Psychiatry in Communist Europe

‘Was there a Communist psychiatry?’ This is the overarching question of this edited volume. Previous studies have emphasized the misuse of the profession, the forced hospitalization and involuntary drugging of dissidents, or they dealt with ideologically informed approaches such as the rejection of psychoanalysis and the simultaneous devotion to physiological approaches to mental illness. This book provides nuanced views from within Communist psychiatry. The editors’ expert introduction concedes that psychiatric abuse for political and other purposes did happen, although both the scale and the motivation of Soviet psychiatrists involved in this practice remain highly controversial. The focus on this issue has led to an incomplete picture of psychiatry in Communist Eastern Europe, and the objective of this book is to fill some of the gaps. Perhaps the most interesting insight of the volume is that the dogmatization of Ivan Pavlov’s theory of higher nervous activity did not result in a homogenization of Communist psychiatry. Neither in Romania, in Hungary nor in the Soviet Union did the ‘Pavlovian turn’ displace previously practised therapies. The various ramifications of Pavlovism in different socialist countries demonstrate the variety of Communist psychiatries. In Czechoslovakia, researchers harnessed Pavlovian ideas in creative ways and, for instance, used it to draw inspiration for environmental psychiatry. They were ‘committed to the Marxist project’, but ‘by no means dogmatic ideologues’ (Sarah Marks). In Budapest, on the other hand, psychiatrists paid lip service to Pavlov while psychotherapy, psychology, and psychoanalysis persisted in informal educational groups and private networks, as Melinda Kovai points out. In the USSR, the insulin coma therapy, a Western method, had been adopted, reframed, and widely used. Although ineffective, it did not disappear after 1950. As Benjamin Zajicek shows, insulin coma therapy was even more frequently practised for a while since ‘Pavlov’s doctrine’ rejected other brutal therapies such as lobotomy and electroshock which were used in the West. Another main theme of the book is the construction of diagnoses within the context of a Communist regime. In Romania, the rebranding of the diagnosis of neurasthenia in Pavlovian terms (called ‘asthenic neurosis’) turned out to be a success story. Corina Dobos considers ‘asthenic neurosis’, which bundled up fatigue, boredom, apathy, conflicts, and stress, a ‘creative translation’ of the experiences in state-socialist societies ‘into medical language and daily practice’. In Central Asia, the term ‘narcomania’ became a weapon of Soviet psychiatrists to fight native Islamic medical practices. Other contributions highlight knowledge transfer which did not stop at the Iron Curtain: East European practitioners strove to actively contribute to Western psychiatry, too. Matt Savelli describes how illegal drug-taking was treated as a social problem in Yugoslavia. The re-socialization of ‘drug addicts’ was not confined to Tito’s state; the social therapeutic approach developed by Vladimir Hudolin was used in more than thirty countries. Another example is the conference on ‘Integrative Human Ecology’ that took place in Czechoslovakia in 1969. The volume is not without its problems. Since most of the contributors focus on national histories, the book lacks in coherence. For instance, Volker Hess has meticulously examined which psycho-pharmaceuticals were prescribed in the GDR, and when, but does not provide any references to other East European countries. Hence his chapter does not really contribute to the overarching question of the book. Most of the authors are rather affirmative of the examined practices. The essay on work therapy in the Soviet Union, for instance, would have benefited from a more critical assessment of the success stories of the Stalinist era which are referenced. The ‘comparative concluding chapter’, which the editors announced in the introduction (p. 20) but unfortunately left out of the volume, would have lent this book more importance. Still, it is a valuable collection that gives insights that help change the emphasis from sensationalist stories to the everyday business of psychiatry. However, the initial question, if there was a Communist psychiatry, remains open.