Rebecca Reich. State of Madness: Psychiatry, Literature, and Dissent after Stalin. DeKalb: Northern Illinois University Press, 2018. x + 283 pp. $60.00 (cloth), ISBN 978-0-87580-775-1; $60.00 (e-book), ISBN 978-1-60909-233-7.
Reviewed by Amanda Williams (University of Leeds)
Published on H-Russia (January, 2019)
Commissioned by Oleksa Drachewych (Western University)
In State of Madness: Psychiatry, Literature, and Dissent after Stalin, Rebecca Reich examines how dissident writers used various forms of literary discourse to resist the Soviet state’s attempts to declare them insane. Soviet psychiatry was different from its Western counterparts as it was willing to act as a political tool on behalf of the government. Reich chooses writers who had varying degrees of political engagement, but all disagreed with the state by “sitting apart” (p. 4). These writers came into conflict with the state-sanctioned psychiatric system by engaging with inakomyslie, the idea of thinking differently, which Soviet psychiatrists used as evidence of insanity or madness to have dissidents committed to psychiatric hospitals. Dissenters scrutinized the diagnosis process and treatment of psychiatric patients through a variety of literary genres, helping to expose many of the abuses of Soviet psychiatry. Their literary works did not attack just psychiatry but also the state as a whole; they demonstrated how the USSR was still far from the reform-minded, modernized, and law-abiding society it portrayed itself to be, following Joseph Stalin’s death. Reich aptly illustrates how portrayals of madness were contested in the late Soviet Union.
Chapter 1 of State of Madness delivers a brilliant framework and provides crucial background that Reich refers to throughout the rest of the text. By dissecting the art of diagnosis, she breaks down how psychiatrists used their own ambiguous terminology to turn subjective judgments into seemingly scientific objective facts. Dissenters criticized punitive psychiatry specifically due to the biased nature of the diagnosis. For many of these dissenting writers, the art behind the Soviet psychiatrist’s conclusion lay in revealing or fabricating hidden mental disorders. Psychiatrists examined the dissenter’s files over long periods of time; they could then begin to point out the symptoms of the disease the dissenter supposedly suffered from. This ability to make retrospective diagnoses was critical for psychiatrists who had to determine the subject’s responsibility for his or her criminal acts. Reich emphasizes that in order to form this diagnosis, the dialogue between the psychiatrist and patient had to become a monologue where the psychiatrist’s authority determined the patient’s past, present, and future story. To present their diagnosis as objective, their comments and observations regarding the patient had to be situated within the scientific language of a disease. Many dissidents were diagnosed with schizophrenia or paranoaic disorders as these psychiatric categories were particularly flexible to manipulation by state psychiatrists. For dissidents, these two diagnoses were particularly problematic as it was easy for dissidents to fall into, what Reich titles, “the discursive trap”: the very questioning of the validity of the psychiatrists’ conclusions could be enough to confirm being labeled mad or insane. Recovery involved acknowledging one’s illness and accepting the state’s treatment of it; this affirmed not just the psychiatrist’s authority but also the state’s.
In conceiving of their diagnosis, it was critical for psychiatrists to analyze dissidents’ creative work. Reich reiterates throughout the text that it was only through illegal printed literary works that dissidents were able to pathologize the Soviet state and society. Literature provided an outlet for action in order to describe the horrors and abuses of psychiatrists and their institutions. Yet each dissident author conceived of different ways to pursue their literature. As shown in chapter 2, Aleksandr Vol’pin refused to engage with psychiatric discourse and used logic to showcase the irrationality of state-sponsored psychiatry. However, in this process, he personified the ambiguity of inakomyslie. Yet Vladimir Bukovskii and Semen Gluzman argued that those who dared to think differently needed to be pragmatic. In their view, the only way to avoid a diagnosis was to engage with the very same psychiatric discourse. Dissidents needed to exploit the ambiguity of psychiatric terms. Reich frames Joseph Brodsky’s case study around his invention of the “art of estrangement” that he developed in contrast to the Marxist dictum of “existence determines consciousness” (p. 102). He reinvented the categories of consciousness and existence to reposition the equation of creative dissent with madness. It was Brodsky’s own diagnoses and hospitalizations that allowed him to use psychiatric discourse in his own writing and also exposed him to the potential threat of psychiatric hospitals being an incubator of silence. Reich examines two of his works, but his poem “Gorbunov and Gorchakov” truly illuminates his ideas and extremes of consciousness and existence.
In chapter 4, Reich portrays what may be her best case study by examining the trial and selected works of Andrei Siniavskii. Siniavskii was a literary critic who produced provocative literary works under the pseudonym Abram Terts. At his trial, Siniavskii contended that he could not be held responsible for the works of fiction written by Terts, including the plots, characters, and extreme fantastic realism of the settings. He insisted that the state was blending his life and his art together as psychiatric, literary, and legal discourses were used to confirm his responsibility for the actions and language of his fictional characters.
The final case study examines Venedikt Erofeev, a man who seems fundamentally different from many of the other dissident authors previously examined due to him presenting his literary career as an exercise in pretending to be insane. Erofeev’s authorial personality straddled the line between lived and literary expression. His fictional heroes were social deviants who were typically named after him. Erofeev also mirrored his own heroes’ lifestyles by dropping out of university, changing jobs, and excessively drinking until requiring treatments in psychiatric hospitals for alcoholism. Erofeev was the living embodiment of simulation and dissimulation.
The criticisms of State of Madness are rather minor. First, while these case studies eloquently prove Reich’s argument, there is no justification on why she picks these particular dissidents to focus on. For those less familiar with dissident literature in the late Soviet period, they may want an explanation, particularly as half of the dissident writers chosen did not actively participate in political activity. Second, while understanding that Reich’s framework involves examining literary works by the dissident authors, readers may feel lost in the extremely detailed literary analysis that Reich conducts in certain areas. This would include the several pages per case study of poems, stories, and plays, as well as the deconstruction of grammar. Last, in terms of the dissidents who were not particularly politically active, it seems Reich works twice as hard to prove her point. For example, Reich seems to struggle to make her final case study, Erofeev, fit into her original argument, leaving me uncertain if the additional example was necessary for her study.
Reich has a refreshing angle on Soviet psychiatry in the post-Stalin period that examines the ideology and thorough processes behind psychiatrists’ and dissidents’ attempts to work this system to their advantage. She is able to tap into the new and emerging trends in the history of medicine by exploring the gray areas of morality, subjectivity, and power within Soviet medical and psychiatric practices. Reich’s interdisciplinary methodology was created by examining how dissenters turned their supposed madness into an outlet for preserving and demonstrating their sanity and overall mental health. Both psychiatrists and dissenters used the preoccupation of literature in Russia and the Soviet Union to examine their medical reports and literary works. Within this literary and psychiatric discourse, dissenters and psychiatrists each asserted their authority to determine what it meant to be mad in post-Stalinist Soviet Union.
If there is additional discussion of this review, you may access it through the network, at: https://networks.h-net.org/h-russia.
Amanda Williams. Review of Reich, Rebecca, State of Madness: Psychiatry, Literature, and Dissent after Stalin.
H-Russia, H-Net Reviews.
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