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Psychiatry in Communist Europe / Edited by Sarah Marks, Teaching Fellow, University College London, UK and Mat Savelli, Research Fellow, Mcmasters University, Canada

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Psychiatry in Communist Europe / Edited by Sarah Marks, Teaching Fellow, University College London, UK and Mat Savelli, Research Fellow, Mcmasters University, Canada Copyrighted material – 978–1–137–49091–9 Selection and editorial matter © Mat Savelli and Sarah Marks 2015 Individual chapters © Respective authors 2015 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identifi ed as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2015 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN 978–1–137–49091–9 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Psychiatry in communist Europe / edited by Sarah Marks, Teaching Fellow, University College London, UK and Mat Savelli, Research Fellow, McMasters University, Canada. pages cm — (Mental health in historical perspective) ISBN 978–1–137–49091–9 (hardback) 1. Psychiatry—Europe—History—20th century. 2. Mental health—Europe— History. 3. Psychiatric hospitals—Europe—History. I. Marks, Sarah, 1984– II. Savelli, Mat, 1982– RC339.E85P79 2015 616.89—dc23 2015012940 Typeset by MPS Limited, Chennai, India. Copyrighted material – 978–1–137–49091–9 Copyrighted material – 978–1–137–49091–9 Contents Acknowledgements vii Notes on Contributors ix 1 Communist Europe and Transnational Psychiatry 1 Sarah Marks and Mat Savelli 2 The Dialectics of Labour in a Psychiatric Ward: Work Therapy in the Kaschenko Hospital 27 Irina Sirotkina and Marina Kokorina 3 Insulin Coma Therapy and the Construction of Therapeutic Effectiveness in Stalin’s Soviet Union, 1936–1953 50 Benjamin Zajicek 4 Soviet Psychiatry and Drug Addiction in Central Asia: The Construction of ‘Narcomania’ 73 Alisher Latypov 5 Psychiatry and Ideology: The Emergence of ‘Asthenic Neurosis’ in Communist Romania 93 Corina Doboş 6 The History of the Hungarian Institute of Psychiatry and Neurology between 1945 and 1968 117 Melinda Kovai 7 Ecology, Humanism and Mental Health in Communist Czechoslovakia 134 Sarah Marks 8 Beyond the Therapeutic Revolution: Psychopharmaceuticals Crossing the Berlin Wall 153 Volker Hess Translated from the German by Arthur Eaton 9 Blame George Harrison: Drug Use and Psychiatry in Communist Yugoslavia 180 Mat Savelli v Copyrighted material – 978–1–137–49091–9 Copyrighted material – 978–1–137–49091–9 vi Contents 10 Over the Cuckoo’s Nest: Russian Variations on a Psychiatric Theme 196 Rebecca Reich Index 216 Copyrighted material – 978–1–137–49091–9 Copyrighted material – 978–1–137–49091–9 1 Communist Europe and Transnational Psychiatry Sarah Marks and Mat Savelli In a 2002 article published in the Harvard Review of Psychiatry, historian Greg Eghigian posed the question: was there a Communist Psychiatry? Specifically, he was asking if there was “something essentially ‘com- munist’ about East European psychiatry” and if a distinct and identifi- able school or system of mental health practice existed across Eastern Europe.1 Eghigian raised his query against a backdrop of opinion that assumed that psychiatric policy across the Eastern bloc originated in Moscow and spread outwards.2 Imagined hallmarks of Communist Psychiatry might include the misuse of the profession for political ends, the wholesale rejection of Freud, Pavlovization and strict adher- ence to physiological approaches to mental illness in accordance with ideological materialism, and a stress on work as the primary means of therapy. The extent to which the countries of Eastern Europe under- went shared or unique experiences of Communism is highly debated among historians, but, as of yet, psychiatry and mental illness have rarely figured into this debate.3 Given psychiatry’s prominent role in regulating deviance (and thus helping to create and defend the norms of a society), this development is somewhat surprising. Historians of psychiatry and medicine have also been relatively slow in addressing the topic of mental health care in the former Communist world. When compared against the voluminous material on psychiatry in Western Europe, North America, and the colonial world, this shortfall is espe- cially remarkable. This volume, Psychiatry in Communist Europe, high- lights the need for addressing the topic of mental health in the context of Marxist-Leninism. It is not so much an attempt to answer Eghigian’s question (much more work will need to be done before that is possible), but rather it is meant to stir debate and remind readers that it is a ques- tion well worth asking. 1 Copyrighted material – 978–1–137–49091–9 Copyrighted material – 978–1–137–49091–9 2 Sarah Marks and Mat Savelli Although not necessarily profound, interest in how psychiatrists in the Communist world approached mental illness is longstand- ing. With a few exceptions, Western observers first started reporting regularly on Soviet psychiatry in the post-Second World War period. In a foreshadowing of the later scandals over psychiatric abuse, early commentators were particularly interested in the issue of forensic psychiatry.4 Undoubtedly the most important work during this period was carried out by Joseph Wortis. A psychiatrist himself, Wortis’ mono- graph Soviet Psychiatry served as the primary source of knowledge for those interested in mental health matters in the USSR for quite some time.5 Amidst the brewing tensions of the Cold War, the book proved sufficiently controversial that the publisher’s president felt it necessary to include a foreword in which he stated that the book should not in any way be viewed as evidence of “any admiration on our part for Soviet science, economy, or ideology.”6 The reason for the controversy stemmed from Wortis’ sympathetic appraisal of Soviet mental health care. Although not visiting the USSR himself, Wortis studied Soviet medical literature and concluded that, ultimately, Soviet psychiatrists might very well better meet the needs of the country’s citizens than their American counterparts. Perhaps naive about the actual conditions in the country (at one point Wortis refers to Trotskyists as “doubting Thomases,” vanquished in their belief that socialism could not be built in the Soviet Union), Wortis did a commendable job in highlighting some major tendencies in Soviet mental health practice in very inhos- pitable research conditions.7 A more nuanced (but still broadly sympathetic) assessment came from the sociologist Mark Field, who, over a series of trips, researched various aspects of the Soviet psychiatric system. Along with his col- league, the psychiatrist Jason Aronson, Field produced a series of articles that served to educate readers on the key developments and trends in Russian psychiatry.8 Through their reports, they began to sketch a pic- ture of Soviet (and perhaps East European) psychiatry that has, to some extent, persisted to this today; namely a therapeutic outlook that relied heavily on work therapy, an elevation of Pavlov’s beliefs with a simulta- neous rejection of Freud, and a devotion to physiological approaches to mental illness. Dismissing the prevailing notion that Soviet authorities cared little for the welfare of their citizens, Field and Aronson praised many elements of the Soviet approach, including the great strides made in community care, the warmth of doctor-patient relations, and the ability of Soviet psychiatry to help reintegrate patients into the working community. In particular, Field was effusive in his praise of community Copyrighted material – 978–1–137–49091–9 Copyrighted material – 978–1–137–49091–9 Communist Europe and Transnational Psychiatry 3 care, noting that “[t]he main contribution the Soviets have made lies, probably, in their concepts of not condemning psychotic patients to the idle, demoralizing, de-socializing, untherapeutic and wasteful life of the chronic patient in the large mental hospital.”9 Other reports from this period were similarly impressed with Soviet psychiatric developments, especially in terms of outpatient care.10 The tone of reporting on Soviet and East European psychiatry changed dramatically during the 1970s. While earlier texts concerned themselves with ideological and practical concerns in mental health care, from the early 1970s until the collapse of Communism commen- tators overwhelmingly concentrated on the misuse of psychiatry for political purposes. Soviet dissidents, Western practitioners, and
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