Mat Savelli, Sarah Marks, eds. Psychiatry in Communist Europe. Houndmills, Basingstoke, Hampshire: Palgrave Macmillan, 2015. 240 pp. $90.00 (cloth), ISBN 978-1-137-49091-9.
Reviewed by Susan Burch (Middlebury College)
Published on H-Disability (January, 2016)
Commissioned by Iain C. Hutchison (University of Glasgow)
Challenging standard interpretations of psychiatry in communist-era Europe, this collection offers important contributions to the social history of medicine. The ten chapters illustrate a rich variety of topics, particularly around treatment options, national-cultural differences, and contest within the Soviet psychiatric profession. As the editors astutely note, global politics and culture wars across the twentieth and twenty-first centuries have strongly shaped historical studies of psychiatry in communist Europe. They acknowledge the powerful impact of "psychiatric abuse"--a phrase commonly invoked to describe Soviet efforts to discredit and subdue political dissidents and ideas that challenged the state. According to Mat Savelli and Sarah Marks, however, "the intensity of debate regarding the issue of psychiatric abuse has, on the whole, deflected attention away from attempts to understand the development of psychiatry in Eastern Europe and the USSR in a wider context" (p. 6). Consequently, their anthology primarily explores less familiar terrain.
Each chapter centers on a different geographical context. This is a great asset of the work. As counter-stories to one another, the various focused studies of communist Czechoslovakia, Hungary, Romania, Russia, and Yugoslavia shatter the stereotype of the Soviet bloc as monolithic (and primarily ethnically Russian). Those generally interested in the USSR will appreciate the editors' introduction, which details some of the complex and fractured relations between members of the Soviet Union. It also acknowledges gaps in the research collection, such as the absence of essays about Albania. Overall, the scholarly scope of the volume is varied--mostly to the anthology's benefit. Some essays examined individual institutions: one particularly vivid work details the (in)famous Kaschenko Hospital outside of Moscow as a way to understand the impact of broad forces across the USSR and the power of individual medical professionals. Other works consider large regions, such as Central Asia or the whole USSR, highlighting tensions between center and periphery. Tensions in the field of religious diversity are, however, confined primarily to discussion on indigenous (Muslim) healers in Central Asia.
Several pieces demonstrate especially innovative historical interpretations. Alisher Latypov's insightful study of the "narcomania" (drug addiction) in Central Asia, for instance, shows how the construction of this psychiatric category especially cast narcotic addiction as a "regional problem" (pp. 73-75). In this Soviet construction, indigenous medical practitioners were portrayed as "backward" cultural relics whose use of opiates directly contributed to "narcomania." Such depictions, Latypov deftly explains, affirmed Russian Soviet superiority and justified the center's efforts to Sovietize peripheral regions. The chapter by Volker Hess on psychopharmaceuticals in West and East Germany draws attention to what he calls the "magical triangle" of science, industry, and the state (p. 154). This powerful essay clarifies how, before the 1960s, the German Democratic Republic (East Germany) and Federal Republic of Germany (West Germany) enjoyed considerable exchanges of research knowledge, medical societies, and pharmacological materials. After the Berlin Wall was erected in 1961, Hess contends, the psychopharmacological innovation slowed to a near halt in East Germany. Hess's case study challenges standard historical interpretations of the modern medical industrial complex that rely heavily on Western (non-communist) contexts.
Benjamin Zajicek’s chapter, "Insulin coma therapy and the construction of therapeutic effectiveness in Stalin's Soviet Union, 1936–1953," details how this therapy "came to be seen as an effective, modern, and distinctly Soviet treatment" even after political-scientific attitudes shifted dramatically (p. 51). Drawing on historian Joel Baslow's critiques of American psychiatry to understand psychiatry in a totalitarian context, Zajicek emphasizes social and institutional factors, including personal and professional, in constructing medically effective treatments. Soviet psychiatrists' shifting representations of insulin coma therapy proved contradictory, Zajicek shows. But each depiction served multiple, often sustained, purposes, including justifications for additional resources, professional affirmation, and an abiding belief in the promise of "cure" for presumed psychiatric disabilities. Matt Savelli's chapter on youth drug use and psychiatry in Yugoslavia notes the rise of the medicalization of the issue and then its de-medicalization, but does not engage deeply with changes among political regimes and how these connected to psychiatric practice.
As a collection thoroughly rooted to the social history of medicine, Psychiatry in Communist Europe ultimately may have limited offerings to disability historians interested in more critical study of key concepts like "mental health," "cure," and "normalcy," or of ableism and other interlocking systems of power and privilege. Another conspicuous drawback is that people deemed mentally ill play a restricted role in this work. Most often, they appear as case studies supporting larger theoretical arguments and as subjects ("patients") of psychiatric interventions. Still, the extensive array of primary sources cited, and the variety of topics and settings offered, demonstrate the scope for continuing study in this sphere. As Sarah Philips, Frances Bernstein, Jitka Sinecka, and other critical disability studies scholars have shown, Soviet and post-Soviet histories raise significant, challenging, and necessary questions for our field. It is hoped that Psychiatry in Communist Europe may spark additional projects to pursue those questions.
. Sarah Philips, "'There Are No Invalids in the USSR!': A Missing Soviet Chapter in the New Disability History," Disability Studies Quarterly 29, no. 3 (2009), available at http://www.dsq-sds.org/article/view/936/1111; Frances Bernstein, "Panic, Potency, and the Crisis of Nervousness in the 1920s," in Everyday Subjects: Formations of Identity in Early Soviet Culture, ed. Christina Kiaer and Eric Naiman (Bloomington: Indiana University Press, 2006); and Jitka Sinecka, "Peeping over the wall: Communism, Goffman and the deinstitutionalisation of people with autism in the Czech Republic," in The Imperfect Historian Disability Histories in Europe, ed. Sebastian Barsch, Anne Klein, and Pieter Verstraete (New York: Peter Lang Publishers, 2013), 215-234.
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