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Psychiatry Past and Present in the Russianterritory of Primor'e

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Psychiatry Past and Present in the Russianterritory of Primor'e BRIEFINGS Psychiatry past and present in the Russian territory of Primor'e S.A. Alekseyev Primor'e is a former Soviet colonial area in the heads all commissions of any importance, and Far East. It is now part of free Russia's national settles any disputes about diagnosis. He goes parkland, rich in flora and fauna. In the present through the motions of asking his colleagues' chaotic period of transition to a market economy, advice, but they all know that they are com business leaders from Japan, China and Korea pletely dependent upon him. He is always right have rushed in to develop its potential. by virtue of his position. The main city in Primor'e is Vladivostok. The During the Soviet period, the Moscow school of psychiatric service, however, originated in the psychiatry (led by A. Snezhnevsky) held sway in town of Ussuriisk, where the first psychiatric the Primor'e region; indeed, it still does. The hospital was built by public subscription in diagnostic methods and the approach of the 1904, and staffed by highly educated people Moscow school brought with them formulations such as I.D. Shcherbak who graduated from the such as 'invisible symptoms of schizophrenia', University of Yurevsky (previously Derptsky), and 'inertly-fluid schizophrenia'. where he was taught by Kraepelin himself. He This situation lies at the root of Soviet psychi visited many progressive mental hospitals, both atric abuse. The state monopoly on psychiatry, at home and abroad. During World War I, he was its bureaucratic administration, the absence of evacuated to the Far East, and worked in the mechanisms for free discussion, the suppression mental hospital at Ussuriisk. of dissenting views, the fear that initiative would The doctors of the pre-Soviet period had a be punished, and the state of psychiatry as a European approach to psychiatry, but this ended science have all contributed to the present state with the arrival of those educated under the of affairs. To add to the list of our problems we communist regime. Professor Lastovetsky who may include the following: the irregular and dis worked in Ussuriisk from 1922, wrote that: organised provision of medicines and equipment to psychiatric hospitals and clinics; and an "The struggle for the health of the working ineffective bureaucratic administration, which people, including their mental health, has serves the concealed aims of members of the entered a new phase, bringing us closer to a ruling group. bright future for mankind and to the building of a happy communist society. Primor'e: the psychiatry of yesterday "The chief objective is to incorporate the In 1987, a sick old man whom we will call Petrov scientific principles of Soviet psychiatry into was living in the town of X in Primor'e. Petrov everyday practice in the Ussuriisk Hospital." distinguished himself from his Soviet neigh bours in that he made complaints to different It is a bitter fact that these principles still authorities about the chairman of the town operate today. council, whom we will call Comrade A. Having Psychiatry is a branch of medicine in which previously worked under Comrade A, Petrov medical and human problems are closely inter knew all about his machinations. Comrade A was woven. Psychiatric disorders do not present weary of Petrov, and found a way of dealing with objective signs in the same way as physical him. disorders such as diabetes. There is no single A Dr B was invited to take part in a commission conclusive test for schizophrenia. Consequently which was looking into the Petrov affair. He was the role of psychiatrists is a powerful one: they even sent to Petrov's flat to 'examine' him. Dr B determine the fate of the patient. Diagnostic arranged to send Petrov to the Regional Psychi methods are therefore of vital importance. In atric Hospital no. 1 at Ussuriisk. Dr B justified every Soviet psychiatric hospital, the chief psy this action on the grounds that Petrov was chiatrist has the final say in all matters. He 'making complaints' and 'fighting for justice'. He Psychiatric Bulletin (1994), 18, 765-767 765 BRIEFINGS diagnosed a paranoid syndrome with 'querulous lished in the Primor'e Psychiatric Bulletin No. 9, tendencies'. November 1992, was as follows: Petrov was seized at his summer cottage in the country, without explanation. The ambulance "(Hospital H) is the only psychiatric insti arrived; a policeman climbed out and put the old tution to have been built according to a com man in. plete design. It occupies large grounds Petrov arrived at the psychiatric hospital in (389 012 sq.m.) and it has a large farm, with a state of shock, and asked to be discharged fields, a garden, a greenhouse, a piggery, a at once. Fortunately for him, a competent com herd of cows, etc. It is a town in itself, situated mission of enquiry, led by the assistant chief in the green belt 20 km from Ussuriisk. psychiatrist, sorted out the problem quickly, and According to official figures for 1991, the hos he was discharged. pital has 620 beds. It is the largest psychiatric Following this, he made a complaint about hospital in the region, and comprises two the activities of Comrade A and Dr B, as a result spacious modern buildings. Living conditions of which a commission of enquiry visited X. are excellent. The commission consisted of representatives of the regional Public Prosecutor's office and of the "The number of patients in the hospital has regional Executive Committee, as well as the decreased rapidly, from 1045 in 1988 to 145 in present writer. The commission brought to light 1991. The most recent building, completed numerous irregularities in the activities of both in 1990, has never been used for psychiatric Comrade A and Dr B. patients and is two thirds empty. It appears The commission took its findings to the chair that there is a deliberate policy of avoiding man of the regional Executive Committee, Com admissions. Between January and November rade C, who is now a Governor. After listening to 1992, 101 patients were admitted, compared the report. Comrade C gave this astonishing with 665 admissions to a 100-bed unit at No. 1 reply: "We won't hurt our leader's feelings. Petrov Hospital and 250 patients to a 30-bed psy had no right to make those allegations!" chiatric unit in Lesozavodsk town hospital." It is not known where Petrov is now, but the other players in this psychiatric comedy are still The commission concluded that there was no in their places, with some adjustments. During organised practice of psychiatry, as generally his time as Governor, Comrade C was dismissed understood. Patients were refused admission in for bribery. He now heads the regional fund for spite of the fact that large parts of the hospital the privatisation of property. He gives instruc were empty. The administration of this hospital tions on privatisation and puts reforms into appeared capricious and wasteful of time and practice. money, while other psychiatric hospitals in the region laboured under an intolerable load. The situation demanded the immediate replacement Primor'e: the psychiatry of today of the chief psychiatrist. A few days after presenting the report, the The following example illustrates the standard of members of the commission discovered that they recent psychiatric administration. The findings had achieved the expected result, no result at all. were made in 1992. Dr D remains in control of the hospital, failing to In the territory of Primor'e, there are four large use it for its intended purpose. The chief psychia psychiatric hospitals and two neuropathological trist of Primor'e adopted an ambiguous position: clinics/hospitals. These institutions are short while admitting the existence of numerous of space and overcrowded. Admission and abuses at Hospital H, he took no steps to change discharge rates are high. the situation, or to use the generous resources There is, however, one exception, which we will of the hospital for the benefit of the under call hospital H. This establishment occupies a funded and overloaded psychiatric service of the special place in the regional psychiatric service. whole region. An experienced local psychiatrist For the last 16 years, Dr D has been the chief expressed the opinion that the psychiatrist at psychiatrist there. She hires and fires, decides on Hospital H had protectors in the regional health building work and closures, introduces new administration who condoned her caprices. methods and gives medical advice, transfers Delegations come to our region, and sometimes patients between sections and punishes and there are visits by foreign psychiatrists. Ordinary reprieves her subordinates. psychiatrists do not have the privilege of meeting Hospital H is closed, not only to ordinary mor such unusual guests; generally it is our leaders tals, but also to psychiatrists. It is difficult, who meet them. Recently some foreign psychia therefore, to find out what goes on there. How trists were taken to Hospital H and of course they ever, I was able to visit this hospital as a member were impressed. No doubt it is regarded as a of a commission. Its report, which was pub model hospital, and the pride of our authorities. 766 Alekseyev BRIEFINGS Today we find ourselves at a crossroads. We continue with our attempt to form an Inde Opinions differ as to how we may best organise pendent Psychiatric Association, but while our our work under changing conditions. My opinion society is suffering from disruption and fragmen is that since we have no mechanism for the tation, many people, including doctors, feel that free exchange of opinions, official views, those of under the present conditions, it is a case of'every the authorities, will prevail.
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