A review of Scientific Psychiatry in Stalin’s Soviet Union: The Politics of Modern Medicine and the Struggle to Define ‘Pavlovian’ Psychiatry, 1939-1953, by Benjamin Zajicek.
Benjamin Zajicek’s dissertation constitutes a detailed study of a decisive period in the development of Soviet psychiatry. In these years, psychiatrists confronted pressing practical challenges, but also considered broader questions of the scope of psychiatry’s jurisdiction and the philosophy of mind. Even before the outbreak of war brought devastating upheaval, mental hospitals were seriously overcrowded, and psychiatrists were concerned that this prevented the exploitation of new technologies that offered the hope of more effective treatments. The chronological framework of Zajicek’s study is linked to a consideration of the impact of two major interventions in psychiatry by the state: a 1936 ban on psychological testing in industry and education, which effectively prevented psychiatrists from claiming expertise in the detection and treatment of social problems; and a 1951 conference organized to establish the means by which Soviet psychiatry could operate in accordance with the ideas of the physiologist Ivan Pavlov. Without dismissing the importance of such interventions, this dissertation draws on a wide range of archival and published sources to analyze other factors that proved equally, or perhaps even more important, in shaping the development of Soviet psychiatry in this period. Thus, Zajicek’s study places these two famous interventions by the state in a broader context to offer a detailed and nuanced account of the development of Soviet psychiatry.
Historical studies of Soviet psychiatry are few, and this study breaks much new ground. Russian-language studies are limited to “internalist” histories written by practitioners, which, Zajicek writes, tend to “suffer from a lack of historical context or critical distance” (p. 13). Critical accounts are frequently coloured by personal grievances, but otherwise tend to echo the view — prevalent in the West during the Cold War years — that psychiatry was perverted by Stalinist totalitarianism along with other Soviet sciences. Zajicek draws on recent reassessments of Stalinist science — especially the studies of Nikolai Krementsov (Stalinist Science. Princeton, NJ: Princeton University Press, 1997) and Aleksei Kojevnikov (Stalin’s Great Science: The Times and Adventures of Soviet Physicists. London: Imperial College Press, 2004) — to argue that, although the state did compel psychiatrists to adopt certain language, they remained able to express a remarkably wide range of ideas. As Zajicek’s title indicates, he argues that the crucial development in these years was not the imposition of a Pavlovian framework by the Soviet state, but instead a struggle among psychiatrists to define what Pavlovian psychiatry would be. As he demonstrates, disputes over professional jurisdiction, institutional and personal rivalries, informal networks of patronage, the development of technology, generational change, and competition for scarce funding and material resources all shaped this struggle and shaped decisively the development of the theory and practice of psychiatry.
The first chapter traces the impact of “active therapies,” such as electroshock and insulin shock therapy, first introduced in 1936, which many hoped would herald a major advance in psychiatric treatment that would confer on psychiatry a stature equal to that of other medical disciplines. These hopes were soon disappointed, as overcrowded and understaffed psychiatric hospitals lacked the facilities necessary to conduct insulin therapy effectively. Moreover, the outbreak of war in 1941 brought the development of such therapies to a standstill as psychiatric hospitals directed all their resources to managing acute shortages of basic necessities and yet greater overcrowding. Despite such limitations, with the introduction of active therapy came a vision of a modern scientific hospital, with orderly wards organized around routines of treatment, administered by well-educated, professional staff. As public health authorities assessed the state of psychiatric care after the war, that vision shaped the changes they sought to implement.
The second chapter examines the impact on psychiatrists of treating psychiatric casualties of war. Here they encountered a much broader range of problems than they did in peacetime, and struggled especially to understand cases of traumatic neurosis — which in the military context were fairly common. Despite the wartime conditions, some psychiatrists were able to carry out studies of soldiers’ psychiatric injuries, making use of new technologies, such as x-rays, electroencephalography, and chemical analysis. Using these methods, they sought to identify physical bases for traumatic neuroses that had eluded psychiatrists during the First World War. These studies helped to advance the development of physiological and biochemical approaches to psychiatry, which shaped the development of the discipline in the postwar years.
Chapter 3 examines the ways in which the war’s aftermath dominated psychiatry between 1945 and 1949. Until 1948, psychiatric institutions that had been devastated by wartime hardships struggled to provide adequate treatment for war veterans suffering from psychoneurological illnesses. In large part because the process of being periodically recertified as an invalid became more bureaucratic and difficult, such patients’ numbers dwindled after 1948. The suggestion that the experience of the war might have caused widespread damage to the psychological health of the civilian population prompted a revival of calls for psychiatry to implement prophylactic ‘mental hygiene’. A major reorganization of psychiatric care in 1949, however, reflected a desire on the part of public health officials to see psychiatric hospitals become more streamlined institutions, to solve the problem of chronic overcrowding and increase their effectiveness as treatment centres.
Chapter 4 examines debates over the interpretation of Pavlov’s physiology and its implications for psychiatry between 1940 and 1948. It demonstrates that conflicts over such questions were intensified by personal and institutional rivalries in the context of competition for limited funding, resources and access to publication. It also demonstrates that psychiatrists were deeply engaged with physiological theories even before the state and Communist Party leadership insisted upon the centrality of Pavlovian physiology to Soviet psychiatry. Chapter 5 argues that the decision to ban the practice of lobotomy in 1950 resulted from a professional conflict over treatment methods that was linked to a struggle for resources and institutional power. It became intertwined with a wider campaign of chauvinism and anti-Semitism in Soviet society, and opponents of lobotomy prevailed by successfully portraying lobotomy as a Western, anti-Pavlovian practice.
Chapter 6 examines the October 1951 ‘Pavlov session’, at which the practical implications of Pavlovian physiology for the practice of Soviet psychiatry were to be defined, and thus became decisive for establishing who would control key institutions in the field. Although this session was decisive for the redistribution of institutional power in the field, Zajicek rejects the characterization of it as an egregious intervention in science by political elites. The idea of Pavlovian psychiatry was sufficiently vague that all participants could claim to be its true representatives, he argues, and the final outcome depended not upon ideological pronouncements of scientific principles, but upon administrative priorities and on an anti-Semitic campaign to attack leading Jewish figures within the profession. Moreover, Zajicek contests the frequent characterization of the 1951 session as a fundamental break in the development of Soviet psychiatry. Rather, he argues, it reinforced long-standing trends, such as the creation of a clinical foundation for psychiatry, the use of new technology and laboratory methods to develop more effective treatment methods, and the advance of a younger generation of psychiatrists who had been educated after the 1917 revolution and had trained in provincial institutions. This argument is developed in the final chapter, which explores how these developments were implemented in practice in the years after 1951, as health officials encouraged the regimentation of hospital wards to make them better suited to new treatments like shock therapy and sleep therapy. In terms of the administration of psychiatric hospitals, Zajicek emphasizes that the practical consequences of the campaign for Pavlovian psychiatry — whereby “psychiatric hospital directors were given new tools to ask for funds, discipline their staff, and justify using drugs and other methods to subdue agitated patients” (p. 434) — accelerated and reinforced pre-existing trends.
In sum, this dissertation makes important contributions in a number of areas. At the most basic level, it provides a detailed account of the institutional, intellectual, and methodological development of Soviet psychiatry during a decisive period that has been little studied. More broadly, it contributes to a re-evaluation of Soviet science that calls into question the significance of political leaders’ interventions in scientific debates. Most importantly, it enriches our understanding of the array of other forces that shaped scientific debates in the Soviet Union by illuminating the way in which institutional forces, personal rivalry, limited resources, and practical challenges all shaped scientific knowledge and practice. Its detailed, nuanced, multi-dimensional, and carefully contextualized approach is a model for others to follow as historians explore other neglected areas of Soviet science and medicine.
School of Slavonic and East European Studies,
University College London
State Archive of the Russian Federation (Gosudarstevennyi Arkhiv Rossiiskoi Federatsii).
Russian State Archive of Social and Political History (Rossiiskii Gosudarstvennyi Arkhiv Sotsial´no-Politicheskoi Istorii).
Central State Archive of the City of Moscow (Tsentral´nyi Arkhiv Goroda Moskvy).
Zhurnal nevropatologii i psikhiatrii (Journal of Neuropathology and Psychiatry).
University of Chicago. 2009. 501 pp. Primary Adviser: Sheila Fitzpatrick.
Image: Ivan Pavlov. Wikimedia Commons.