page 1page 2page 3page 4page 5page 6page 7page 8page 9page 10page 11page 12page 13page 14page 15page 16page 17page 18page 19page 20page 21page 22page 23page 24page 25page 26page 27page 28page 29page 30page 31page 32page 33page 34page 35page 36page 37page 38page 39page 40page 41page 42page 43page 44page 45page 46page 47page 48page 49page 50page 51page 52page 53page 54page 55page 56page 57page 58page 59FINAL REPORT TONATIONAL COUNCIL FOR SOVIET AND EAST EUROPEAN RESEARCHTITLE:Soviet Psychiatry:TheHistorical and Cultural ContextAUTHOR:Martin A. MillerCONTRACTOR:Duke UniversityPRINCIPAL INVESTIGATOR:MartinA.MillerCOUNCIL CONTRACT NUMBER:626-9DATE:May, 1986The work leading to this report was supported by funds providedby the National Council for Soviet and East European Research.EXECUTIVE SUMMARYMadness under communism is an indisputable fact. What isunclear is the extent of its presence in the Soviet Union.Official Soviet publications report that about 2% of the generalpopulation suffers from severe mental disorders, a rate comparableto that for the United States. Some practitioners of Sovietpsychiatry who have made their way to the West believe that theincidence is at the higher rate of approximately 5% of thepopulation.If the higher figure for the USSR is correct, andrising according to some emigre psychiatrists and psychologists,there are millions less people who are capable of functioningeffectively in the military and in the workplace than we haveassumed, and the cost of maintaining such a large dependentpopulation is substantial enough to affect the national economy.The Soviet Union, despite marked advances in psychiatricservices in recent decades, is not equipped to deal with thepersonal and psychological problems which the system continuallygenerates. Schizophrenia and alcoholism figure prominently inSoviet studies of ills that plague their society. Other problemssuch as drug abuse, domestic violence, delinquency, crime andsexual problems as manifestations of mental illness are rarelysubjects of serious psychiatric study in a society which continuesto downplay or deny their presence in a communist order.This report is a study of mental illness in the Soviet Unionand of the psychiatric profession which treats it. The sourcesavailable for such a study consist of published Soviet psychiatricliterature in the form of textbooks, histories of Sovietpsychiatry, and clinical articles in the professional journal ofSoviet psychiatry:The Korsakov Journal of Neuropathology andPsychiatry(Zhurnal neuropatologii ipsikhiatrii im. Korsakova);the data which exist in published form, however problematical1;and interviews with emigre Soviet psychiatrists.On the basis of these materials, I introduce the major formsof mental illness in the Soviet Union and discuss their culturaldeterminants. I then describe the Soviet profession of psychiatryas it has developed to deal with psychosis under communism.Ialso include a section on the practice of forensic psychiatry forhandling non-conformists and dissidents, and conclude withasummary of the findings of this study. There are two appendices.The first provides a historical sketch of psychotherapy inRussian and Soviet history. The second addresses the problemsthat arise in a study of this type and explains my effort toproduce an objective and informative study. Three articles havegrown out of this research and have appeared in journals ofpsychiatry and Slavic studies.21See Appendix A of this report for a discussion of thedifficulties that arise when using Soviet data on psychiatric disorders.2Martin A. Miller, "The Theory and Practice of Psychiatry inthe Soviet Union,"Psychiatry,Vol. 48, February 1985, pp. 13-24;Miller, "The Origins and Development of Russian Psychoanalysis,1909-1930,"Journal of The American Academy of Psychoanalysis,Vol.14,No. l, 1986, pp. 125-135; Miller, "Freudian Theory UnderBolshevik Rule: The Theoretical Controversy During the 1920s,"Slavic Review,Winter1985, pp. 625-646.iiCommunism as a political, economic and socio-cultural systemis responsible for the context and the content of many instancesof individual stress. In addition to the stress of individualismin a militantly collectivist society, the stress of economichardship, deprivation and, to some extent, poverty, exertsaprofoundly negative psychological influence over the population ofthe Soviet Union. These dimensions of stress feed into the dailylife of ordinary Soviet citizens at all levels, from childhood toold age, from family to workplace. One evident sign of the extentto which mental problems disrupt the functioning of the Sovieteconomy and society is the recent innovation of the so-called"mood phone" which has been installed in selected factories acrossthe country. Workers who are dysfunctional on the job may eitheruse the phone themselves or have a call placed for them byamanager or colleague to connect with a team of psychiatrists inMoscow. The existence of this system points to serious personaldifficulties on the assembly lines and an urgent need to deal withthem.Mental illness poses a theoretical problem for Sovietideology. In most areas of human knowledge, reference is made tothe work of Marx, Engels or Lenin in order to establishafoundation for the legitimacy of the problems under study. Thiscannot be done for mental illness, because there isnothingin thewritings of the founding theories of communism which deals withthe subject. The problem, therefore, is how to explain theiiipersistence of psychopathology in a society that is allegedlymoving forward to transcend the class dilemmas of capitalismwhich are, according to the theory, responsible for the misery oflife in the non-socialist world. If the building of communism isa reality based on new and more humane principles, why then isthere a high incidence of social problems related to alcoholismand rates of mental illness which are at levels similar to thosereported in Western capitalist countries?Beneath the silence on the theoretical issue of madness undercommunism in the absence of Marxist-Leninist ideological guidance,there remains a vast sector of Soviet society which continues tosuffer the unhappiness, pain and stigma of severe mentaldisorders, a sector which may actually be increasing at present.The two most frequently diagnosed mental disorders in the SovietUnion are schizophrenia and alcoholic psychosis. In addition,from interviews with emigre psychiatrists, it is clear thatdomestic