State of Madness

Psychiatry, Literature, and Dissent After Stalin

Rebecca Reich

• Publisher: Northern Illinois University Press
• Year: 2018
• ISBN:
  9781609092337
• Topic: History
• Subtopic: Russian History
• Index: History

What madness meant was a fiercely contested question in Soviet society. State of Madness examines the politically fraught collision between psychiatric and literary discourses in the years after Joseph Stalin's death. State psychiatrists deployed set narratives of mental illness to pathologize dissenting politics and art. Dissidents such as Aleksandr Vol'pin, Vladimir Bukovskii, and Semen Gluzman responded by highlighting a pernicious overlap between those narratives and their life stories. The state, they suggested in their own psychiatrically themed texts, had crafted an idealized view of reality that itself resembled a pathological work of art. In their unsanctioned poetry and prose, the writers Joseph Brodsky, Andrei Siniavskii, and Venedikt Erofeev similarly engaged with psychiatric discourse to probe where creativity ended and insanity began. Together, these dissenters cast themselves as psychiatrists to a sick society. By challenging psychiatry's right to declare them or what they wrote insane, dissenters exposed as a self-serving fiction the state's renewed claims to rationality and modernity in the post-Stalin years. They were, as they observed, like the child who breaks the spell of collective delusion in Hans Christian Andersen's story "The Emperor's New Clothes." In a society where normality means insisting that the naked monarch is clothed, it is the truth-teller who is pathologized. Situating literature's encounter with psychiatry at the center of a wider struggle over authority and power, this bold interdisciplinary study will appeal to literary specialists; historians of culture, science, and medicine; and scholars and students of the Soviet Union and its legacy for Russia today.

CHAPTER 1

SOVIET PSYCHIATRY AND THE ART OF DIAGNOSIS

When the Soviet Union’s most prominent psychiatrist, Andrei Snezhnevskii, died in 1987, the S. S. Korsakov Journal of Neuropathology and Psychiatry—a publication that Snezhnevskii had edited for thirty-six years—opened its October issue with a full-page photograph and a lengthy obituary. According to the obituary, Snezhnevskii had been a “true doctor and healer” who began each day meeting with patients and their relatives while producing groundbreaking research that was celebrated worldwide.¹ Having helmed many of the country’s top centers for psychiatric research and practice, he had passed on his teachings to generations of students. The state had rewarded him handsomely for his work, the obituary continued, decorating him at different times with one Order of the October Revolution, two Orders of Lenin, and four Orders of the Red Banner of Labor; in 1974, it had named him a Hero of Socialist Labor. Snezhnevskii was decisive when defending his views, the article claimed, and he “always commanded great respect for the precision and clarity of his thought.” Yet he never abandoned his “simple” air or his readiness to help those around him.² Born just thirteen years before the Revolution and thus “shaped together with our country,” Snezhnevskii had defined what it meant to be a Soviet psychiatrist.³

Despite these accolades, Snezhnevskii’s passing and the onset of perestroika prompted the Soviet psychiatric establishment to turn a new page. In January 1988, the Korsakov Journal took the unusual step of opening the month’s issue with a letter to its readers. “The atmosphere of creative exploration under the conditions of perestroika in all areas of life demands that each of us fulfill his duty conscientiously, selflessly and without holding back,” the editors wrote.⁴ In keeping with the Communist Party’s new policy of glasnost, or openness, they continued, the journal would now publish lectures on neurology and psychiatry, personal narratives of clinical experience and educational practice, and regular updates on the activities of the All-Union Society of Neuropathologists and Psychiatrists. Also in the spirit of reform and transparency, the editorial board would host a series of reader conferences aimed at critiquing the journal itself.⁵

One major impetus for such reform was the blowback from the human-rights campaign against the punitive hospitalization of dissidents—a campaign that had dogged Snezhnevskii and his colleagues since the late 1960s and that now, with the onset of glasnost, was riveting the public. Whereas in 1987 the Korsakov Journal obituary had called Snezhnevskii a “model of selfless service to science and patients,” by 1989 the journalist Leonid Zagal’skii was writing in the influential cultural weekly Literaturnaia gazeta that it was Snezhnevskii who had facilitated the pathologization of inakomyslie, or “thinking differently.”⁶ For Zagal’skii, Snezhnevskii’s theory of forms of “sluggish schizophrenia” (vialotekushchaia shizofreniia) that developed slowly and often imperceptibly had provided the state with a flexible and politically congenial tool for discrediting dissenters. “Snezhnevskii’s theory made it possible to draw convenient conclusions about any kind of human behavior,” Zagal’skii alleged. “What, you think the war in Afghanistan doesn’t make sense? Welcome to the psychiatric dispensary. So you’re saying the economy is sick to the core? You’re the one who’s sick in the head.”⁷ Emphasizing that Snezhnevskii and his colleagues had risen to power in the final years of Joseph Stalin’s rule, Zagal’skii portrayed the psychiatrist as a relic of the excesses of that authoritarian regime. If at the time of his death in 1987 Snezhnevskii had been memorialized as a consummate clinician and researcher, just two years later he was being remembered as the architect of a diagnostic system that facilitated the pathologization of inakomyslie.

The appearance in Literaturnaia gazeta of Zagal’skii’s article was just one of many signs that the critique of punitive psychiatry was now mainstream. No longer would talk of psychiatric abuse be confined to the essays, letters, manuals, poems, and works of fiction that dissenters had circulated through samizdat and tamizdat, a flood of similarly themed articles now indicated; from now on, the problem would be openly discussed.⁸ Yet Zagal’skii’s depiction of a psychiatric establishment that manipulated psychiatric categories for political purposes was one that dissenters—both dissidents and dissenting writers—had been highlighting for several decades. The forensic psychiatrist Daniil Lunts, of the V. P. Serbskii Institute for Forensic Psychiatry, was, the dissident Vladimir Bukovskii wrote in 1978, a “clean-case master” who “slowly, like a spider, spins a web around his victim. He weaves such a foolproof symptom from every quirk of character and twist of fate that not a single commission would later be able to fault it.”⁹ At the heart of punitive psychiatry, Bukovskii’s commentary suggests, is the physician’s capacity for transforming subjective judgments into seemingly objective facts by building diagnostic narratives and massaging psychiatric terms. A similar characterization of punitive diagnosis is evident in the dissident military officer Petro Grigorenko’s 1969 samizdat account of one of his own evaluations at the Serbskii Institute: “My general impression was that everything had been decided, and that the only reason for holding the evaluation was that the prepared diagnosis needed to be officially ‘rubber-stamped.’”¹⁰ For Grigorenko, as for Bukovskii and Zagal’skii later on, punitive diagnosis revealed psychiatry’s subjectivity and hence its potential for manipulation.

The state’s use of psychiatric hospitalization to suppress dissent has long raised questions of intentionality. Were psychiatrists following explicit or implicit orders when they pronounced dissidents mentally ill? And, by extension, did they and the state indeed believe that resisting the status quo was a mark of insanity? Dissidents in particular tended to argue that psychiatrists like Lunts were well aware of their ethical breaches, and, in their samizdat memoirs and reports, they often insisted that such physicians be prosecuted.¹¹ Following the collapse of the Soviet regime, moreover, Bukovskii gained access to the archives of the Central Committee and came to the conclusion that the Politburo itself had sanctioned the punitive use of psychiatry. “This was no coincidence, no whim of some local agent, but the policy of the Politburo, without whose say-so not one hair on our heads could have been touched,” he wrote in 1996.¹² Yet even as he charged the Politburo with planning to create a “psychiatric GULAG,” Bukovskii followed the logic of many of the figures profiled in this study by connecting the pathologization of dissent to what he presented as the state’s own delusional frame of mind: “Did they actually believe that we were distorting reality, consciously or at least unconsciously? Of course not. But in their language the very concepts of ‘reality’ and ‘actuality’ carried a completely different meaning.”¹³ For him, the pathologization of dissent revealed the delusory nature of the state’s own vision of reality:

Despite all their pragmatism, after all, in actuality they lived in that fantastic world of Socialist Realism wherein it was impossible to distinguish fact from fiction, information from disinformation. All the more so since they were the sort of people for whom truth is by definition instrumental (“class-based”), subject to their ideology. After all, they also, like the rule of law and order, were governed by the principle of “practicability.”¹⁴

What the state considered to be a “normal” understanding of life was catastrophically divorced from reality, Bukovskii indicated. Yet there was precedent for its irrational vision, he continued: Socialist Realism’s own propensity for rampantly conflating fact and fiction. As dissidents and dissenting writers repeatedly emphasized in ways that inform this chapter’s analysis, the state-sanctioned aesthetic doctrine was instrumental in shaping social and political norms.

From the late 1960s to the present day, explanations of punitive psychiatry have primarily focused on institutional and political factors such as entrenched professional hierarchies and the subordination of the rule of law to state policy.¹⁵ Soviet dissidents and Western observers have likewise stressed the effect of diagnostic categories such as sluggish schizophrenia and “delusions of reformism,” the markers of which appeared to outwardly overlap with dissident behavior. Also a contributing factor, some critics have argued, were the broad definitions of disease that resulted at least in part from the psychiatric establishment’s arrangement of mental illnesses along a spectrum or continuum.¹⁶ Still other critics have attributed punitive psychiatry to the generally “under-developed nature of psychiatric science” while faulting Soviet psychiatry, in particular, for failing to sufficiently acknowledge “the evaluative element in the meaning of disease” and thus for allowing subjective judgments to acquire the clout of objective fact.¹⁷ Yet the subjective element of psychiatric diagnosis also contained a significant aesthetic dimension. For the dissident poet Viktor Nekipelov, who was evaluated at the Serbskii Institute in 1974 and wrote a memoir of the experience, psychiatric theory provided certain practitioners with flexible categories for reconfiguring inakomyslie as evidence of insanity:

And indeed, this broad and diffuse mold (which, in another sense, is precise and streamlined, as suits our well-trained dogmatism of thought) can easily accommodate any expression of our “thinking differently,” “love of freedom,” “love of truth,” and so on. “Originality of thought,” “heightened interest in social and political problems,” “tendency toward conflict situations”—just listen to how they label their symptoms!¹⁸

Taking such critiques of punitive psychiatry’s subjective and narrative-building impulse as a launchpad for its own analysis, this chapter suggests that the pathologization of inakomyslie stemmed not only from the institutional, political, and theoretical factors described above, but also from the discipline’s broad adherence to an established aesthetic framework.

And indeed, dissenters who portrayed psychiatry as a subjective discipline were not inventing an epistemological platform for analyzing psychiatric diagnosis; they were pointing to a subjective stance that certain physicians conceded with pride. As Snezhnevskii himself wrote in 1968, the business of a psychiatrist was making accurate diagnoses based on objective facts and methods. Yet within that context was room for a subjective skill that ultimately amounted to an “art”:

The recognition of a disease and of all the particularities of the patient under examination constitutes a creative act [tvorcheskii akt], the success of which depends not only on a sufficient knowledge of the subject and acquired experience, but also on the personal qualities of the physician. According to K. A. Timiriazev, “Science and theory cannot and should not provide ready recipes; the ability to match the technique to the circumstance always remains a matter of personal resourcefulness, of personal art [iskusstvo]. This art is what forms the sphere of that which is meant by practice in the best sense of the word.”¹⁹

Citing the pre-Revolutionary scientist Kliment Timiriazev, Snezhnevskii compares a well-wrought diagnosis to a “creative act” not only in its penetration and articulation of the truth of the patient’s condition, but also in its revelation of the physician’s “art.” The success of the diagnosis depends on how well the psychiatrist speaks to and listens to the patient, weighing individual symptoms against general patterns of disease progression. It also depends on how precisely the psychiatrist penetrates to the “essence” of the disease and articulates it in the clinical or forensic report that then emerges. “If, during the examination, the doctor has not managed to grasp the most important thing—the essence—then the report fills up with unnecessary details; it becomes a picture of everyday life and not a medical document,” Snezhnevskii concludes.²⁰ Snezhnevskii’s emphasis on the physician’s subjective powers of intuition and expression likens diagnosis to an art in both the medical sense of the skill of examining patients and the aesthetic sense of grasping and narrating the disease’s essence. However objective psychiatric diagnoses might claim to be, Snezhnevskii’s comments would seem to suggest, their success ultimately depends on the subjective capacities of the individual psychiatrist.

Snezhnevskii’s description of psychiatric diagnosis as a “creative act” or “art” sheds light on dissenters’ own critiques of the subjective excesses of punitive diagnosis. What Snezhnevskii seems to have meant by these terms was the psychiatrist’s ability to marshal his or her individual insight, knowledge, and resources to reveal an empirical reality—the patient’s psychological state. By contrast, dissenters who criticized punitive psychiatry implied that the subjective component of diagnosis was potentially so extreme as to rule out scientific objectivity. For them, the “art” of the Soviet psychiatrist was art in a far more literal sense: rather than reveal the patient’s hidden condition, dissenters suggested, it created or imagined mental disorders where, quite possibly, none existed. What this chapter terms the “art of diagnosis” thus contains an inherent ambiguity. On the one hand, it captures what psychiatrists acknowledged and celebrated as the skillful manifestation of their professional expertise. On the other hand, it highlights the subjective and thus politically manipulable nature of psychiatric diagnosis. And indeed, attention to the aesthetics of both punitive psychiatry and psychiatric practices in general demonstrates that dissenters did in fact have grounds to pinpoint Soviet psychiatry’s subjective dimension.

In much the same way as dissenters combined psychiatric and literary discourses when pathologizing the state and depathologizing themselves, physicians accessed literary modes of expression and analysis in their own theoretical and clinical writings. Snezhnevskii and other prominent psychiatrists thus taught students of psychiatry to generate narratives of disease that proved able to flexibly accommodate dissenters’ life stories. These reports turned the doctor-patient dialogue into a medical monologue that constructed new diagnostic realities through words. As will be discussed in the following chapter, dissenters were not alone in emphasizing the manipulability of psychiatric diagnosis; even as dissenters produced their own narratives criticizing Soviet psychiatric practices, “antipsychiatrists” in the West were drawing attention to the subjectivity of the discipline as a whole. What heightened that subjectivity in the Soviet case was the particularly authoritative role of the state psychiatrist, whom the government entrusted with the protection of politically and ideologically determined norms. The art of diagnosis—and, in particular, the art of punitive diagnosis—amplified Soviet psychiatry’s subjectivity and so its potential for abuse.

Though psychiatrists of the post-Stalin period saw themselves as scientists and defined their “art” as the diagnostician’s skill, critical attention to their theories and practices uncovers their adherence to an aesthetic framework. Claims to objectivity collided with claims to subjectivity in such a way as to elide the latter, allowing for the psychiatrist’s personal input and facilitating the pathologization of dissent. While the art of diagnosis was certainly not art in the sense of the poems, essays, novels, and plays analyzed in later chapters, it shared with those dissenting texts a readiness to move between psychiatric and literary discourses. In the case of the art of diagnosis, however, that combination acquired the recognizable stamp of the literary doctrine of Socialist Realism. Snezhnevskii was thus echoing the didactic aesthetic of Socialist Realism when, in 1967, he told a Literaturnaia gazeta reporter: “The field of psychiatry is intimately tied up with aesthetic and ethical education. And literature, after all, is an education—an ethical as well as aesthe...