Alexander Frese and the establishment of psychiatry in the Russian Empire

Introduction

Modern Russian and foreign historiography have already focused on biographies of such famous ‘metropolitan’ psychiatrists as I. Balinsky, N. Bazhenov, V. Bekhterev, among others, but the significance of so-called ‘provincial’ psychiatrists has been neglected. Nevertheless, the term ‘metropolitan’, or ‘peripheral’, can hardly be analytically applicable for several reasons. It is often employed in historiography to emphasize the decisive role of a doctor in the local history of his/her native region, then globally to maintain the dichotomy of the discourse of ‘metropolitan country vs. periphery’ in the understanding of the imperial past. ¹ The narrative itself, as a rule, consists of three pivotal periods in the biography of a psychiatrist: the crucial significance of his work for the region, a brief mention of his study abroad for several months, and the subsequent departure to the capital as a new stage in his professional career. This type of analysis is illustrated by the well-known example of Bekhterev’s biography: after working for a long time as a zemskii (provincial) physician and psychiatrist in Kazan province, he then moved to St Petersburg and founded the St Petersburg Psycho-Neurological Institute. ² From this perspective, much attention is given to the major scientific ideas of the psychiatrist, his professional career and local activity in the hospital, which, of course, are significant. However, within this approach, less attention is paid to transboundary means of communication between scientists, the flow of transnational ideas and practices, which composed the subjectivity and lifepath of the ‘local’ actor.

While there was considerable interest in some aspects of the transnational nature of imperial psychiatry in Russia, biographies of psychiatrists are still written from a more national viewpoint, and to some extent are limited to their local activities. ³ For example, little significance has been attached to overseas trips, traineeships, international publications, and the scientific connections of Russian imperial psychiatrists with Europe and other countries. The ‘imaginary West’ was viewed as a distant land and ideal world, and when Russian physicians returned from these trips, they implemented the latest and most up-to-date treatment practices for the mentally ill. Moreover, writing this history in the logic of national constructivism by using such terms as ‘a great Russian psychiatrist’ (velikij russkij psihiatr) or ‘the founding father of Russian psychiatry’ (otez osnovatel russkoj psihiatrii) is unconvincing; in fact, many psychiatrists regarded themselves as subjects and scholars of the Russian Empire, while at the same time being descendants of different cultural identities (Jewish, German, Polish, etc.).

In contrast, writing an imperial biography of a psychiatrist in a conventional logic of regionalism, local history or even within the logic of present sociocultural reality does not seem possible due to the ‘complex’ social and spatial structure of empires. ⁴ Alexander Frese’s biography is a case in point because each of these logics seems untenable. In 1864, Frese was appointed the first director of the Kazan District Hospital (Kazan hospital). He also became a pioneer in the organization of the Institute of Psychiatry in Russia. The scientific ties which he had established with various psychiatric institutions and doctors were both local and global. Moreover, he travelled frequently throughout the whole empire and beyond it, and his biography exemplifies an imperial career which led in opposite directions: first, from the geographical periphery to the centre, then vice versa, then beyond the empire, and finally back to the periphery. Furthermore, because of Frese’s ‘Ostsee’ (Baltic German) origin, and the lack of Russophone psychiatric journals until the last quarter of the nineteenth century, he actively participated in the scientific life of German Empire. He was not only the creator of the all-imperial project of district hospitals in Russia, but also one of the first scientists to travel abroad. Such travels became obligatory for Russian psychiatrists and, during many years, scientific contacts were established over a wide area. The conditions of these scientific networks and the causes of their eventual breakdown are a crucial topic that should be scrutinized further. Last but not least, openness of the scientific boundaries between major European powers determined the dissemination of Frese’s travel paths and channels of communication. Even from the point of view of Russian medical bureaucrats, Western and Eastern Europe were seen as areas from which to borrow ideas and methods that could contribute to the practices of Russian psychiatry. All these questions cannot be structured within any single logic, for example in a ‘vertical’ (centre-periphery) narrative. The very diversity of the imperial space and the openness of the scientific boundaries require the inclusion of various contexts and horizontal linkages between psychiatric institutions. ⁵

The concept of an imperial biography is not used here for the essentialization of an ‘imperial identity’, or as being cross-border, marginal or multicultural, or with the aim of revealing the particular nature of the Russian Empire through its reflection in the biography of an imperial subject. Instead, I agree with Ballantyne (2002: 14–15), who wanted to stress the following:

At a general level . . . the empire was a structure, a complex fabrication fashioned out of a great number of disparate parts that were brought together into a new relationship . . . The web captures the integrative nature of this cultural traffic, the ways in which imperial institutions and structures connected disparate points in space into a complex mesh of networks.

From the province to Moscow: Frese’s biography

Alexander Frese (1826–84) was born in 1826 in Revel (Tallinn) – according to some sources near the city of Revel – in the Governorate of Estonia (Akkerblom, 1884: 337) (see Figure 1). Frese’s father, Justus Benedict Frese (1796–1861), was a pastor of the Lutheran church in Revel. His lineage is unknown, but most likely it was of mixed origin, probably Estonian and Ostsee-German. At the age of 19, Alexander graduated from the male gymnasium in Revel (Brjancev and Kovalevskij, 1884: 1), where he received an excellent education and mastered Latin, English, French and, of course, German. It is known from Frese’s obituaries that in this period he had great difficulty with the Russian language.

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Figure 1.

Alexander Frese (photographer and date unknown, possibly 1880; source: Bazhenov, 1909).

He eagerly learnt how to become a private healer. Then, having studied the Russian language and being well-prepared for the entrance examinations, he was enrolled in the medical faculty of Moscow University. On 1 June 1851, Frese passed the last examination for the degree of a physician (lekar’) and in March 1852 was approved by the resident physician at the estate of the landlord Kanshin in Kaluga Province (Kurashov, 1939: 117; see also Akkerblom, 1884). He stayed there for about two years and in 1854 was seconded by a supernumerary resident at the Moscow Military Hospital. During his medical activities, the young man had a keen and serious interest in psychiatry and became acquainted with the famous Moscow psychiatrist Vasilii Sabler (Akkerblom, 1884: 337). Like Frese, Sabler had Ostsee-German heritage, and for over 30 years was the chief physician and director of the Moscow ‘Dolgauz’, which was renamed the ‘Moscow Preobrazhensky Hospital’ on his instructions. The hospital’s original name goes back to the Senate decree of Peter III of 20 April 1762, in which he pointed out the need to treat ‘mad people’ in specialized institutions for the first time in Russian history. Describing this in the German way, ‘Dolgauz’ can be literally translated as ‘Tollhaus’, which in old German means ‘madhouse’ (Polnoe Sobranie Zakonov, 1830a).

From the centre to Europe: Frese’s travels

In 1857, Frese was sent on his first four-month overseas trip across Europe. He visited several European countries and almost all the psychiatric institutions in Germany, Austria, Belgium, Holland and England. Unfortunately, in the archival data Frese’s impressions of his first trip are not preserved, but it is known from some obituaries that he paid particular attention to the new psychiatric hospital in the German town of Achern (the Heil und Pflegeanstalt Illenau in Achern, Baden) (Brjancev and Kovalevskij, 1884: 1). The asylum started accepting the first patients in 1842, and by the beginning of the 1850s they numbered about 300; most of them were recovering patients. Its founder and the first director, Christian Friedrich Wilhelm Roller, used much recreational therapy and arranged walks for patients in the fresh air. However, in the monograph that brought him worldwide fame, Die Irrenanstalt nach allen ihren Beziehungen dargestellt (Roller, 1831), he concluded that doctors should decide whether to apply the whip and the stick as a measure for calming the ill (Bazhenov, 1909: 68). Frese probably observed such treatment during his stay there and, of course, he was familiar with Roller’s book. Having learnt much on his trip, Frese was planning his first great publication, the only one of its kind at the time in the Russian Empire: On the Organization of Houses for the Insane (Ob ustrojstve domov umalishennyh; Frese, 1862). I will examine and discuss this work, as the author gives a detailed and critical reflection on how the treatment of patients was carried out in Western Europe and which practices could eventually be borrowed by Russia.

The book is divided into 10 chapters. The first, second and third chapters are devoted to the function, purpose and priorities of a mental hospital, but the third is of particular interest because the author compares Russian and European psychiatry. In Europe, special significance is attached to the choice of a site for the construction of a hospital. Quoting the French psychiatrist Jean-Pierre Falret, Frese agrees that a psychiatric hospital should be arranged exclusively by the principles of the well-ordered treatment of mental illnesses (Frese, 1862: 22). Referring to German doctors (Oppert, Essay, Schlager), he concludes that a psychiatric hospital should be located in an elevated and airy place not far from the city, but not in the town in order to avoid the polluted air and noise from the factories. The hospital must have access to drinking water, sewerage and a main road. The exterior should look neat and well designed (pp. 23–4). On the question of the internal arrangement of the hospital, Frese favours centralization, stressing that treating 500 patients in the new Viennese psychiatric hospital is much easier than if it were run in a decentralized way. Dr Joseph Guislain, the well-known Belgian humanist and psychiatrist – the ‘Belgian Pinel’, as he was called at the time – proposed that the number of patients should not exceed 350. Frese reports that this is the number in most of the English institutions. The principles of centralization and of having a small number of (mostly convalescent) patients would later be fully implemented by Frese in the Kazan hospital; this characterizes him as an advocate of the English model – the most humane way of treatment according to contemporaries at that time. He found that the treatment of 1000 patients in the Hanwell Asylum (West London) was disadvantageous. In many asylums in Germany, there were 300, 400 or 500 patients. The maximum number of patients, according to Conolly, mentioned above, should be 400, and Falret preferred 200–300 but at the same time allowing large institutions for 400 patients (pp. 26–7). Concerning the issue of the separate treatment of women and men, Frese, unlike most of his colleagues in the field, supports the idea of their cohabitation, since it is not only economically beneficial but to some extent also has a therapeutic value.

Examining Jacobi’s, Guislain’s and Roller’s principles of separation in wards by the nature of the disease, curability, incurability and social strata, Frese entirely agrees with Jacobi’s opinion because, unlike Roller, he does not propose an additional department for convalescent patients. Frese believes that in addition to the senselessness and inconvenience of the segregation of sick and recovering patients, the former may lose the beneficial influence of the latter on psychical conditions (pp. 34–5). As evidence, the author refers to the positive examples he witnessed in German hospitals, where the benevolent effect of convalescing patients on the chronically ill was significant. Frese gives an example of the practical implementation of the most convenient separation of patients in the Sonnenstein hospital near to Dresden: (1) calm, convalescent and quiet patients; (2) anxious, violent and riotous; (3) paralytic, feeble-minded and untidy; (4) those with accidental diseases (p. 35). However, a very different system is the separation of patients by class. For example, in Charenton (Paris), patients are divided into three and even four categories according to their level of education and social class. In Frese’s view, to place patients without regard to the level of their social class, professional affiliation and rank would mean rejecting the requirements of humanness for the sick (pp. 37–8). As in ordinary hospitals, the separation into social groups should also be respected by mental hospitals, since the patients are held there for a very long time and not by their own choice. A single, uniform attitude to all patients, ignoring the differences between them, would be tyrannical, unjust, and a punishment (p. 39). For a doctor, it is proper to take into account specific social and spatial conditions in conjunction with the features of a patient’s mental state. Frese stresses that underestimation of these factors can lead to a deterioration in the patient’s condition. Such key principles reflect the conscious moulding of the patient’s identity in the hospital. The fundamental distinction between the actual nosology of the patient’s illness and its social importance is the most crucial foundation of the modern discourse of psychiatry. The concept was also known as the principle of ‘individualization’ of the patient and was firmly adhered to by Frese in his professional practice. The aim of this individualization is not only to heal the patient’s physical body but also to shape and recover his ‘social body’.

Towards the end of the third chapter, Frese draws attention to the spatial organization of German hospitals and their first-night dormitories for new patients (Schlafsäle) and its dining rooms (Tagesräume); he regards this as the correct setting for treatment. He agrees with Jacobi that the appearance of houses for the mentally ill should have a combination of simplicity, modesty and a pleasant impression. Hospitals for the insane should not resemble castles, monasteries, prisons or factories, and certainly not houses of correction or workhouses (p. 48). Frese once again cites Guislain, who believes that the work given to patients, and their greater involvement in work, should not be an end in itself. However, it can serve as a consolation for the patient and therefore helpful in maintaining order within the hospital (pp. 45–6). Regarding the classification of architectural types by Guislain, Falret and Jacobi (cross-shaped, straight with wings, in the form of a cube and with private square gardens, or star-shaped), Frese agrees with Falret that the mixed type of hospital is the best layout. However, Frese notes that having enclosed courtyards or gardens at a hospital for the mentally ill is much easier abroad, especially in the southern countries of Europe, than it is in Russia. Enclosed areas, namely courtyards surrounded by walls and planned following the principles of simplicity and unity of the overall plan, are not feasible in Russia due to frequent rain and heavy snow (p. 55).

Concerning the treatment system within a hospital, Frese once again quotes Conolly, who had recently published his essay on the treatment of the mentally ill without mechanical restraint. Nevertheless, while rejecting any mechanical means of coercion, a psychiatrist often resorts to restraint by the supervisors. Other doctors, in particular German psychiatrist Dietrich Kieser, had shown non-restraint to be one-sided, hyper-philanthropic and in practice completely unrealizable. ⁷ Thus, physical coercive measures are replaced by another type of coercion, which Frese does not accept. He believes that the matter is not about external pressure on the patients, but rather about the most tolerant attitude towards them, and that forcible constraint should be used only in extreme cases.

Often the patients themselves, in anticipation of an epileptic seizure or any other attack of disease, beg to wear a straitjacket to protect others. Besides, we must not forget that the very stay of the insane in a psychiatric hospital is a forced necessity, and one must always remember this and resort to coercive measures only when they are a vital necessity. (p. 87)

Frese is also quite sceptical about the emerging practice of labour therapy. In his view, an asylum for the mentally ill is not a workhouse. Work in the asylum can be used only for the benefit of the patient’s early recovery if he requires it. It cannot be forced on the patient or given as a punishment, but it can be designated as a reward. Referring to a famous French psychiatrist, Jean Parchappe, and to Roller, Frese points out the following characteristics of work therapy that are worth the psychiatrist’s attention: (1) the work must be diverse; (2) highly skilled workers must participate in collaborating with the patients; (3) the choice and purpose of the activity depends on the decision of the doctor; (4) the patients can work only for the institution; (5) it should have a purpose and should not be routinely mechanical; (6) labour in the open air, like gardening, is beneficial. ⁸ The question of gaining profits from the work of the mentally ill is essential for the doctor to consider. Frese stresses firmly that any money earned can be taken by the institution for its own purposes only when the patient cannot and does not want to use it. In all other cases, earnings from work should go exclusively to the needs and desires of the patients and not to the hospital. In Foucault’s opinion, nineteenth-century psychiatrists actively sought to impose labour therapy in order to absorb additional profits from the mentally ill, because they were following the logic of capitalist rationality. In a certain sense, this is questioned in the case of Frese. In this passage, he writes that occupational therapy should not be prescribed by a doctor for the purpose of gaining a profit, but rather should be used systematically for some categories of patients, primarily for medical reasons and the patient’s convalescence (pp. 72–5).

In one of the last chapters in his book, Frese raises an important question about the independence of the director of a psychiatric hospital from the higher government institutions in Europe and the Russian Empire. Here he provides a comparative analysis of France, Germany, England and Belgium and outlines the prospects of the administrative project in Russia. Referring to the French experience of Esquirol, Parchappe and Falret, Frese agrees that the chief doctor (psychiatrist) should be the leader and sole head of the entire institution, in both administrative and medical capacities. Similar to the Russian provincial charity institutions (Prikazi Obchestvennogo Prizrenia), in France this function is performed by L’Assistance Publique. Its management includes almost all civilian hospitals, each managed by its director. All directors of the individual institutions are subordinate to the chief director. He submits his reports to the prefect, and the prefect directly refers to the Ministry of Internal Affairs. Such intricate bureaucracy is the source of extensive correspondence between officials, and directly limits the opportunities and independent activities of the psychiatric hospital (Frese, 1863b: 219). Besides, in France most mental hospitals had been managed, and are still administered, by non-medical directors, although the post of the chief medical examiner, occupied by a physician, has also been established there (Frese, 1862: 103–4).

Criticism of such a system had led to a change in Germany, where the directors of hospitals were at that time predominantly psychiatric doctors. Frese found this administrative system in Illenau (Achern, Baden), where he considered it entirely satisfactory. This was confirmed by Essay, the director of the Charité hospital in Berlin: only a doctor can better understand the needs of the suffering and the most convenient ways to meet them. He echoes another German psychiatrist and the director of mental hospital in Oldenburg, Franz Kelp, stating that the whole fate of the institution depends on the intelligent and vigorous management of doctors in general. Frese concludes that the administration of hospitals in Austria and Prussia in general depends on the physicians. Thus, in German states, most of the directors of institutions are directly under the services close to the Ministry of Internal Affairs in Russia. Since every mental disorder is treated not only with medicines, but with a constant moral influence on the patient and the hospital as a whole, any external interference that does not accord with the scientific view of the case can only be harmful. It would be wrong to give the doctor-director full power over the clinic. The director’s goal is not to dominate the entire institution, but to transfer the principles of humanity and science to his medical staff, on whom he relies. In this regard, Frese points to the broad discussion between Austrian physicians, where personnel of a new psychiatric hospital in Vienna (for 500 people) raised the following question: Should only the director treat patients or should he delegate some of his duties to assistants? At the suggestion of the Viennese Professor Viscanyk, they favoured delegation and, in addition to the director, more experienced physicians were appointed, who undertook all medical duties (Frese, 1862: 105–9).

In England, all the current psychiatric hospitals are in the department of a special commission (Lunacy Commission), which reports to the Ministry of Internal Affairs. The Commission consists of three psychiatric doctors and three lawyers, who, at on-site meetings, decide questions about the daily life of patients, so the leading doctors inside the hospitals do not have all the power (pp. 110–11).

In conclusion, Frese finds it challenging to define which of the above systems is most suitable for the government and the psychiatric hospitals of the Russian Empire. The vast geographical spread of the empire and the large distances between the provincial cities and the centre of state administration make it necessary to seek and establish a different system for psychiatric hospitals. However, in Frese’s opinion, the city hospitals for the insane could be subordinated directly to the Ministry of Internal Affairs (as in Germany), while the provincial cities have an intermediary between the hospital and the Ministry in the person of a civil or military governor. However, both for the capital and for rural towns, Frese acknowledges that the French system of introducing medical and economic inspectors is successful and their responsibilities are determined according to the instructions given by the Ministry of Internal Affairs (p. 112).

The comprehensive knowledge that Frese acquired during his first trip was not wasted. Since the 1840s, the government had been thinking about a radical reorganization of psychiatric aid to the population of the empire. The so-called provincial asylums – zheltye doma (yellow houses) – which had been built following a decree of Catherine II, were in terrible condition (Polnoe Sobranie Zakonov, 1830b; Shul’ts, 1865: 14–15). The patients were often kept in chains and without real professional treatment from the doctor or the administration of the province. In 1842, the former director of the Medical Department of the Ministry of Internal Affairs, the general-staff-doctor A. Richter, went on a trip to explore whether it was necessary to improve hospitals for the insane within the central European provinces of Russia. He found that ‘all the houses of the insane are overwhelmed with incurable madmen and idiots, and [that] an early and radical reform of charity for the mentally ill is needed in general’ (Smolenskii, 1889: 4). In 1844, a new Commission was set up under the direction of the Ministry of Internal Affairs. This was assigned the task of finalizing the draft plan for the so-called ‘district mental houses’, to rebuild and reshape the conception of notorious ‘provincial madhouses’. By 1856, the project for eight district houses was developed, but their construction slowed down, and by 1862 the Commission found that the plan was obsolete (p. 5).

Once again to the centre, to Europe, and back to the province

After his first short trip abroad, Frese returned home. The book had brought him widespread fame throughout the empire. It is also known that the book was read to the Emperor, Alexander the II (Akkerblom, 1884: 338). Afterwards Frese was summoned to the Ministry of Internal Affairs to testify on the arrangement of a new district mental hospital in Kazan. He, along with other professional psychiatrists Balinsky, Seifart, Rozov and Stein, joined the reconstituted Commission for the establishment of the first district hospitals. After discussing the project for such a hospital in the framework of the Commission, and with the approval of the Emperor, Frese was once again sent to the Ministry of Internal Affairs. He was given an 18-month internship for a detailed examination of European hospitals, to discover the most suitable model for the planning of a district hospital in Kazan (Zagoskin, 1904: 365).

While he was abroad again, Frese published an influential article, ‘A few words about Bicêtre and Salpêtrière in Paris’, in which he typifies their detailed day-to-day activities (Frese, 1863a). Such articles seemed to be necessary, and they reflected his critical views on the process of institutionalization of psychiatry in Europe in comparison with that in Russia. Frese begins with a comprehensive history of the origin of these hospitals in Paris. He also gives statistics on the numbers of patients treated there. However, in a second article, in contrast to the purely factual information in the first, he is critical (Frese, 1863b). Undoubtedly, his primary concerns are the advantages and disadvantages of the oldest French institutions, which he analyses for a better understanding of the arrangement of the administrative system, and also the treatment regime and the internal space, being planned for the new district hospital in Kazan. Divided from each other for the most part by stone walls, the departments of the Salpêtrière are not interconnected. The premises have both large rooms and small cells. Restless patients are put in the cells, and all the rest are in the other rooms. Children of idiots and epileptics are kept in an old, cramped, irregular building, with poor hygiene conditions. In the afternoon, the patients gather together and walk through the halls or the courtyard. With such internal planning and the absence of systematic treatment for each category of patients, their individualization is overlooked. Also, there is a significant number of quiet patients who, due to their illness, should be isolated from others, but instead they are put in cells with the noisy patients (p. 216). In a spacious courtyard surrounded by stone walls, there are two rows of houses like Swiss chalets. Each usually has one patient, just for the night or the afternoon. If the weather is good, the patients walk around the yard, but if not, they gather in a long and cramped room called the chauffoir. Two houses, one at each end of a row, are for the supervisors. Frese questions how patients are cared for when it is raining or on a cold night, when both overseers are sleeping in their own houses. He tries to understand the purpose of these individual chalets. Of course, they provide seclusion for the patients but do not serve any other medical purpose. Frese himself had already heard many times about the so-called cottage system, and had learnt much about it from British psychiatrists. Nevertheless, he cannot even imagine that this architectural ensemble, which had not yet been the subject of a deep critical analysis, is, in fact, a collection of small jails (p. 217). In addition to the French institutions, there is also a brief note about Frese’s latest visit to some German ‘Rhein Bavaria’ psychiatric hospitals (nowadays, Pfalzklinikum für Psychiatrie und Neurologie in Rheinland-Pfalz). At this hospital, he noticed another important practice: sending graduate students from universities to familiarize themselves with actual psychiatric practice and to train in one of the government hospitals. Frese (1873: 50) wrote:

There has long been a law in Bavaria that obliges young people, who started medical science courses at the university, to be seconded in one of the state houses for the insane. The proposed measure would undoubtedly contribute much to the development of the correct views on mental illness among the doctors themselves.

In April 1864, Frese was sent to Kazan for two months to take part in a meeting on the construction of the first district hospital in the history of imperial psychiatry in Russia, and on 5 June he was appointed its director. In December of the same year, he was sent back to St Petersburg to address the issue of increasing the number of places in the district hospital (from 150 to 200), to which the Ministry gave a positive response. In March 1866, he was appointed Professor of Psychiatry at the Kazan Imperial University. During the period from 1866–9, he also travelled widely around the empire. In May 1867 he was sent to St Petersburg again, and then to Kiev, Odessa, Simferopol and Perm to find suitable sites and to advise on the construction of similar hospitals there (Akkerblom, 1884: 338; Brjancev and Kovalevskij, 1884: 2; Zagoskin, 1904: 366).

Conclusion

The mobile ‘imperial biography’ of the Kazan psychiatrist Alexander Frese has been analysed here. Partly German in origin, he faced many difficulties, especially in studying the Russian language and absorbing its culture, but he moved frequently between different parts of the multinational empire and he successfully integrated into it. Nevertheless, writing history within the framework of the transnational approach is challenging, because it diminishes the analytical potential of border/boundary studies. By applying an imperial biography approach to citizens of the British Empire, Lambert (2014: 40) concludes:

In particular, it is difficult to know where to draw the boundaries when studying imperial history in this mode. Networks link to other networks, many of them extra-imperial, and without the clear, if misleading limits provided by a territorial space such as Britain or one of its particular colonies, the object of study can seem daunting and unmanageable. This is precisely why a mobile imperial-biographical approach has much to offer: it provides an empirical, interpretive and narrative focus – a thread to follow through the sources and a central historical protagonist.

A carefully chosen stance between the grand approach and a selective case study brings new and challenging interpretations. Many ‘mobile’ and ‘imperial’ scientists could allow certain boundaries (cultural, national, social, etc.) and could also participate in their dynamic creation and maintenance. In other words, to what extent can one differentiate between national and transnational views by studying the imperial biography of a psychiatrist in the nineteenth century? Which mechanisms of interaction could lead to the transnational (imperial) logic of the functioning of the field of psychiatry, whereas other mechanisms are, in contrast, rooted in a national stance? For instance, in the language of the ideology of contemporaries, this was expressed in the often-encountered stereotype of the Russian ‘ever-lagging’ psychiatry in comparison with European psychiatry, even though the present study proves the impossibility of using this type of analysis. At the practical level, Frese’s biography allows us to look at the variety of contradictions and uncertainties in the implementation of seemingly the same medical, architectural and spatial systems of different European countries. Neither German nor English nor French psychiatrists had rashly sought to borrow innovations from each other. This is also true for Russian psychiatry, and a good example is Frese’s thoughtful and cautious reflection on diverse aspects of the internal and external structure of psychiatric hospitals. Although there were national, ideological and state borders between Russian and other European psychiatric societies, it is remarkable that international channels of communication were able to reduce the significance of these contradictions and to establish a reliable network for an interchange of scientific ideas. Even if one assumes that institutes were purely national, at least there was much active exchange between them.