TCS Daily


Freeing the Soviet Mind

By Irwin Savodnik - August 9, 2004 12:00 AM

MOSCOW -- Psychiatry, sometimes thought to be a mirror of society, has undergone a dramatic transformation in the former Soviet Union that offers an ironic vision of ourselves. From the austere view of man as a Pavlovian organism, the new Russian psychiatrists are reading Freud with a vengeance and retaliating against what one psychiatrist called the "attack on the mind" that the Soviets sustained throughout their tenure.

Psychiatrists here and elsewhere in the former Soviet Union provided nearly univocal views of the changes that have transpired in their profession since 1992. They varied in age, background and ethnicity but they all felt strongly that the decline of the Soviet system was the best thing that had happened to them. Briefly, they were no longer bound by an ideological straight jacket that prevented them from inquiring into the basis of various psychiatric conditions. They were able to buy psychoanalytic books, learn psychoanalysis and other forms of psychotherapy and view their patients as free agents.

The old Soviet psychiatry subscribed to a harsh biological determinism. The psychiatric physician was an absolute authority while the patient's words mattered little more than raindrops at sea. That the patient might have something to add to the doctor's assessment of him made little sense since the origin of his difficulties was thought to be a disordered biology that had to be set right. The idea of a person was quaint but irrelevant.

Part of Soviet psychiatry involved the well-known use of psychiatry as an instrument for political ends. Indeed, there were few other ends in the system. The brothers Zhores and Roy Medvedev offer a shocking, though typical, picture of what things were like in the Stalinist era. In the Soviet scheme of things, political dissent was interpreted as a psychiatric disorder, a difficulty in reality testing, which justified confinement in a mental hospital. Such niceties as due process, length of stay and an appeals process meant nothing. In a state where individual freedom was a bourgeois myth, there was no need to respect basic human rights.

Treatment modalities included medications, electroconvulsive therapy, insulin coma therapy and various other so-called "somatic treatments." These aversive procedures were thought effective against political heresy. I suspect they were. For a psychiatrist to engage in Freud 's "talking cure" during the Soviet period would have been a criminal act. The reason: such a treatment presumed the patient was free to make his or her own decisions.

Today in Russia, there are patient protections against involuntary psychiatric hospitalization similar to those in the United States. While some may argue that unwilling confinement is always wrong, such hard-core legislation recognizes the freedom of the individual, which represents a radical change from the pre-Gorbachev era.

The movement from a narrow-minded, highly politicized, biological view of human nature to what we might call a libertarian one says a great deal about the way Russian life has changed. While many people I spoke with were reticent to declare that a revolution -- at least in thought -- had occurred, none regarded this liberalizing process as routine.

The great irony is that American psychiatry is moving in exactly the opposite direction. For the better part of the 20th century, psychiatry was dominated by psychoanalysis, so much so that in the public eye the two were nearly synonymous. Five-day-a-week-on-the-couch treatment was de rigueur. Psychoanalysts authored most of the prominent textbooks in the field. Gradually, though, psychoanalysis, under attack from some sectors of the intellectual community, perceived as too expensive and unscientific, began to lose its grip on the psychiatric community. Just as political science, history and sociology have strived to emulate the scientific methods of physicists, so too did psychiatry decide to embrace a mainstream biological approach to its subject matter. In the past 30 years, the overriding ideology of American psychiatry has shifted to a biological model. Psychopharmacology has become its therapeutic backbone.

The problem, however, is that this model doesn't tolerate free agency. It views psychiatric problems -- moral problems, really -- as medical ones, just as Soviet psychiatry did. It has become more prominent in the courts as the hefty influence of medical diagnoses has replaced the literary-like "assessments" of psychoanalysts. Always, the emphasis is on relieving the individual of moral responsibility. Interpersonal problems, family conflicts, sexual malaise, even shyness, have become medical problems.

So, as the Soviet system came undone and its psychiatrists freed themselves from the confines of a strangulating ideology, American psychiatrists have embraced uncritically the same narrow vision. But as the Soviet example demonstrates with distressing clarity, a conception of people as little more than biochemical bundles fails to address those aspects of ourselves that make us human -- the moral and esthetic dimensions of our lives about which chemical equations have little to say.

To be sure, the United States is nothing like the Soviet Union. Nor are we in danger of descending into such darkness. Psychiatry, though, is a leading indicator, a barometer of social practice and political change.

The Soviet example places in bold relief the deficiencies and fallacies of a truncated view of human life, one without freedom, without a soul. The metamorphosis of American psychiatry portends the danger of a loss of freedom as we relinquish a sense of ourselves as moral beings. We can't tolerate such a loss and the lesson of Soviet psychiatry is that we shouldn't.

Irwin Savodnik is a psychiatrist and philosopher who teaches at UCLA. He has recently completed a book on the nature of consciousness and has written widely on philosophy, psychiatry and politics. His articles have appeared in the Baltimore Sun, the Chicago Tribune, The Jerusalem Post, TCS and other publications.


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