- Soviet Psychiatry through the Prism of CirculationThe Case of Outpatient Psychiatry in the Interwar Period
The whole mental hygiene movement in Russia has completely revolutionized the concept of psychiatry in the direction of medical, biological, and social hygiene disciplines.—Lev Rozenshtein, First International Congress on Mental Hygiene, 19301
This article examines the transnational dimension of Soviet psychiatry by focusing on outpatient psychiatry. By “outpatient psychiatry,” we mean the policy of care and prevention that took place beyond the walls of psychiatric hospitals and the structures that supported them. This policy was formulated in opposition to the asylum tradition, which had advocated confining patients to help them regain their sanity.2 We use this syntagma less narrowly in reference to the Russian expression to which it corresponds—vnebol´nichnaia psikhiatriia or vnebol´nichnaia psikhiatricheskaia pomoshch´, and more broadly to encompass the various terms most heavily used during the interwar years, [End Page 781] such as “mental hygiene” (psikhogigiena) and “psychiatric assistance” (psikhiatricheskaia pomoshch´). Competing with one another in usage, these terms evolved semantically, as occurred with “psychiatric assistance,” which had by the early 1930s come to designate psychiatric policy in general. In choosing the term “outpatient psychiatry,” we wanted not only to avoid lexicographic difficulties but also to use a fairly neutral expression that allows for establishing equivalency with words that, in languages other than Russian, refer to closely related ideas and similar approaches.
Soon after the revolution, psychiatrists developed outpatient psychiatry with the support of officials at the Commissariat of Health (Narkomzdrav), who prioritized the new approach in the late 1920s, once collectivization and forced industrialization began. Through outpatient psychiatry, psychiatrists sought to reduce overcrowding in hospitals, counter the development of chronic symptoms in patients, and attend to pathologies that lacked acute psychotic symptoms but nonetheless required appropriate care. To what extent and in what ways were Soviet psychiatrists’ initiatives inspired by the ideas of their foreign colleagues? Did outpatient psychiatry, as it was implemented in the Soviet Union, generate interest abroad? How were exchanges carried out in practice? In taking up these questions, our investigation draws on the historiography on circulation of knowledge and practices. As Yves Cohen points out, the study of circulation entails resetting global phenomena in a local context. This literature is concerned with the successive transformations of ideas, practices, and objects and with the potential effects of their movement on the original situation. Cohen emphasizes the necessity of identifying “who” and “what” was being displaced, and of studying the discourses that accompany circulation and borrowings.3 For the USSR, this effort raises, of course, the question of the reflective capacity of the actors involved.
The image of a country that is self-sufficient and inward-looking has been largely overturned by recent historiography examining transnational exchanges. The area of medicine and health in the interwar period has been largely overlooked, however, while forms of cooperation have drawn the most attention. Susan Solomon has edited a book on collaborations between [End Page 782] German and Soviet doctors. Cast out of the international community, Germany and the USSR drew closer with the signing of the Treaty of Rapallo. Doctors took advantage of this alliance, using their prior connections to develop joint projects that allowed these two medical communities each to pursue their own agendas. After the loss of its colonies at the end of the war, Germany was in need of a new terrain for observation and experimentation; the Soviet Union in turn benefited from German skills and intermediaries who helped Soviet scientists publish their work abroad.4 Michael Z. David has studied the Soviet effort to combat tuberculosis, with preventive mechanisms put in place in the early 1920s culminating in the introduction of the vaccine BCG in the late 1930s. The BCG solution would not have been possible without Soviet collaboration with the Pasteur Institute in France, and David has traced that collaboration step by step from the Soviet side.5
This article covers a wide variety of interactions, drawing on a range of sources from various locations, including Russia, Germany, and the United States. In some regards, our study intersects with Benjamin Zajicek’s analysis...