Medicine: Soviet Psychiatry

In a silent, standing tribute to “this great man who has now gone from us,” 2,800 doctors attending the Third World Congress of Psychiatry in Montreal last week paid honor to Carl Gustav Jung. Among them were doctors from 60 nations —most interestingly, ten psychiatrists from Russia. Soviet psychiatry thus for the first time got into substantial personal contact with Western psychiatry, and so eager were the Russians to meet their Western colleagues that—having been refused travel funds by their employer, the government—they scraped up the fare out of their own pockets.

Freud? Nyet! Western psychiatrists who had been hoping to find the Russians tapering off in their single-minded adherence to the theories of Ivan Petrovich Pavlov, of dog, bell and saliva fame, were disappointed. The delegation chief, Moscow’s Dr. Andrei Vladimirovich Snezhnevsky, laid down the line uncompromisingly: “There has been no change in principle in our approach. The theory of Pavlov and its applications are still expanding in Russia.”

To Freudian psychoanalysis and the use of analytic principles in psychiatry, Snezhnevsky & Ko. gave a firm nyet. “We reject psychoanalysis,” he said, “because its methods and theory are unscientific. Psychoanalysis rejects the material basis of psychological life. We use instead rational psychotherapy—we prefer to work with the conscious mind, where we find the material bases for mental illnesses.”

Sick, Sick, Sick Pay. If Western psychiatrists could pity the Russians for being still confined in the straitjacket of Pavlov’s physiological, conditioned-reflex theories, they could feel no superiority about the availability and effectiveness of straightforward, pragmatic psychiatry in Russia—at least the way the Russians told it. There seems to be about as much mental illness (certainly the handicapping forms such as schizophrenia) in the U.S.S.R. as in the West. But there are many fewer patients in mental hospitals at any one time. Reason: the Russians are taking psychiatry to the patients at the street-corner level. They expect family physicians to make diagnoses and to refer patients to local clinics, where psychiatrists are on hand to give intensive treatment with drugs and psychotherapy on an outpatient basis.

Only if the patient is violent, or his illness stubbornly persistent, is he sent away to a hospital. His stay there is almost certain to be less than three months. In the hospital, he gets much the same treatment he would get in the West: drugs, psychotherapy (but non-Freudian), insulin coma and, more rarely, electric shock. The Russians have virtually abandoned their prolonged (ten-day) drug-induced sleep treatment because too many patients developed fevers or anemia. As soon as possible, the patient is discharged to his family, which is paid by the government to care for him if he is unable to work.

Russian mental hospitals average only about 1,000 beds, said Snezhnevsky, and the newer ones range from 300 to 600 beds. Big barracks like U.S. state hospitals are rare; only three have as many as 3,000 beds, whereas in the U.S. they go as high as 14,000. Most important of all, perhaps, is the number of psychiatrists and other skilled personnel in proportion to patients. In the U.S., it works out at one psychiatrist for 200 hospitalized patients. In the U.S.S.R., the Russians say (and U.S. visitors believe it true), the proportion is one for every 25.