective capacity of the actors involved. The image of a country that is self-sufficient and inward-looking has been largely overturned by recent historiography examining transnational exchanges. The area of medicine and health in the interwar period has been largely overlooked, however, while forms of cooperation have drawn the most attention. Susan Solomon has edited a book on collaborations between [End Page 782] German and Soviet doctors. Cast out of the international community, Germany and the USSR drew closer with the signing of the Treaty of Rapallo. Doctors took advantage of this alliance, using their prior connections to develop joint projects that allowed these two medical communities each to pursue their own agendas. After the loss of its colonies at the end of the war, Germany was in need of a new terrain for observation and experimentation; the Soviet Union in turn benefited from German skills and intermediaries who helped Soviet scientists publish their work abroad.4 Michael Z. David has studied the Soviet effort to combat tuberculosis, with preventive mechanisms put in place in the early 1920s culminating in the introduction of the vaccine BCG in the late 1930s. The BCG solution would not have been possible without Soviet collaboration with the Pasteur Institute in France, and David has traced that collaboration step by step from the Soviet side.5 This article covers a wide variety of interactions, drawing on a range of sources from various locations, including Russia, Germany, and the United States. In some regards, our study intersects with Benjamin Zajicek’s analysis...