Psychiatric knowledge on the Soviet periphery: mental health and disorder in East Germany and Czechoslovakia, 1948-1975 Sarah Victoria Marks UCL PhD History of Medicine 1 Plagiarism Statement I, Sarah Victoria Marks confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 2 Abstract This thesis traces the development of concepts and aetiologies of mental disorder in East Germany and Czechoslovakia under Communism, drawing on material from psychiatry and its allied disciplines, as well as discourses on mental health in the popular press and Party literature. I explore the transnational exchanges that shaped these concepts during the Cold War, including those with the USSR, China and other countries in the Soviet sphere of influence, as well as engagement with science from the 'West'. It challenges assumptions about the 'pavlovization' and top-down control of psychiatry, demonstrating that researchers were far from isolated from international developments, and were able to draw on a broad range of theoretical models (albeit providing they employed certain political or linguistic man). In turn, the flow of knowledge also occurred from the periphery to the centre. Rather than casting the history of psychiatry as one of the scientific community in opposition to the Party, I explore the methods individuals used to further their professional and personal interests, and examples of psychiatrists who engaged ± whether explicitly or reluctantly ± in the project of building socialism as a consequence. I also address broader questions about the history of psychiatry after 1945, a period which is still overshadowed in the literature by 19th century asylum studies and histories of psychoanalysis. I argue that the generation of new theories of mental disorder often occured through interaction with other fields in science and technology; including cybernetics, genetics, pharmacology and ecology, with the resulting nosologies, aetiologies and therapies often sitting in theoretical incoherence with one other. The place of these scientific disciplines in the broader political culture of Cold War Eastern Europe is fundamental to disentangling how both normal and abnormal human behaviour was understood, and how this in turn shaped social and political thought under socialism. 3 Acknowledgments My first thanks goes to my supervisors, Sonu Shamdasani and Susan Morrissey for their support and advice during the PhD. I also wish to thank a number of members of staff at UCL who have informed this work, especially Brian Balmer and Jon Agar for their advice on the Science Studies aspect of the project, as well as Roger Cooter, Helga Satzinger, Carole Reeves and Wendy Bracewell. ,¶PHVSHFLDOO\JUDWHIXOWRWKHPHPEHUVRIWKH8&/&HQWUHIRUWKH+LVWRU\RI Psychological Disciplines for innumerable informative discussions, especially Matei Iagher, Sarah Chaney, Corina Dobos, Martin Liebscher and Arthur Eaton. In addition, the UCL STS History of Science Reading Group has been especially helpful, as were discussions with my students on the µ0DGQHVVDQG6RFLHW\¶FRXUVHWKHUH, µ(DVWHUQ Europe 6LQFH¶DW8&/ SSEESDQGµ(DVWHUQ(XURSHVLQFH¶DW6W0DU\¶V University, Twickenham. Many other colleagues have informed the project, most especially Mat Savelli ZLWKZKRP,¶YHEHHQWDONLQJDERXWSV\FKLDWU\XQGHU&RPPXQLVPIRUDORQJWLPH now, as well as Dora Vargha, Joao de Almeida, Oriana Walker, Lynne Williams, Chantal Marazia, Fabio de Sio, Richard Rawles, Claire Shaw, Paul Vickers, Simon Pawley, Nadège Ragaru, Rhodri Hayward, Bradley Matthys Moore, Benjamin =DMLFHN,YDQD9DMGRYi.DWHĜLQD/LãNRYi-HOHna Martinovic, Alisher Latypov, John Forrester, Hasok Chang, and Claudia Stein. ,¶PHVSHFLDOO\JUDWHIXOWRWKH,QVWLWXWIU*HVFKLFKWHGHU0HGL]LQXQG(WKLNLQ Berlin for hosting my research trip in Spring 2013, particularly Volker Hess, Maria Schlotter and the members of the Psychiatriegeschichte Arbeitsgruppe. Meanwhile, 0LOHQD-RVHIRYLþRYiDQG-DQ&KRGČMRYVNêDWWKH$UFKLYHVRIWKH$FDGHP\RI Sciences of the Czech Republic were immensely helpful and patient with my requests. I have also received generous funding and bursaries from the AHRC, the DAAD, the German Historical Society, the former Wellcome Trust Centre for the History of Medicine at UCL, the British Society for the History of Science, and the European Society for the History of the Human Sciences. In addition, I was lucky to be awarded a six month Junior Research Fellowship at the Institute for Historical Research, University of London and would like to thank Miles Taylor for his advice while I was there. 4 Finally I would like to thank Robert Priest for always being there to cheer me up, in addition to his sound academic advice; and my husband Michael Marks for his support and patience, and his unsurpassed 24-hour editorial assistance. 5 Table of Contents Psychiatric knowledge on the Soviet periphery: mental health and disorder in East Germany and Czechoslovakia, 1948-1975 .................................................................... 1 Plagiarism Statement ..................................................................................................... 2 Abstract: ......................................................................................................................... 3 Acknowledgments: ........................................................................................................ 4 Table of Contents ........................................................................................................... 6 Introduction .................................................................................................................... 8 Chapter 1: The Limits of Sovietization and Pavlovization: Psychiatry in the Early Years of Communism. ................................................................................................. 29 1.1 Narratives of late-Stalinism and Sovietization: Periodizations in the USSR .... 29 1.2 Czechoslovakia .................................................................................................. 33 1.2.1 Before 1956 ................................................................................................. 33 1.2.2 Destalinzation and Thaw ± From the Soviet Union to Czechoslovakia ..... 39 1.3 East Germany ..................................................................................................... 50 1.4 Conclusion ......................................................................................................... 60 Chapter 2: Nosologies and Diagnostic Categories ....................................................... 63 2.1 Diagnostic Categories in the GDR and Czechoslovakia .................................... 65 2.2 Neurasthenia ...................................................................................................... 67 2.3 Schizophrenia and the Endogenous Psychoses: Karl Leonhard and Andrei Snezhnevsky ............................................................................................................ 74 2.4 Social and Political Functions of Diagnostic Categories ................................... 91 Figure 12GYUiFHQiWYiĜ$PHULN\ ...................................................................... 96 2.5 Conclusion ......................................................................................................... 97 Chapter 3: Aetiologies ................................................................................................. 99 3.1 Environmental Aetiologies .............................................................................. 103 'LDOHFWLFDO0DWHULDOLVP3DYORYDQGDQµ2UWKRGR[¶0DU[LVW3V\FKLDWU\"103 3.1.2 Cybernetics in Czechoslovakia ................................................................. 105 3.1.2.1 Cybernetics, Medicine and Psychopathology .................................... 114 3.1.3 Human Ecology ........................................................................................ 127 3.2 Biological Aetiologies ..................................................................................... 138 6 3.2.1 Hereditary and Neuroanatomical Factors ......................................................... 139 3.2.2 Experimental psychosis and biochemical hypotheses .............................. 143 3.2.2.1 Pharmaceuticals, LSD and Psychosis Research ................................. 146 3.3 Conclusion ....................................................................................................... 156 Chapter 4: Therapies .................................................................................................. 159 4.1 Sleep Therapy: Implementing Orthodox Pavlovian Therapeutics ................... 160 4.2 Autogenic Therapies: Innovation and Integration of Pavlov with Somatic Approaches ............................................................................................................ 162 4.3 Insulin Coma Therapy ...................................................................................... 168 4.4 Looking to China: Bringing Acupuncture to Czechoslovakia ......................... 169 4.5 The Prague LSD Psychotherapy Projects ........................................................ 175 4.6 Conclusion ....................................................................................................... 181 Concluding Chapter. .................................................................................................. 183 Appendix 1: ICD-6 (1948) .......................................................................................