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The Psychopharmacological Revolution in the USSR: Schizophrenia Treatment and the Thaw in Soviet Psychiatry, 1954–64

  • Benjamin Zajicek (a1)

Abstract

Twentieth-century psychiatry was transformed in the 1950s and 1960s by the introduction of powerful psychopharmaceuticals, particularly Chlorpromazine (Thorazine). This paper examines the reception of Chlorpromazine in the Soviet Union and its effect on the Soviet practice of psychiatry. The drug, known in the USSR by the name Aminazine, was first used in Moscow in 1954 and was officially approved in 1955. I argue that Soviet psychiatrists initially embraced it because Aminazine enabled them to successfully challenge the Stalin-era dogma in their field (Ivan Pavlov’s ‘theory of higher nervous activity’). Unlike in the West, however, the new psychopharmaceuticals did not lead to deinstitutionalisation. I argue that the new drugs did not disrupt the existing Soviet system because, unlike the system in the West, the Soviets were already dedicated, at least in theory, to a model which paired psychiatric hospitals with community-based ‘neuropsychiatric dispensaries.’ Chlorpromazine gave this system a new lease on life, encouraging Soviet psychiatrists to more rapidly move patients from in-patient treatment to ‘supporting’ treatment in the community.

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Corresponding author

*Email address for correspondence: bzajicek@towson.edu

Footnotes

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This article is based on research conducted with the support of a US Department of Education Fulbright–Hays Doctoral Dissertation Research Abroad Fellowship, with additional funds provided by the Towson University Academy of Scholars. An earlier version was presented at the conference Continuity and Change in Russian Therapy, held at St Antony’s College, University of Oxford, 5–6 June 2014. The author would like to thank Fran Bernstein, Chris Burton, Daniel Todes and the anonymous referees for their helpful comments.

Footnotes

References

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1. A.V. Snezhnevskii, ‘Psikhofarmakologicheskie sredstva’, in Klinicheskaia psikhiatriia (Izbrannye trudy) (Moscow: Meditsina, 2004), 93. [Original publication: Klinicheskaia meditsina, 10 (1961), 126–34].

2. Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley, 1997), 279–81; Andrew Scull, Madness: A Very Short Introduction (Oxford: Oxford University Press, 2011), 102–21.

3. Anne E. Caldwell, Origins of Psychopharmacology from CPZ to LSD (Springfield, IL: Thomas, 1970); Judith Swazey, Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation (Cambridge, MA: Harvard University Press, 1974); David Healy, The Creation of Psychopharmacology (Cambridge, MA: Harvard University Press, 2002); Joanna Moncrieff, The Bitterest of Pills: The Troubling Story of Antipsychotic Drugs (Houndmills: Palgrave, 2013); Nicolas Henckes, ‘Magic bullet in the head? Psychiatric revolutions and their aftermath’, in Jeremy A. Greene, Flurin Condrau and Elizabeth Siegel Watkins (eds), Therapeutic Revolutions: Pharmaceuticals and Social Change in the Twentieth Century (Chicago: University of Chicago Press, 2016), 65–96.

4. Henckes, Nicolas, ‘Reforming Psychiatric Institutions in the Mid-Twentieth Century: A Framework for Analysis’, History of Psychiatry, 22, 2 (2011), 165.

5. Field, Mark G. and Aronson, Jason, ‘The Institutional Framework of Soviet Psychiatry’, Journal of Nervous and Mental Disease, 138, 4 (1964), 305322.

6. ‘Godovoi otchet MZ o seti, deiatel’nosti i kadrakh meditsinskikh uchrezhdenii SSSR’ [1954], Rossiiskii gosudarstvennyi arkhiv ekonomiki[hereafter RGAE], f. 1562, op. 27, d. 48.

7. Philip Hanson, The Rise and Fall of the Soviet Economy: An Economic History of the USSR, 1945–91 (London and New York: Routledge, 2014); Donald Filtzer, The Hazards of Urban Life in Late Stalinist Russia: Health, Hygiene, and Living Standards, 1943–53 (Cambridge: Cambridge University Press, 2010), 346–52; Mary Schaeffer Conroy, ‘The Soviet Pharmaceutical Industry and Dispensing, 1945–1953’, Europe–Asia Studies, 56, 7 (November 2004), 964–67.

8. Volker Hess, ‘Beyond the therapeutic revolution: psychopharmaceuticals crossing the Berlin Wall’, in Mat Savelli and Sarah Marks (eds), Psychiatry in Communist Europe (Palgrave, 2015), 153–79.

9. The term ‘the Thaw’ came from the title of a 1954 novel by Ilya Eherenburg. See Denis Kozlov and Eleonory Gilburd (eds), The Thaw: Soviet Society and Culture during the 1950s and 1960s (Toronto: University of Toronto Press, 2013).

10. Mark B. Adams, ‘Networks in action: the Khrushchev era, the Cold War, and the transformation of Soviet science’, in Garland Allen and Roy MacLeod (eds), Science, History and Social Activism, Boston Studies in the Philosophy of Science (Springer Netherlands, 2001), 257. On de-Stalinisation, see Polly Jones, ‘Introduction: the dilemmas of de-Stalinization’, in Polly Jones (ed.), The Dilemmas of De-Stalinization: Negotiating Cultural and Social Change in the Khrushchev Era (London: Routledge, 2006), 1–18.

11. Julie Vail Brown, ‘Heroes and non-heroes: recurring themes in the historiography of Russian-Soviet psychiatry’, in Mark S. Micale and Roy Porter (eds), Discovering the History of Psychiatry (New York: Oxford University Press, 1994), 297–307; David Joravsky, Russian Psychology: A Critical History (Oxford: Basil Blackwell, 1989); Martin A. Miller, Freud and the Bolsheviks: Psychoanalysis in Imperial Russia and the Soviet Union (New Haven, CT: Yale University Press, 1998); Irina Sirotkina, Diagnosing Literary Genius: A Cultural History of Psychiatry in Russia, 1880–1930 (Baltimore, MD and London: Johns Hopkins University Press, 2002).

12. Aleksandr Podrabinek, Karatel’naia meditsina (New York: Izd. ‘Khronika’, 1979), 83–94; Vladimir Bukovskii, ‘Psikhiatricheskii GULAG’, in Moskovskii protsess (Paris and Moscow: Russkaia mysl’, 1996), 144–61; Dan Healey, ‘Russian and Soviet Forensic Psychiatry: Troubled and Troubling’, International Journal of Law and Psychiatry, 37 (2014), 71–81.

13. On the view ‘from below’, see Benoit Majerus, ‘Making Sense of the “Chemical Revolution”: Patients’ Voices on the Introduction of Neuroleptics in the 1950s’, Medical History, 60, 1 (2015), 54–66 and Viola Balz, ‘Terra Incognita: An Historiographic Approach to the First Chlorpromazine Trials Using Patients Records of the Psychiatric University Clinic in Heidelberg’, History of Psychiatry, 22, 2 (2011), 182–200.

14. Healy, op. cit. (note 3), 85.

15. Edward Shorter, A Historical Dictionary of Psychiatry (Oxford: Oxford University Press, 2005), 53–6.

16. Aminazine was first synthesised in the USSR by researchers M.N. Shchukina and N.V. Savitskaia at the All-Union Chemical-Pharmacological Scientific Research Institute. M.D. Mashkovskii, S.S. Liberman and A.I. Polezhaeva, ‘K farmakologii aminazina’, Farmakologiia i toksikologiia, 18, 1 (1955), 14–22; T. A. Nevzorova, Aminazin v klinicheskoi i ambulatornoi praktike (Moscow: Medgiz, 1961), 6.

17. G.K. Tarasov, ‘Rezul’taty klinicheskogo issledovaniia deistviia aminazina pri lechenii psikhicheski bol’nykh’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 56, 2 (1956), 146–54.

18. M.Ia. Sereiskii et al., ‘Lechenie bol’nykh shizofreniei aminazinom’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 56, 2 (1956), 155.

19. O.V. Kerbikov’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 65, 6 (1965), 955–6.

20. ‘Zasedania Prezidiuma US MZ SSSR’, 3 May 1955, Gosudarstvennyi arkhiv Rossiiskoi Federatsii[hereafter GARF], f. r-8009, op. 2, d. 2154, ll. 17–18.

21. ‘Klinicheskaia konferentsiia sotrudnikov bolnitsyim im. Gannushkina, kafedra psikhiatrii TsIU, Gos. Institute psikhiatrii, i sotrudnikov 3 p-nev dispansarov’, 27 October 1955, Tsentral’nyi arkhiv goroda Moskvy[hereafter TsAGM], f. 533, op. 1, d. 27, ll. 49ob–52ob.

22. Tarasov, op. cit. (note 17), 152.

23. Ibid., 154.

24. ‘Klinicheskaia konferentsiia…’, op. cit. (note 21), l. 52.

25. Ibid., ll. 48ob.

26. Ibid., l. 51ob.

27. Ibid., l. 52.

28. Galenko, V.E., Osberg, I. Iu. and Azbukina, V.D., ‘Aminazin v psikhiatricheskoi klinike’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 56, 2 (1956), 162.

29. Tarasov, op. cit. (note 17), 146.

30. L.L. Rokhlin, M.V. Peskova, and Z.P. Bakhar, ‘Opyt lecheniia aminazinom bol’nykh shizofreniei’, in L.L. Rokhlin, et al. (eds), Aktual’nye problemy nevropatologii i psikhiatrii (Kuibyshev: MZ RSFSR, 1957), 363.

31. Filtzer, op. cit. (note 7), 342–53.

32. ‘Stenogramma zasedanii Kollegii MZ SSSR’, 11 February 1949, GARF, f. r-8009, op. 1, d. 757, l. 119.

33. Letter to the editor of Pravda, 26 October 1954, GARF, f. r-8009, op. 33, d. 648-ts, ll. 93–5, 100–2.

34. Nevzorova, op. cit. (note 16), 113.

35. T.L. Taranenko, ’Vidoizmenenie sposoba vnutrimyshechnogo vvedeniia aminazina i ukhod za bol’nymi vo vremia lecheniia etim preparatom’, Meditsinskaia sestra, 6 (1958), 32.

36. ‘Instruktsiia po lecheniiu aminazinom psikhicheski bol’nykh’, 1959, GARF, f. r-8009, op. 1, d. 1371b, ll. 26–7, 55–7; Nevzorova, op. cit. (note 16), 25.

37. Galenko et al., op. cit. (note 28), 156. Soviet psychiatrists summarised and publicised international findings about the side effects and complications of Chlorpromazine treatment in 1958. G.K. Tarasov, ‘O neirolepticheskom sindrome’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 58, 2 (1958), 234–7.

38. Rokhlin, Peskova and Bakhar, op. cit. (note 30), 363.

39. T. A. Nevzorova, ‘Sravnitel’naia terapevticheskaia effektivnost’ insulina i aminazina pri lechenii bol’nykh shizofreniei’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 2 (1959), 161.

40. ‘Obzor deiatel’nosti psikhonevrologichesikh bol’nits RSFSR za 1960 god’, GARF, f. a-482, op. 50, d. 5188, l. 55.

41. ‘Otchet o rabote komitetov i komissii pri UMS MZ SSSR’, 10 February 1956, GARF, f. r-8009, op. 2, d. 2479, l. 14.

42. ‘Godovoi meditsinskii otchet bol’nitsy [Kashchenko] za 1956 god’, TsAGM, f. 4-389, op. 1, d. 94, ll. 11–12.

43. Nevzorova, op. cit. (note 39), 161, 165.

44. ‘Obzor deiatel’nosti’, op. cit. (note 40), l. 59.

45. Ibid., l. 51.

46. Hanson, op. cit. (note 7); Filtzer, op. cit. (note 7), 346–52; Conroy, op. cit. (note 7), 964–7.

47. ‘Reshenie kollegii MZ SSSR’, 11 February 1949, GARF, f. r-8009, op. 1, d. 757, l. 25.

48. ‘Otchet o rabote otdela po razdachu psikhonevrologicheskoi pomoshchi za 1957 god’, GARF, f. a-482, op. 50, d. 3570, ll. 46–7.

49. ‘Spisok medikamentov, vydelennykh na 1960 god v nedostatochnykh kolichestvakh’, GARF, f. a-482, op. 50, d. 4984, l. 75.

50. ‘Prilozhenie no. 1 k prikazu MZ SSSR 170’, 12 March 1966, GARF, f. r-8009, op. 1, d. 1511, ll. 7–9.

51. E.P. Egorovskaia (Zam. nachal’nika otdela spets. pomoshchi MZ RSFSR) to Z.G. Gurevich (Gl. Aptechnoe Upr.), 22 August 1956, GARF, f. a-482, op. 50, d. 1325, l. 88–90.

52. ‘Prikaz #153 po psikhonev. Gorodskoi bol’nitse #3 im. Giliarovskogo’, 11 June 1956, TsAGM, f. 1126, op. 1, d. 95, l. 21; ‘Prikaz 324 po psikhonev. gorodskoi bol’nitse #4 im. Gannushkina’, 18 July 1962, TsAGM, f. 533, op. 1, d. 55, ll. 67-67ob.

53. Lavrishchev (Zam. nach. Gl. lechebno-prof. upravl. MZ RSFSR) to MZ ASSR, Zaved. obl. krai. Gorzdravotdelami Respub., kraevym, oblastnym, gorodskim psikhiatram, Glavnym vracham psikhonev. bol’nits i dispanserov, 1 May 1958, GARF, f. a-482, op. 50, d. 3568, l. 101.

54. ‘Ob’iasnitel’naia zapiska k godovomu stat. otchetu psikho-nev. dispansera Leningradskogo Raiona za 1964 god’, undated [1964], TsAGM, f. r-551, op. 1, d. 1547, ll. 38–9.

55. Benjamin Zajicek, ‘Soviet Madness: Nervousness, Mild Schizophrenia, and the Professional Jurisdiction of Psychiatry in the USSR, 1918–36’, Ab Imperio, 4 (2014), 167–94; Benjamin Zajicek, ‘A Soviet system of professions: psychiatry, professional jurisdiction, and the Soviet Academy of Medical Sciences, 1932–51’, in Susan Grant (ed.), Russian and Soviet Health Care from an International Perspective: Comparing Professions, Practice and Gender, 1880–60 (Palgrave Macmillan, 2017), 97–117.

56. Daniel P. Todes, Ivan Pavlov: A Russian Life in Science (Oxford: Oxford University Press, 2014), 287–302; Roger Smith, Inhibition: History and Meaning in the Sciences of Mind and Brain (Berkeley, CA: University of California Press, 1992), 200–5; Joravsky, op. cit. (note 11), 295.

57. Ethan M. Pollock, Stalin and the Soviet Science Wars (Princeton, NJ: Princeton University Press, 2006), chapter 6 passim; Nikolai Krementsov, Stalinist Science (Princeton, NJ: Princeton University Press, 1997), 272–5; Joravsky, op. cit. (note 11), chapter 14 passim.

58. George Windholz, ‘Soviet Psychiatrists under Stalinist Duress: The Design for a “New Soviet Psychiatry” and Its Demise’, History of Psychiatry, 10, 3 (1999), 329–47; Benjamin Zajicek, ‘Banning the Soviet Lobotomy: Psychiatry, Ethics, and Professional Politics during Late Stalinism’, Bulletin of the History of Medicine, 91, 1 (2017), 33–61.

59. Joravsky, op. cit. (note 11), 425–226.

60. Robert van Voren, Cold War in Psychiatry: Human Factors, Secret Actors (Amsterdam and New York: Rodopi, 2010).

61. ‘Stenogramma zasedaniia Prezidiuma US MZ SSSR’, 18 December 1953, GARF,f. r-8009, op. 2, d. 1925, ll. 22–7.

62. Todes, op. cit. (note 56), 632, 647–8.

63. ‘Sistematicheskii ukazatel’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 53, 12 (1953), 965.

64. E. Sh. Airapet’liats et al. (eds), Nauchnaia sessiia posviashchennaia problemam fiziologicheskogo ucheniia akademika I.P. Pavlova, 28 iiunia – 4 iiulia 1950 g.: Stenograficheskii otchet (Moscow: Izd. Akademii Nauk SSSR, 1950), 59.

65. ‘Stenogramma…’, op. cit. (note 61), l. 33.

66. ‘Otchet Komissii po oblsedovaniiu zhurnala “Nevropatologii i psikhiatrii im. Korsakova”’, 15 December 1953, GARF, f. r-8009, op. 2, d. 1925, ll. 43–6.

67. N. Chetverikov, ‘Nekotorye zamechaniia o rabote Zhurnala nev. i psikh im. Korsakova’, 12 December 1953, GARF, f. r-8009, op. 2, d. 1925, l. 56.

68. ‘Stenogramma…’, op. cit. (note 61), ll. 24–5.

69. Ibid., ll. 26–8.

70. Ibid., ll. 29–34.

71. Iu. E. Segal’, ‘K neirodinamike sosudistykh refleksov pri galliutsinnatorno-paranoidnoi forme shizofrenii. Soobshchenie I’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 53, 3 (1953), 182–90; D.A. Kaufman, ’K voprosu o patofiziologii shizofrenicheskogo defekta’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 53, 4 (1953), 259–66.

72. Tarasov, G.K., ‘Aminazin (Obzor literatury po primeneniiu v psikhiatrii odnogo iz proizvodnykh fenotiazina)”’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 55, 4 (1955), 296310.

73. Ibid., 308.

74. E. Ia. Skuin’, ‘K voprosu o prirode biokhimicheskikh sdvigov pri terapii shizofrenii’, in V.M. Banshchikov et al. (eds), Trudy Vsesoiuznoi nauchno-prakticheskoi konferentsii posviashchennoi 100-letiiu so dnia rozhdeniia S.S. Korsakova i aktual’nym voprosam psikhiatrii (Moscow: Medgiz, 1955), 356–8.

75. N.N. Timofeev, ‘O psikhofarmakologii i ee otnoshenii k drugim metodam terapii psikhozov’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 58, 2 (1958), 129–37: 129.

76. ‘Stenogramma zasedaniia Plenuma pravleniia vsesiouznogo obshchestva nevropatologov i psikhiatrov’, GARF, f. r-9592, op. 1, d. 39, l. 3.

77. Ibid., l. 12.

78. Ibid., ll. 6, 11.

79. B.S. Bamdas et al., ‘Materialy k mekhanizmu deistviia aminazina’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 56, 2 (1956), 132–6; K.V. Stroikova, ‘O lokalizatsii deistviia aminazina u bol’nykh shizofreniei’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 9 (1959), 402–9.

80. L. I. Lando, ’Elektroforeticheskoe issledovanie belkovykh fraktsii syvorotki krovi bol’nykh shizofreniei i ikh dinamiki pod vlianiem lecheniia neirolepticheskimi veshchestvami’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 2 (1959), 135–42; N.N. Lapteva, ‘K mekhanizmu vliianiia aminazina na belkovyi sostav plazmy krovi’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 2 (1959), 143–50; T.E. Romel’, ‘Pronitsaemost’ gemato-entsefalicheskogo bar’era i ee izmenenie pod vlianiem aminazinoterapii u bol’nykh shizofreniei’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 2 (1959), 151–5.

81. Healy, op. cit. (note 3), 107.

82. V.M. Banshchikov and G.V. Stoliarov, ’Eksperimental’nye psikhozy: Dietilamid lizerginovoi kisloty v psikhiatrii (Obzor zarubezhnoi literatury)’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 59, 2 (1959), 222–32.

83. M. Kislov (Nach. Gl. Aptechnogo upr. MZ RSFSR) to Safonov A.G. (Nach. Gl. Lech-prof. Upr. MZ RSFSR), 18 September 1956, GARF, f. a-482, op. 50, d. 1325, ll. 83–5; ‘Stenogramma zasedaniia Preiziduma UMS MZ SSSR’, 26 February 1957, GARF, f. r-8009, op. 2, d. 2314, l. 46. David Healy notes that in Western scientific literature reserpine was mentioned much more than Chlorpromazine, and it was crucial for testing theories about serotonin and dopamine. This Western research was reported in the Soviet Union, but Soviet authors themselves published very little reserpine research, perhaps because they had difficulty getting access to it. Healy, op. cit. (note 3), 106; V.M. Morozov, ‘Novoe v terapii psikhicheskikh zabolevanii’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 56, 7 (1956), 591–9.

84. Tarasov, ‘Rezul’taty klinicheskogo issledovaniia novykh lekarstvennykh sredstv, provedennogo v institute psikhiatrii MZ RSFSR v 1958–60 godakh’, in Sovremennye metody lecheniia psikhicheskikh zabolevanii: Metodicheskie materialy v pomoshch’ prakticheskomu vrachu, L.L. Rokhlin and G.K. Tarasov (eds) (Moscow: MZ RSFSR, 1961), 5–14.

85. I.G. Ravkin and M.S. Zeleva, Polozhenie o klinicheskoi proverke novykh lekarstvennykh sredstv v usloviiakh psikhonevrologicheskogo statsionara’, in L.L. Rokhlin and G.K. Tarasov (eds), Sovremennye metody lecheniia psikhicheskikh zabolevanii: Metodicheskie materialy v pomoshch’ prakticheskomu vrachu (Moscow: MZ RSFSR, 1961), 56–8.

86. A set of clinical trial records can be found in TsAGM, f. 533, op. 1, d. 156. See, for instance, ‘Rezul’taty klinicheskogo ispytaniia meprotan (andaksin) na baze kafedry psikhiatrii TsIU i klinicheskoi psikhonevrologicheskoi b-tsy #4 im. Gannushkine’, TsAGM, f. 533, op. 1, d. 156, ll. 1–4.

87. Tarasov, op. cit. (note 84), 11–12. On America’s ’popular frenzy for Miltown, see Shorter, op. cit. (note 2), 315–6.

88. These drugs included Aminazine, Haloperidol, Imizin (Melipramin), Meprotan (Meprobomat), Mazheptil (Thioproperazine), Tisercin (Levomepromazine), Transamin (Tranexamic Acid), Triftazin (Trifluoperazine), Etaperazin (Perphenazine) and Elenium (Librium). B. Petrovskii, ’Perechen’ vazhneishikh meditsinskikh preparatov, kotorymi neobkhodoimo obespechit’ uchrezdheniia zdravookhraneniia v dostatochnykh kolichestvakh pervoocheredno’, 26 January 1966, GARF, f. r-8009, op. 1, d. 1511, l. 10.

89. A.V. Snezhnevskii, ‘Psikhopatologiia’, in Klinicheskaia psikhiatriia (Izbrannye trudy) (Moscow: Meditsina, 2004), 102. [Original publication: Bol’shaia meditsinskaia entsiklopediia, vol. 27, 2nd edn (Moscow: Sovetskaia entsiklopediia, 1962), 372–92.].

90. Ibid., 95.

91. Snezhnevskii, op. cit. (note 1), 96.

92. A.V. Snezhnevskii, ‘O nozologicheskoi spetsifichnosti psikhopatologicheskikh sindromov’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 60, 1 (1960), 91–107.

93. ‘O merakh uluchsheniia psikhonevrologichskoi pomoshchi’, 20 August 1954, GARF, f. a- 482, op. 49, d. 8347, l. 113.

94. ‘O merakh uluchsheniia psikhonevrologichskoi pomoshchi’, 20 August 1954, GARF, f. a- 482, op. 49, d. 8347, l. 113.

95. ‘Sprakva k protokolu no. 5 zasedanii kollegii MZ SSSR’, 2 February 1956, GARF f. r-8009, op. 1, d. 1287, l. 186.

96. ‘Klinicheskaia konferentsiia’, op. cit. (note 21), l. 51ob.

97. Albert Deutsch, The Shame of the States (New York: Harcourt, Brace and Company, 1948).

98. Shorter, op. cit. (note 2), 280. During this period, American psychiatrists became very interested in the USSR’s non-hospital psychiatry system, and a series of articles appeared which attempted to use the Soviet model as a source of lessons about how to implement community mental health in the United States. Gary S. Belkin, ‘Writing about Their Science: American Interest in Soviet Psychiatry during the Post-Stalin Cold War’, Perspectives in Biology and Medicine, 43, 1 (Autumn 1999), 31–46.

99. D.E. Melekhov (ed.), Sotsial’naia readaptatsiia psikhicheski bol’nykh (Moscow: Gos. NII psikhiatrii MZ RSFSR, 1965), 3.

100. ‘Godovye spetsializirovanie otchety MZ SSSR o rabote psikhonevrologicheskikh bol’nitsakh i dispanserov’ [1955], RGAEf. 1562, op. 27, d. 165; Narodnoe khoziaistvo SSSR: Statistcheskii ezhegonik (Moscow: Gosudarstvennoe statisticheskoe izdatel’stvo, 1965, 1975, 1990).

101. Joravsky, op. cit. (note 11), 432–3.

102. L.M. Rozenshtein, ‘Novye zadachi Sovetskoi psikhiatrii (o psikhogigiene i psikhoprofilaktike)’, in A.I. Miskinov and L.A. Prozorov (eds), Vtoroe vserossiiskoe soveshchanie po voprosam psikhiatrii i nevrologii (Moscow: Izd. San-Prosv. Otd. NKZ, 1924), 6–10; L.M. Rozenshtein, ‘O nevro-psikhiatricheskoi dispanserizatsii’, in A.I. Miskinov, L.A. Prozorov and L.M. Rozenshtein (eds), Sovetskaia meditsina v bor’be za zdorovye nervy (Samara: Izd. Ul’ianovskogo kombinata PPP, 1926), 20–37; L.M. Rozenshtein, ‘O rekonstruktsii nevropsikhiatricheskoi pomoshchi’, Sovetskaia nevropatologiia, psikhiatriia i psikhogigiena, 1, 3–4 (1932), 63–77, 136–8.

103. Gregory Dufaud and Lara Rzesnitzek, ‘Soviet Psychiatry through the Prism of Circulation: The Case of Outpatient Psychiatry in the Interwar Period’, Kritika: Explorations in Russian and Eurasian History, 17, 4 (2016), 781–803; David Joravsky, ‘The construction of the Stalinist psyche’, in Sheila Fitzpatrick (ed.), Cultural Revolution in Russia, 1928–31 (Bloomington, IN: Indiana University Press, 1978), 105–28.

104. ‘Otchet NKZ SSSR o seti, deiatel’nosti i kadrakh meditsinskikh uchrezhdenii SSSR[1940], RGAE, f. 1562, op. 18, d. 203; ‘Kolichestvo psikhonevrologicheskikh bol’nits’, in E. Babaian, ‘Spravka o sostoianii psikhonevrologicheskoi pomoshchii naseleniiu SSSR’, 20 May 1961, GARF, f. r-8009, op. 1, d. 1411, l. 103; ‘Godovye spetsializirovanie otchety…’, op. cit. (note 100).

105. For a typical litany of the problems with the psychoneurological dispensary system, see ‘Prikaz 140 MZ RSFSR, ‘O sostoianii vnebol’nichnoi p/nev-oi pomoshchi v Rossiskoi federatsii i merakh po ee uluchsheniiu’, GARF, f. a-482, op. 49, d. 6605, ll. 199–204.

106. T.I. Gol’dovskaia and I.S. Iolovich, ‘O razvitii dispansernoi psikhonevrologicheskoi pomoshchi v Rossiiskoi Federatsii’, ZNiP, 60, 9 (1960), 1085–8.

107. ‘Polozhenie o podderzhivaiushei terapii aminazinom v usloviiakh dispanera’, 15 May 1957, TsAGM, 533, op. 1, d. 59, ll. 3–4; L.L. Rokhlin and I.G. Ravkin (eds), Podderzhivaiushchaia terapiia neirolepticheskimi sredstvami bol’nykh shizofreniei: metodicheskie materialy (Moscow: Gos. nauchno-issledovatel’skii institut psikhiatrii, 1961), 4–13, 46–53.

108. I.G. Ravkin and N.F. Samter, ’Osnovnye printsipy podderzhivaiushchei, profilakitcheskoi terapii pri shizofrenii’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 60, 9 (1960), 1204.

109. V.G. Levit, ‘K voprosu ob organizatsii podderzhivaiushchei terapii neirolepticheskimi sredstvami’, Zhurnal nevropatologii i psikhatrii im. S.S. Korsakova, 58, 5 (1958), 625–7.

110. M.S. Kogan, in ‘Stenogramma konferentsii Instituta psikhiatrii MZ SSSR po itogam nauchnoi raboty za 1957 god’, 15 May 1958, GARF, f. r-9592, op. 1, d. 24, l. 45.

111. Free medication for outpatient psychiatric patients was mandated by the USSR Council of Ministers and implemented by USSR Ministry of Health decree #317 (4 July 1963). See ‘Otchet o vypolnenii plana raboty Gl. Upr. Lechebno-prof. pomoshchi MZ SSR za 1963’, GARF, f. r-8009, op. 33, d. 976, l. 13.

112. ‘Instruktsiia MZ SSSR o poriadke organizatsii i ucheta besplatnogo otpuska medikamentov pri ambulatornom lechenii nekotorykh kategorii bol’nykh’, 8 August 1965, GARF, f. r-8009, op. 33, d. 1061, ll. 88-91ob.

113. ‘Ob’iasnitel’naia zapiska…’, op. cit. (note 54), ll. 38–9.

114. Interestingly, the report also noted that: ’In recent years the organs of health protection have been given a large number of prisons and corrective labour camps, in which new psychoneurological hospitals and psychiatric colonies have quickly been organised.In other words, GULAG buildings vacated by Khrushchev’s amnesty of labour-camp prisoners were being repopulated with psychiatric patients. Babaian, op. cit. (note 104), l. 93.

115. Ibid., ll. 90–1. Nathan Kline described the beds in the psychiatric hospitals that he visited as ‘a full 6 inches narrower than our own and, in many places, only 1 foot or so apart’. Nathan S. Kline, ‘The Organization of Psychiatric Care and Psychiatric Research in the Union of Soviet Socialist Republics’, Annals of The New York Academy of Sciences, 84 (April 1960), 169.

116. Babaian, op. cit. (note 104), ll. 95, 99.

117. Ibid., l. 92.

118. Ibid., l. 114.

119. Narodnoe khoziaistvo SSSR: statistcheskii ezhegonik (Moscow: Gosudarstvennoe statisticheskoe izdatel’stvo, 1965), 750.

120. ‘Svedeniia dlia raikoma KPSS Kuib. R-na po kiln. p/nev b-tse #4 im. Gannushkina’, TsAGM, f. 533, op. 1, d. 81, l. 9.

121. ‘Stenogramma zasedaniia uchenogo soveta instituta psikhiatrii MZ SSSR’, 21 March 1956, GARF, f. r-9592, op. 1, d. 21, l. 15ob.

122. ‘Vypolnenie plana raboty po upravleniiu za 1962 god po gruppe psikhonevrologii’, GARF, f. r-8009, op. 33, d. 946, l. 23.

123. V.I. Butorin, Chto nado znat’ o nervno-psikhicheskikh zabolevaniiakh (Moscow: Meditsina, 1965), 28.

This article is based on research conducted with the support of a US Department of Education Fulbright–Hays Doctoral Dissertation Research Abroad Fellowship, with additional funds provided by the Towson University Academy of Scholars. An earlier version was presented at the conference Continuity and Change in Russian Therapy, held at St Antony’s College, University of Oxford, 5–6 June 2014. The author would like to thank Fran Bernstein, Chris Burton, Daniel Todes and the anonymous referees for their helpful comments.

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