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Postsocialist Reforms of the Mental Health System in Ukraine Shelly Ann Yankovskyy University of Tennessee - Knoxville, [email protected]

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Postsocialist Reforms of the Mental Health System in Ukraine Shelly Ann Yankovskyy University of Tennessee - Knoxville, Syankovs@Utk.Edu University of Tennessee, Knoxville Trace: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 5-2013 Medicalizing Suffering: Postsocialist Reforms of the Mental Health System in Ukraine Shelly Ann Yankovskyy University of Tennessee - Knoxville, [email protected] Recommended Citation Yankovskyy, Shelly Ann, "Medicalizing Suffering: Postsocialist Reforms of the Mental Health System in Ukraine. " PhD diss., University of Tennessee, 2013. https://trace.tennessee.edu/utk_graddiss/1798 This Dissertation is brought to you for free and open access by the Graduate School at Trace: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of Trace: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Shelly Ann Yankovskyy entitled "Medicalizing Suffering: Postsocialist Reforms of the Mental Health System in Ukraine." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, with a major in Anthropology. Tricia Redeker-Hepner, Major Professor We have read this dissertation and recommend its acceptance: Gregory V. Button, Marisa O. Ensor, Dawn Szymanski Accepted for the Council: Dixie L. Thompson Vice Provost and Dean of the Graduate School (Original signatures are on file with official student records.) Medicalizing Suffering: Postsocialist Reforms of the Mental Health System in Ukraine A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Shelly Ann Yankovskyy May 2013 ii Copyright © 2013 by Shelly Yankovskyy All rights reserved. iii Dedication Нина Фёдоровна Зель (1918 - 2013) iv Acknowledgements My time at the University of Tennessee has been quite a journey! I am so very thankful for all the support and assistance from so many individuals. To my committee, thank you for being so patient, as I would never have gotten this far without you! I’ve lost count of exactly how many versions of this dissertation were edited by Dr. Tricia Redeker-Hepner! Dr. DeAnn Pendry, I have enjoyed working as your teaching assistant all these years – you have been an inspiration in so many ways. A special thanks to Dr. Sarah Phillips, your generosity and support along the way has been very much appreciated. Thank you to Dr. Michael Angrosino, now Professor Emeritus at the University of South Florida, working with you provided the foundation for my research in Ukraine. Thank you to my first professors of anthropology at Valdosta State University; Dr. Stephen Childs, Dr. Marvin T. Smith and Dr. Matthew Richard – what a great learning environment you provided your students! A special thanks to Dr. Matthew Richard, your continued support to myself and others combined with your passion and dedication to the field of anthropology is remarkable. You are a constant inspiration! Thank you to my sponsor in Ukraine, to all the patients that shared their stories of suffering, and to the psychiatrists and social workers working to better conditions in the country. Thank you to my Ukrainian in-laws, you provided so much support for my research, from housing and childcare to finances, food and laughter! To my parents and siblings – we have had some good times, but so often we have found ourselves struggling. My persistence for learning and quest for knowledge grew out of these experiences. Finally, to my husband Sasha, and my daughter Nadia – you two have really been my “partners in crime.” We are in this together and I am so glad to have you along for the ride!!! v Abstract This dissertation explores how mental health reforms in postsocialist Ukraine, specifically the push for privatized community mental health services, are playing out on the ground through provider and patient perspectives and are mediated by nongovernmental organizations (NGOs). I argue that the international agenda promoted in Ukraine that pushes for western neoliberal political and economic reforms has produced cultural and structural discrepancies and tensions which can be seen in the mental health field. As major reforms are promoted, including the shift from state hospitals to private “community-based” services as part of a transition from socialized to privatized or insurance-based care, and as providers adopt the U.S. – modeled International Classification of Diseases [ICD-10] to diagnose and treat mental health disorders, the cultural meanings of socialism and capitalism collide and coalesce around questions such as where (or with whom) the responsibility for health lies, the proper relationship between psychiatrists and patients, and the prioritization of the individual vs. the collective, and the implications of these. Amid these cultural and structural changes, moreover, the neoliberal agenda forces Ukrainians to replace deeply rooted cultural tenants shaped by socialism with those of U.S. dominated corporate capitalism. Human rights discourse has been adopted by some NGOs as a way to mediate and critique these processes of cultural change induced by transformations in political economy. I use psychiatry and mental health as a window into this struggle. vi Table of Contents Introduction ......................................................................................................................... 1 Mental Health Care Reform in Postsocialist Ukraine ..................................................... 3 Biomedicine and Mental Health ..................................................................................... 9 Methods......................................................................................................................... 18 Soviet/Ukrainian History .............................................................................................. 28 Early Soviet Rule ...................................................................................................... 28 Late Soviet Rule ........................................................................................................ 33 After Independence ................................................................................................... 34 Conclusion .................................................................................................................... 38 CHAPTER I ...................................................................................................................... 41 Political-Economic Determinants of Health ..................................................................... 41 The Politicization of Psychiatry .................................................................................... 42 Neoliberalism in Ukraine – Combating Poverty? ......................................................... 48 Civil Society and Democracy a la Neoliberalism ......................................................... 55 Medical Anthropology as Ecological, Interpretive and Critical ................................... 62 Chapter II .......................................................................................................................... 73 Structural Underpinnings of the Post socialist Transition ................................................ 73 Forms of Healing .......................................................................................................... 77 The Paternalistic Approach ........................................................................................... 80 Who’s Responsible for Health? .................................................................................... 83 Infrastructure and Funding: Structural Discrepancies and Tensions ............................ 85 Lack of Community Infrastructure ........................................................................... 85 “Human Rights” and the Role of Non-governmental Organizations ............................ 87 Lack of Funding ............................................................................................................ 91 Morality of Money ........................................................................................................ 94 Diagnosing and Diagnostics: Westernizing the Understanding of the Human Mind ... 98 Chapter III ....................................................................................................................... 104 Mental Health Care, Diagnosis and the Medicalization of Social Problems .................. 104 What’s Ailing Ukraine? Diagnosing and Diagnoses ................................................ 104 Authoritarianism and Suffering .................................................................................. 108 Social Problems and the Link to Neoliberalism ......................................................... 118 Conclusion ...................................................................................................................... 125 List of References ........................................................................................................... 128 Appendix ......................................................................................................................... 139 vii List of Figures Figure 1 Administrative Building of state-run Psychiatric Hospital in South Central Ukraine .....................................................................................................................
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