Writing about Their Science: American Interest in Soviet Psychiatry during the Post-Stalin Cold War

WRITING ABOUT THEIR SCIENCE: AMERICAN INTEREST IN SOVIET PSYCHIATRY DURING THE POST- STALIN COLD WAR GARY S. BELKIN" In May 1953, three months after Stalin's death, the lead article in the New EnglandJournal ofMedicinewas a paper by a graduate student in sociology , Mark Field, entitled: "Some Problems of Soviet Medical Practice: A Sociological Approach." The paper portrayed Soviet physician certification ofworker disability and illness as a social mechanism to ease the difficulties oflife, "one of the many 'adjustive mechanisms' that keep the social organism going by limiting discontent and hence disaffection" [1, p.925]. That physicians were looking for insights into the social functions of medical practice and saw in Soviet experience an appropriate field upon which to take their investigations begs historical interest. What drew American physicians to the Soviet Union? In fact, Soviet practices were the object of intense interest by American psychiatrists, which—given disclosure about the use of psychiatry to discredit and institutionalize dissidents—raises questions as to how this interest flourished. While widespread awareness of uses of psychiatry with dissidents did not occur until the 1970s, tracking published work in American clinical psychiatric researchjournals before, through, and beyond such disclosures is enormously revealing, showing how debates about the shape of psychiatric knowledge can frame and restrict investigation of broader political and ethical questions. Those who wrote and published on Soviet practices did so to address specific problems and concerns about psychiatry at home, even during the height of condemnation and scrutiny of these The author wishes to thank Loren Graham and the anonymous reviewers for their insights and constructive criticism on prior versions of this paper. An earlier version of this paper was also presented at Cheiron XXVII International Society for the History ofBehavioral and Social Sciences, Bowdoin College, 24June 1995, and benefited from the comments of that audience. "¦Department ofPsychiatry, Harvard Medical School and Department ofPsychiatry, Harvard Medical School and Massachusetts General Hospital, Erich Lindeman Mental Health Center, 25 Staniford St., Boston, MA 02114.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4203-1095$01.00 Perspectives in Biology and Medicine, 43, 1 ¦ Autumn 1999 31 practices. The nature of approval or disapproval of the Soviet system was regularly grounded in these more immediate clinical concerns of the author . While not speaking for the profession as a whole, the clinical research literature is, nonetheless, a central arbiter ofwhat the profession communicates and confirms regarding its knowledge and purpose. This literature is a necessary place to begin to study how psychiatry made sense of the meanings and uses of its work. 1955-1970: Soviet Psychiatry Through the Eyes of Social Optimism Investigations ofRussian psychiatric practices were intimately tied to waxing and waning cycles of enthusiasm for social theories of behavior and for sociological investigations of the nature of illness and medical practice. From 1955 to 1970, Russia primarily served as a resource for exploring these social attributions and justifying optimism about the ability of scientifically grounded interventions acting via social institutions to change human behavior, prevent violence, and reduce suffering. Almost 10 years after his NewEnglandJournalpaper, Field published a study on "The Institutional Framework of Soviet Psychiatry'' [2] . He described psychiatry in Mertonian and Parsonian sociological terms, as a system consisting of and responding to social roles and needs. Because mental illness posed a "functional threat": every society and culture tends to generate patterned responses and specialized roles to deal with the manifestations of this illness, both in interpreting it (i.e. giving it some "meaning") and devising ways and means to cope with it. These patterns may be said to constitute the society's psychiatric system . . . Seen in a sociological perspective, the psychiatric system (as well as the medical system ofwhich it is partly a component) can be considered an element of the "maintenance mechanisms" of the society. [2, p.305] What Field and others accomplished as a consequence of their commitment to social theories ofculture, psychology, and change, was to neutralize Soviet foreignness. The Soviets emphasized social needs and goals, while American psychiatric culture focused on individual happiness and lifestyle. Soviet psychiatric institutions and practices could simply reflect differences in relative emphasis—not necessarily fundamental differences. What united...