Medicine, Law, and the State in Imperial Russia

Conclusion

Conclusion As the Russian state was reforming institutions and social order in the late imperial period, Russian professionals were revising their conceptions of criminality and legal responsibility in an equally dramatic and related manner. Entering the twentieth century physicians joined hands with jurists in order to “rationalize” the state’s legal institutions and system of social management in the name of specialized knowledge and modern technique. Driven by common objectives, prominent members of these groups decided that professional authority could be strengthened in league with one another, in their joint efforts to introduce medical expertise— and psychiatric in particular—more pervasively throughout state institutions. While the medical conceptualization of social deviance —and the social-administrative implications of this redefinition —generated intellectual, cultural, and political debates in both Russia and Western countries, these debates necessarily took a different cast in the Russian context. In both the United States and Western Europe, forensic psychiatrists engaged in bitter jurisdictional disputes with members of well-established legal professions , within the context of long-standing judicial institutions. In Russia, by contrast, the emergent medical and legal professions— both critical of the autocracy and the state institutions in which they worked—joined forces in their attempts to fundamentally transform the autocratic system and its institutions, based on claims of technical expertise and scientific rationality. Under these shared occupational objectives, which had roots in Peter’s eighteenth-century administrative state, professional iden- tity was associated with the state rather than opposed to or separate from it. However, this close connection between Russian professionals and the state was not altogether anomalous. Rather, it was one variation on the spectrum of European experience. The incorporation of occupational groups in the state was part and parcel of eighteenth-century European models of governance, which Peter I also had borrowed, particularly the notions of rational organizations and administrative tutelage of German cameralism. Centralized states enlisted occupational groups in their administrative apparatus, including the establishment and “policing” of public order and social welfare. Within these general parameters, there was no single or dominant European model. Professional development in Continental Europe was a warp and weft of corporate groups and state regulation. Guild-like bodies evolved along an uneven path, intersected from above by periods of state intervention and regulation (varying in extent and duration). The resulting, overall pattern varied from country to country and was shaped by local political circumstances. Notwithstanding these variations, one can safely say that the state played a large role in the evolution of the European professions, through the process of bureaucratic regulation , state-controlled credentialing and education, de jure monopolies, regulation of fees, bureaucratic disciplining, and public employment.1 What distinguished the imperial Russian case is that it exhibited all of these characteristics, all at once, across the imperial period . Moreover, there were no guilds as starting points. The medical occupation, as a social group, was an eighteenth-century creation of the state, and in turn, the state administration blanketed the entire medical occupation.2 Thus although Russians borrowed their medical-administrative institutions from foreign models, the comparative medical actors are not identical despite nominal similarity . In Germany, the “forensic physician” occupied a distinct occupational service post (separate from other police and therapeutic duties), and therefore formed a subgroup of the medical civil service, and an even smaller subset of the occupation as a whole. In France, any freely practicing physician licensed by the Medicine, Law, and the State in Imperial Russia 268 Conclusion state could be invited to serve the courts, and it was his choice whether to accept or not. In Russia, by contrast, all medical functions (forensic, police, and therapeutic) were combined in one and the same state physician who was legally obliged to perform them all. This arrangement reflected the autocracy’s approach to the social and material realities it faced: the effort to structure and manage society through legal-administrative categories, and a chronic dearth of personnel to administer its vast territory. Consequently , all Russian physicians were, in theory, forensic physicians . As in the rest of Continental Europe, which shared the same tradition of civil law, medical testimony was a mandatory element of legal procedure; however, in Russia alone, forensic-medical practice was diffused throughout the entire medical profession. As a result, forensic practice and issues shaped its outlook in a way that was unique to Russia. In the absence of a tradition of guilds in the...