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Ukraine, a nation of 48 million, became independent in 1991 following the collapse of the USSR. Ukraine still lags far behind many European countries in absolute income per capita and indices of transparency and corruption in public life, but its economy, grounded on robust industrial and agricultural resources, has grown 10% annually in the past 4 years. The extraordinary developments associated with the 2004 presidential elections and the Orange Revolution mean that democracy is now at the core of the state-building process and that Ukrainians are ready for radical changes. These changes are bound to include the principles and methods that have long prevailed in Ukrainian psychiatry.
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Nadine Bogdan, SHO, Psychiatry
16 February 2007
I have read the article about Psychiatry in Post Communist Ukraine (Psychiatric Bulletin, 30) with enormous interest. What struck me was the attempt to present this issue largely in the context of Soviet influence rather than take a more balanced overall view of Ukrainian psychiatry. This article might not have been as compelling without the focus on political abuse and the criticism of Soviet Psychiatric Theory. Abuse in psychiatry has occurred elsewhere, not just in the USSR but in many western countries, particularly the USA (Freedman 1973, Sundram 1984). However in the Soviet Union that abuse did have a clear political basis.
Whereas I agree that some aspects of Soviet psychiatry deserve criticism, I also believe it should be given some credit. Its outpatient clinics/dispensaries have provided excellent rehabilitation care, social and medical help since the beginning of the previous century. The clinics also provided informative and relevant statistical data (Green 1993). Soviet Psychiatry is well renowned for its academic heritage and achievements, not to mention Pavlovtheories, and has achieved worldwide recognition and respect.
As the article suggests Snezhnevsky classification may seem novel to some, yet it is rooted in a comprehensive phenomenological study. It encompasses not only a cross-sectional picture of the presentation, but also provides a unique understanding of the duration and course of mental illness. Only recently has the West begun to assimilate this classic example of longitudinal approach.
In fact the example presented of this classification is unfortunate. Snezhnevsky divided Schizophrenia in three groups (not in two as cited in the article): 1. Progressive or Continuous,2. Episodic-progressive,3. Recurrent.
Slow Progressive or “Sluggish” Schizophrenia, a subtype of the first two forms, was described well before Snezhnevsky and even Kreapelin. For instance Bleuler described Latent Schizophrenia (1911) while Kronfeldt (1928) defined this type of schizophrenia as “soft”(Calloway 1993).Sluggish Schizophrenia resembles Schizotypal disorder ICD10, where symptoms of constricted affect, social withdrawal, overelaborate thinking,odd beliefs inconsistent with subcultural norms and somatocensory perceptual abnormalities are the cardinal features of the presentation.It shows that the Soviet concept of disease is similar to the one in the West. A survey of Soviet literature showed the similarity between the twoin being strongly scientific in nature. Perhaps it was not the Soviet interpretation of the disease but conceptual difficulties of mental illness in general, which makes psychiatry vulnerable to abuse(Fulford 1993). These difficulties may be due to a variety of factors, such as the evaluative element when interpreting disease, which varies greatly among different cultures. Nevertheless the concept of sluggish schizophrenia has generated a lot of debate among Soviet Psychiatrists, with the majority inclined to believe that this form should be regarded as a personality disorder.
In reality some political dissidents may have fallen into this “borderline” category. They tended to lead an extremely disorganised lifestyle, showed a peculiarity of thought process and stereotyped thinking. However this remains speculative given the lack of clear evidence and follow up studies.
Soviet/Russian Psychiatry is fascinating; at its core it is traditional in its diagnostic approach and yet at the same time shows great innovation in its treatments and management of mental illness. Its scientific works have made extensive contributions to the practice of psychiatry worldwide. The experience and innovation gained from the past should be encompassed and utilised. “Dismantling the past” could be a fatal flaw.
Reference: Calloway P, (1993). Russian/Soviet Psychiatry. A Contemporary Comparative Study.Snezhnevsky AV, (1986 ). Handbook of Psychiatry .Fulford KW, et al, (1993). Concepts of disease and the abuse of Psychiatryin the USSR, BJP 162.Freedman J, (1973). The questionable ethics of defending status Quo. Hospital and Community Psychiatry, volume 24, number 5, 344.Sundram C J, (1984). Obstacles to Reducing Patient Abuse in Public Institutions. Hospital and community Psychiatry, volume 35, number 3,238- 243 ... More
Conflict of interest: None Declared
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