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A Psychiatric Study Tour of the U.S.S.R.^*

New York State University, Downstate Medical Center, Brooklyn, N.Y.

^* From the Department of Psychiatry, New York State University, Downstate Medical Center. This trip was supported by a grant from the National Institute of Mental Health as part of a larger study of Soviet Psychiatry (M-2679).

ABSTRACT

Summary And Conclusions: These travel sketches cannot give a complete or even typical picture of Soviet psychiatry, for the time was too short and the contacts too few for that purpose. These glimpses of scenes and people do, however, contribute to a picture and satisfied the curiosities my earlier study of Russian psychiatry had aroused. How did this reality compare with my earlier picture? On the whole the theory and character of service corresponded to what I tried to depict in my book ten years ago. But there were differences. In spite of the broad and thorough coverage of psychiatric and other health services there was a certain lack of finish and efficiency to the services I could observe. Buildings were often dilapidated and old, treatment wards sometimes seemed crowded, homey and unorganized. Hospital tempo was slow, with manpower lavish and wasted. In spite of theory and research, the treatment methods, like ours, were too often largely empirical. Pavlovian formulae were repeated with stereotyped monotony, and other approaches seemed secondary in comparison. In Leningrad some forward elements were interested in medical psychology and psychodynamics, but in the dispensaries and general hospitals of Kiev or Odessa, minor neuroses and psychosomatic mechanisms seemed to be neglected, and psychotherapy was practically non-existent. Russian psychiatrists know much more about us than we know about them, but in spite of their obvious interest they have only spotty and second-hand information about psychiatric development in the U.S.A. and in the West.

Soviet psychiatry is not all of one piece. I found interesting, at times amusing, and basically healthy evidence of differences in point of view as I moved from place to place. Professor A calls Professor B a "so-called scientist" and thinks Professor C is a great showman. So-and-so thinks electronarcosis is specifically electrophysiological, but—says my informant—it probably works only by producing rhythmic sensations on the skin. Dr. X thinks highly of sleep treatment but Dr. Y says it is over-rated. Pavlov was a great man, but he was wrong in some important matters, says another. In Kiev a newly developed treatment is praised, but in Kharkov they tell me it is a failure.

In spite of what seemed like a strict hierarchical organization there was scope to manoeuvre, and both differences and discontents found expression. Research scientists appear to have comfortable salaries, are anchored and well supported in their research and committed to long careers. There was more separation of research, teaching and clinical service than we usually see in our country, and I had the impression that more research should be done in the clinical settings, and that more clinicians should be doing research. Experimental design tended to be looser than we like, and public health statistics, or large population studies, too infrequent. Much of the research could be described as attempts at detailed description and analysis of phenomena. I was troubled to see distinguished scientists, heads of institutions, bothered with the necessity of writing their own correspondence or making appointments and handling minor chores because, with some exceptions, they have no secretaries. Psychiatric research is too uniformly Pavlovian. Even granting its basic importance it is not always necessary nor desirable to build up knowledge from a base of conditioning studies. One would welcome more approaches from other directions; population and epidemiological studies, more large-scale and systematic therapeutic undertakings, more follow-up and clinical studies, or EEG, endocrine, pathological, anatomical, genetic, chemical, and other approaches.

But there were strongly positive impressions too. The hospital atmosphere always reflected kindness, humanity and an orientation to the needs of patients. The patients—children and adults alike—looked secure in the hospital setting and I did not see any of the forlorn neglected creatures so often found in our own public hospitals. For all its monotony, Soviet psychiatrists had a point of view, probably a correct one, and it permeated their thinking. Their neurophysiological research was on a technically high level, scientifically sophisticated, and likely sooner or later to produce big results. Many of their most talented youths were given splendid opportunities for life-time research careers. Their science, moreover, is advancing very rapidly in pace with their general economic advance. In comparison with their recent past their present accomplishments should give them every reason to feel proud. I think the finish and refinements will come soon, but already Comrade Ivanov of Moscow fares quite well as a psychiatric case, even by our standards.

Certainly there is everything to be gained from further contact and exchange: the inevitable rivalry that is developing between us is all to the good, for this is a contest where there are no losers.