Abstract
Would it be correct to say that it took more than 20 years to produce a major new work in English which tackles communist psychiatry beyond its role in the political abuse of power? There have been articles, publications and even a PhD thesis on the topic, but it would be hard to name anything since Paul Calloway’s Soviet and Western Psychiatry: A Comparative Study (1992) that offers a general overview of psychiatry in the Soviet Union and/or the Eastern Bloc. Psychiatry in Communist Europe finally breaks this spell of prolonged disinterest in the topic and absence of any effort to conceptualize psychiatry in the region. One could go even further by saying that, in some sense, this book is the first post-Soviet historical study, since Calloway’s work was published so soon after the fall of the Soviet Union.
Overwhelming focus on the issue of political abuse of power in communist psychiatry is, of course, one of the reasons for this disinterest and for the somewhat distorted understanding of what communist psychiatry is, but by no means the only one. In the official Soviet discourse, mental health problems were so marginalized that historians might have been unconsciously inclined to think that mental health was not very useful for studying the Soviet society, although the sheer volume of analogical research on Western psychiatry shows that this is not the case. However, the new wave of interest in medical history in general and mental health history in particular, which has emerged in global historiography over the last decade, has brought back the history of communist psychiatry into historical focus. The fact that this book is published as part of the brand new series Mental Health in Historical Perspective speaks for itself.
In this context, it is hardly surprising that the book’s declared aims are to demonstrate that ‘mental health care within Eastern Europe consisted of a more complex and nuanced picture than that which emerges solely through discussions of psychiatric abuse and the prohibition of psychonalysis’ and ‘to integrate Eastern Europe into wider historiographical debates’ (p. 19). However, it is not easy to identify a single unifying framework of this study: it is about psychiatry, it is about communism, and it is about Europe, but these three are combined and interpreted in quite different ways in each chapter of the volume. Psychiatry in this region could be specifically communist (the emergence of ‘asthenic neurosis’ in communist Romania) and generally international (the so-called ‘psychopharmaceutical revolution’); ‘Europe’ covers not only Hungary, Czechoslovakia and Yugoslavia, but also Soviet Russia and even Central Asia; the history of psychiatry took as its objects not only developments in therapy (work therapy or insulin coma therapy), but also the history of psychiatric institutions or variations on psychiatric themes in public discourses. There is no single approach or way of talking about communist psychiatry; this diversity, even eclecticism, of themes and approaches reveals the astonishingly multi-layered world of psychiatry in Eastern Europe. It also tells us something more about the state of historiography on communist psychiatry in general: what we know is so fragmented, so sporadic, that it is impossible to assemble these different pieces into one coherent picture. The historiography on communist psychiatry is still in the stage of formulating problems, not offering solutions.
It could be argued that this state of affairs – the absence of a broader historiographical context, the fragmentation – can account for sometimes contradictory arguments presented in this book, for example Irina Sirotkina and Marina Kokorina argue that work therapy had been the dominant method used in Soviet psychiatric hospitals until the era of pharmaceutical medication, while Benjamin Zajicek assigns the same role to insulin coma therapy. It may also explain some over-representation of certain aspects and under-representation of others (two chapters are dedicated to the problem of drug addiction, but the much more socially prevalent problems of alcoholism and suicide are not discussed at all). Ironically, by trying to patch up the biggest gaping holes in the historiography of communist psychiatry, the book has lost sight of the overall aim of the series in which it appears: ‘to provide more patient-centred histories’. Individual experiences of patients, their subjectivity or self-perception have been left out of the discussion, which means that 30 years after Roy Porter’s famous article, ‘The patient’s view: doing medical history from below’ (1985), the ‘patient’s view’ is still absent from the history of communist psychiatry.
The eclecticism and the lack of context could also explain why the volume virtually fails to offer an efficient comparison of mental healthcare experiences across different communist societies, even though the composition of the book strongly suggests this comparison. Reading chapter after chapter, one gets a only a vague sense that there were some common trends in the psychiatries of each communist country, but also a great deal of variation both in theory and practice, and it is too early to conclude which was dominant – similarity or difference. For example, the influence of Pavlovism is palpable in almost every country, at least in the post-war period, but various authors suggest that the duration and long-lasting effects of this influence differ (compare Corina Doboș’s piece on Romania and Sarah Marks’s on Czechoslovakia). What is behind these variations? Specific psychiatric developments in each country, mere differences of interpretation or, perhaps, these apparent differences notwithstanding, there lies a common foundation? It seems that the authors tend to agree only on the facts that there were: local particularities; some autonomy from the Soviet centre; and interactions with the Western world.
Unfortunately, this agreement is not enough to give a definite answer to the main question that runs across all the chapters without being explicitly voiced (except in the introduction) – was there a communist psychiatry? We cannot say ‘yes’ just because it differed somewhat from the models used in the West; and we cannot say ‘no’ just because we trace certain influences and affinities with the West. It is not clear whether theoretical foundations alone could be the essential criterion for defining communist psychiatry as a substantive and distinct model or system, or whether therapeutic practices are more or at least just as vital for this purpose. To be fair, the editors do not claim that this book gives the answer. Their aim is to ‘to stir debate and remind readers that it is a question well worth asking’ (p. 1). I would go further than that: the question is not merely ‘worth asking’, but is inescapable after the publication of this book which shows – albeit in an eclectic manner – the direction for further research. It would be a shame not to accept the challenge.