In 2002, I published an article in the journal Harvard Review of Psychiatry entitled ‘Was There a Communist Psychiatry?’ Focusing on the history of mental health care in East Germany, I explored the extent to which it was plausible to account for developments in psychiatry in the Eastern bloc as the result of party political and Marxist-Leninist commitments. My conclusion at the time was that, while there were certain ways in which Communist ideology directly influenced psychiatric practice in the German Democratic Republic, many – perhaps most – features and trends were the result of institutional, economic, cultural and international factors that had little or nothing to do with post-war communism. Nevertheless, given the fact that at the time few academic historians had yet examined the history of Eastern European psychiatry in any depth, any general conclusions seemed provisional at best.
Now, almost a decade and a half later, Mat Savelli and Sarah Marks have taken up my original question, using my article as a springboard to edit a collection of historical essays on the history of psychiatry in Communist Europe. The result is a book that makes a strong contribution to the history of medicine by providing us with a more empirically sound and nuanced understanding of the fate of psychiatry under European state socialism.
Reading across the chapters here, a number of key themes emerge. One involves the role of work in institutional care. Irina Sirotkina and Marina Kokorina, for instance, show that until the introduction of the new generation of psychotropic drugs in the 1950s, work therapy was the predominant form of treatment in Soviet psychiatric facilities. To be sure, use of resident labour in asylums and poorhouses predates the USSR by several centuries. But Marxism-Leninism especially venerated work for not only its economic value, but also its presumed health and moral benefits. Under Stalin, Soviet clinicians experimented with creating special labour colonies for the insane and attempted to organise patients into labour collectives – forms of planned work were seen as particularly therapeutic – but these initiatives could not be applied more generally.
It is evident that one long-standing preoccupation in state socialist states was drug abuse. In the USSR, ‘narcomania’ (as drug addiction was widely referred to) was considered a particularly dire problem in post-revolutionary central Asia, where it was viewed as a veritable epidemic brought about by folk healers prescribing opium to their patients. In post-war Yugoslavia, on the other hand, drug addiction was associated with juveniles, and officials explicitly politicised the problem, perceiving it to be an integral part of a rebelliously cosmopolitan youth culture. Illegal drugs therefore were understood to pose not only a danger to one’s health, but also a direct threat to state socialist society and family life, since young people were creating ‘decadent’, alternative communities on the basis of their consumption habits.
As in Western Europe and the United States, biological models of and treatments for mental illness had already assumed a growing prominence in Eastern Europe in the 1930s. Benjamin Zajicek points out, however, that this was due less to any changes in ideology than to the international introduction of a new range of somatic treatments, such insulin coma, sleep, and shock therapies. Where biological psychiatry in the USSR and Eastern Europe differed from its Western counterparts, of course, was in the former’s elevation of Ivan Pavlov’s model of behaviour to the status of sanctioned doctrine. While this came about due to direct party political influence, essays by Corina Doboş and Melinda Kovai reveal that Pavlovism had limited impact on everyday work in places like Hungary and Romania. Instead, the influence of Pavlovian psychology was restricted mainly to two things: providing the theoretical rationale behind already existing clinical practices and offering an explanation of the mechanisms at work in maladies such as neurasthenia and neurosis. And despite its looming presence during the decades under Stalinism, Sarah Marks notes in her essay on Czechoslovakia, Pavlovism hardly hindered the development of a robust environmentalist tradition in post-war psychiatry.
In the end, then, the volume confirms that psychiatry in Communist Eastern Europe was moved by most of the same dilemmas and enthusiasms faced by its Western counterparts. Volker Hess, for instance, tells us that over-crowded facilities and a lack of funding for outpatient treatments, not party doctrine, were responsible for leading authorities in East Germany to rely on sedatives for handling institutionalised patients. And Mat Savelli reveals that in Yugoslavia, where professionals enjoyed a relatively large degree of independence from Moscow, psychiatrists looked to the West, not Pavlov, to draw inspiration for innovation.
This being the case, it is left to consider where the future of historical studies of Eastern European psychiatry lies. After reading this book, two things come to mind. First, it is increasingly clear that Marxism-Leninism had only a very limited effect on the content of psychiatric thought. Where state socialism’s influence was most felt, instead, was in decision-making over the funding of mental health care. More research therefore needs to be done on the ways in which planned economies shaped the structure and consumption of psychiatric services. Second, given that it is now apparent that the ‘iron curtain’ hardly shielded Eastern European psychiatry from long-term trends and international forces of change, specialists in the field will need to conduct more comparative histories as well as studies that explore developments over lengthier periods of time.
