The conference “From the New Socialist Person to Global Mental Health: The Psy-ences and Mental Health in East Central Europe and Eurasia” (April 29th-30th 2013, University of Chicago)* set out to examine the shifting objects of knowledge and programs of intervention associated with the psy-ences in the former socialist countries of Eastern Europe and Eurasia. Coined by Elizabeth Lunbeck, Emily Martin, and Louis Sass in the title of their seminar series at NYU, and similar to what Nikolas Rose has called the “psy-disciplines”, the “psy-ences” comprise the multitude of sciences and fields of therapeutic interventions that target the human mind, behavior and the brain. There are, of course, the obvious candidates of psychiatry, psychology, psychoanalysis, and psychopharmacology, but also adjacent disciplines such as addiction medicine, sexology and more recently emerging, neuroscience.
In Eastern Europe and Eurasia, these formations of expertise were strongly affected by socio-political changes spanning the state-socialist and post-socialist periods, throughout which these disciplines’ relationship to the state, their modes of knowledge production and the epistemic order and subjectivities they contributed to underwent dramatic ruptures. It would be easy to describe these processes through a commonly-used script that pitches the imaginaries of homo sovieticus against an emerging homo oeconomicus, and explores their distinction, and metamorphosis in time. Such tracing of the ever-shifting social, spatial, epistemic and material assemblages is often abridged as post-Soviet “transition” or “transformation”, both of which assume to varying degree a linear trajectory from A to B, from then to now. It is this kind of uni-linerarity that most of the presentations during this conference sought to unsettle and complicate, while still account for and delineate concrete forms of change. While the interest in the variance and divergence of trajectories in Eastern and Western psy-ences was central to many presentations, their locus, expression and political stakes became visible through different conceptual lenses and historical vantage points – some of which I revisit in this review. I will not follow the structure of the panels here, but try to put into conversation different themes that emerged from the two-day conference.
Tracing trajectories of medical concepts through East & West
A number of presentations illuminated the fascinating institutional and epistemic histories of the psy-ences as they evolved quite differently in emphasis and direction in (post-) socialist Eastern Europe and Russia compared to Western Europe and North America. For example, Benjamin Zajicek followed the historical trajectory of insulin shock therapy for the treatment of schizophrenia, which he described as a “Soviet peculiarity”. Introduced to the USSR, North America and England in 1936 and abandoned by the West in the mid-50s, the treatment continued to be central in Soviet psychiatry until the 1970s. The talk focused particularly on the early years of its introduction, when insulin shock therapy, according to Zajicek, was perceived as a step into medical modernity as it required specialized spaces, staff and equipment that transformed psychiatry’s dingy hospital spaces into modern clinical environments. The rather harsh treatment method that induced seizures and a temporary coma through high doses of insulin was one of the first “active” treatment of mental conditions, aiming to cure, instead of simply housing and feeding, the mentally ill. Quoting from sources and reports of psychiatric staff at the time, Zaijcek highlighted the gratifying effect this had for the staff as hospital routines normalized, time and place came to be neatly structured, and patients were calm and quieted. The effects of the treatment were palpable: psychiatry for the first time appeared to be a modern and objective medical institution.
Eugene Raikhel’s work on the treatment of alcohol addiction in Russia explored the differential historical trajectory of hypnosis and suggestion-based treatments in the former Soviet Union, which resulted in the rather unusual addiction treatment method known as “coding” (kodirovanie). The treatment that seeks to induce sobriety through the performative act of a charismatic healer/clinician creates the suggestion that the patient’s body does not tolerate alcohol for a distinct period of time; “If you drink – you die.” Such stress- and fear-based psychotherapies evolved after the Great Patriotic War (WWII) in Russia and their continued use today, Raikhel argued, could easily be perceived as dovetailing with Soviet ideas of authority, social control and modes of subjectification. However, a careful analysis of contemporary professionals who are practicing “coding” reveals a more complex picture of claims, clinical encounters, conceptions of the individual/customer and the effects of “coding” in Russia’s contemporary “therapeutic economy”. For example, the resurgence of the Orthodox Church in the 1990s has led some practitioners to reframe “coding” in religious terms. In combination with a widely perceived crisis of institutional authority, different kinds of authority became appealing. The authority invested in “coding”, Raikhel argued, contains a tension between the harnessing of a “cult of personality” and a standardized aspect of the method that can be learned by anyone. Interestingly, “coding”, hypnosis and other suggestion-based therapies have often been identified with the term “psychotherapy” in Russia (particularly during the Soviet period), contrasting with the Western use of the term that commonly references some form of talk therapy, underpinned by notions of interiority and subjectivity.
Following an equally intriguing pattern of incongruence between Eastern and Western development of the psy-ences, Kateřina Lišková’s analysis of sexology advice literature in communist Czechoslovakia revealed a reversed historical tendency in the normative texts on gender relations and sexuality. The advice literature evolved from an imperative for gender equality and sexual liberty during early communism (1948 – 1959) to a more repressive family model based on unequal gender roles in the 1970s following the failed Prague Spring. Hence, the history of sexuality in Czechoslovakia, Lišková argued, did not follow a linear path of steady liberalization marked by the rise of consumerism, the introduction of the pill, and social movements for more liberation as had occurred in the West; most of these elements were absent in Eastern Europe. Instead, sexology under early communism promoted a more “progressive” program of sexual education than it than it did in the 70s when sexual liberation and education was at its height in the West.
Similar in theme, but very different in focus and approach was Sonja Luehrmann’s presentation on the emergence of “post-abortion syndrome” in Russia in which she explored the trajectory, uptake and transformation of a Western psychological concept within Orthodox pro-life organizations. Despite references to the differential construction of “post-abortion syndrome” in the West, Luehrmann emphasized how the syndrome emerged in Russia at a moment when women’s past reproductive choices needed to be aligned with a changing post-Soviet moral and political framework. Throughout the Soviet era, abortion was the most accessible form of birth control resulting in an average of five abortions per woman during the 70s and 80s. In the post-Soviet period, however, the growing influence of the Orthodox Church in conjunction with Western psychological discourses on trauma and PTSD resulted in a shifting perception of abortions engendering individual practices of penance as well as public reflections on the collective history of the Russian nation. “Post-abortion syndrome” in contemporary Russia has become a means of denouncing the abortion practices of the Soviet period as state-fostered genocide, while at the same time demonstrating patriotism for the current state that is seeking to increase birthrates in the midst of a demographic crisis.
While Luehrmann emphasized the mediation and transformation of Western psychological truth claims, Jack Friedman found more of a replacement of Soviet with Western standards in his examination of psychiatric paradigms in Romania. Through an examination of how psychiatric treatment models interlink with models of citizenship and nation building, Friedman argued that Romania’s recent desire to “mimic the West” and its treatment standards reflects that country’s aspiration—throughout the 1990s and early 2000s—to join the European Union. Of course, this was not always the case. During the early communist period mental illness was marked as a Western phenomenon and its existence in Romania was downplayed. Even in the 70s and 80s, when new epidemiological data showed prevalence rates similar to those of the West, Romanian psychiatry remained focused on the social causes of mental illness and a model of care geared towards rehabilitating the workforce. This, Friedman argued, maintained the identification of a person as a worker beyond diagnostic categories. It was in the post-socialist period, when Romanian psychiatry sought to erase its complicity with the communist state, that a full adaptation of Western nosologies (ICD) and pharmacological regimes were embraced. According to Friedman, this development had the effect of thoroughly “flattening” the social dimensions of mental illness and mental health care in Romania. Through the story of Lenuţa, a psychiatric inpatient diagnosed with schizophrenia, he impressively showed how the undifferentiated labels and pharmacological treatments she received fully disregarded her harrowing personal history and social context within the clinical context.
The problem of “history”
While many presentations unfolded far-reaching narratives spanning long periods of institutional, epistemic, moral and political change in Eastern Europe and Eurasia, the modes of historiography themselves and the analytical operations that bring into being Soviet and post-Soviet lineages were also examined during this meeting. In his commentary on the panel “Politics and the Clinic,” discussant Tomas Matza stressed the “tricky relationship between historical comparison and sociopolitical critique”, or in other words, how studies of postsocialism are confronted with the task of carefully exploring the feasibility of a critical project of the present that builds on comparison with the past. He cautioned about falling into a mode of analysis in which aspects of late-socialism appear as a “lost possibility”, or a “promise” that was then disrupted by neoliberal processes, leading into a present that warrants a critique. Drawing on arguments made by Tatjana Thelen, Matza suggested ways in which such comparison could be avoided – for example by looking for continuities that “span moments of political rupture” or for “continuities merged with breaks”. Such an approach was taken by Jessica Robbins, whose analysis of Polish universities for seniors – so called “universities of the third age” (UTA), problematized a historiography that centers on a pre-/post-1989 division. Although these institutions appear seamlessly embedded in the blossoming promotion of the “active senior” or “active aging” all over contemporary Europe, they have a tradition in Poland that reaches back into the ‘70s. Universities of the third age might seem like Western, pan-European phenomena harnessing “self-care” and “education” as an antidote to the looming increase in dependence of seniors that threatens to burden the healthcare system, but upon closer examination, Robbins argued, UTAs “bely any easy understanding of them as representative of either socialism or postsocialism.” Instead, she suggested, markers and meanings of class, associated with the attendence of these universities, might lend themselves to more complex interpretations.
Keynote speaker Alexander Etkind also reflected on modes of historiography following his talk on the events surrounding the death of Trotsky’s daughter Zina. Her suicide in 1933 at a time when she was receiving intense psychiatric treatment by a Russian emigrant psychiatrist in Berlin, carries many signs of an assassination, he suspected, not unlike the death of Trotsky’s son Lev Sedov, who died five years later at the hands of a Russian emigrant surgeon in Boston. Etkind unfolded an intricate story exploring the concrete historical trajectories of actors surrounding Zina’s treatment at the clinic of German psychiatrist Arthur Kronfeld (who later emigrated and practiced in Moscow), as well as the political circumstances that may have led to her suicide as a way to avoid her return to Russia, where she would have been forced to testify against her father. (Etkind’s article about this case has since been published in the Times Literary Supplement, and a version of it is available here). During the discussion following his presentation Etkind responded to questions about his particular historiography, explaining that he prefers to trace Soviet history through contingent, small-scale links between people, places and events rather than utilizing epochal categorizations and broad concepts.
Hannah Proctor’s presentation reflected on history as a tool to critique the present. Coming from a perspective of “critical neuroscience” she stressed that history provides the means to denaturalize the current moment and thereby enable imaginations of alternative futures; a project she deemed particularly pertinent in the face of a contemporary neuroscience that produces a conception of the human consciousness that is largely ahistorical and depoliticized. In contrast with this conception, she drew on the work of Lev Vygotsky, a Russian psychologist of the 1920s and ‘30s, whose work, she argued, could provide an alternative paradigm as it situates human consciousness as emerging in a social and historical context. Vygotsky’s original aim to bridge the dynamics between materialism and idealism, between object and subject through a “dialectical psychology” provided Proctor with an angle from which to question the contemporary object-centered neuroscience, and what she perceived as an equally apolitical social science (i.e. actor-network theory) that erases the distinction between object and subject. Instead, Proctor insisted on the importance of maintaining a political subject that has the capacity to resist domination and articulate radical critique, which to her also meant insisting that the world can still “consciously be altered”.
Exploring the limits of conceptual scripts: Neoliberalism, Michel Foucault, Nikolas Rose
Related to the discussion of historiography was an evolving conversation around conceptual tools and dominant narratives that structure the understanding of post-socialist transformations. What figured most prominently was the question of how, when and in what ways “neoliberalism” entered and affected people’s lives, subjectivities and the professional treatment of their psyche. Yet, while “neoliberalism” often holds a taken-for-granted explanatory power, it came under scrutiny in many talks and discussions at the conference. As a discussant to the panel “subjectivities in transformation” Jack Friedman, for example, pointed out that “the former Soviet bloc could be seen as a laboratory par excellence for testing the analytical value of neoliberalism”, which he saw reflected in the panelists who sought to “problematize the idea that people in the post-socialist world have become uncomplicated neoliberal subjects.”
One paper that stood out in its attempt at tracing the limits of the concept of neoliberalism was Grzegorz Sokol’s presentation on Twelve Step programs for depression in Poland. Sokol challenged the commonly held assumption that neoliberalism necessarily produces self-governing, individualized citizens. While Twelve Step programs arguably do all that, Sokol stressed that they are also accomplishing something else, which cannot be captured by focusing predominantly on the individualizing effects of self-help movements. Instead, he argued that Twelve Step programs rely strongly on the notion of “mutuality” and the value of helping others, which allow for temporally and spatially unstable and dependent, yet tangible alternative subjectivities and collectives. He hence argued for conceiving of neoliberal subjectivity as an effect, a “specific articulation of economic, social, personal, and therapeutic conditions rather than an intrinsic quality of this or that kind of subject.” Exploring other possible political potentialities and forms of subjectivity as a challenge to the familiar narrative of neoliberal subjectivity, Sokol’s analysis went beyond a mere assessment of a precisely circumscribed misfit between conceptual blanket categories.
Similarly, Tomas Matza stressed the importance of paying attention to the concrete sites and meanings of “neoliberalism” and pointed in his commentary to two recent examples – Steven Collier’s Post-soviet Social and Jane Zavisca’s Housing the new Russia – that explore “neoliberalism” in the concrete. In his own paper he then avoided the term completely, while still attending to related phenomena in their specific empirical expression. Matza demonstrated the differential production of class-specific subjectivities through child psychology services in St. Petersburg and explored how such services tie into current biopolitics under Putin’s program of “modernization”. Modernization in this sense is characterized by increasing standardization, audit and reforms that seek “to replace the figure of the welfare recipient with the model of a consumer-citizen”. Drawing from his fieldwork in both state-run and private psychological clinics for children, Matza showed how within the public services for the urban poor “both the social and the affective” dimension of a child’s behavior are “converted into a problem for cognitive inquiry”. In private clinics for middle-class children, on the other hand, affect and the promotion of emotional capacity are at the center of their psychological practice. This radically different formation of the therapeutic object cannot be sufficiently named with the Foucauldian notion of the neoliberal “entrepreneur of the self” as the endpoint of the psy-ences. In this case, state psychological services under Russian “modernization” bring into being an isolated individual child/brain with a standardized cognitive problem; such urban poor children are what Matza calls “becoming psychological”. In contrast, the middle-class child at private clinic is encouraged to experience his/her “psychological becoming” and to harness self-knowledge and affect as skills and capacity to thrive in Russia’s new market order.
Another theme that was present in Matza’s talk and ran through a great number of presentations was the struggle with the conceptual templates of two influential intellectual figures – namely Michel Foucault and Nikolas Rose – who both worked extensively on the historical and contemporary formation of the psy-ences, albeit in Western contexts. Both scholars hence informed, but also frequently seemed to fall short of, the observations made about psy-disciplines in (post-)socialist countries. For example, through her analysis of samizdat literature Rebecca Reich showed how nonconformist citizens of the USSR engaged with and struggled against discourses of punitive psychiatry which defined “thinking differently” (inakomyslie) as a pathology in need of psychiatric attention. In return, nonconformists like Aleksandr Vol’pin, Vladimir Bukovsky, and Semyon Gluzman contested the knowledge and practices they were subjected to by defining madness as “thinking differently”, thereby asserting their own diagnostic authority against psychiatry and the state. This way, Reich argued, nonconformists could experience themselves as a community of sane but differently thinking people in an insane societal and state environment. She went on to argue that Foucault’s argument about the foundation of reason on the grounds of unreason’s exclusion does not hold the same way in the Russian context. Following an argument developed by historian Laura Engelstein, Reich made the case that Foucault’s analysis of French society relied on two things: the rule of law and the delegation of authority to knowledge-based professions, both of which existed in name only in the Russian context. By building their reason on a re-definition of madness as “inakomyslie”, she argued, samizdat writers were able to reverse this Foucauldian image by turning the meaning of madness back on to the discourse of punitive psychiatry.
The second scholar whose work surfaced frequently, albeit in a more contested manner, was Nikolas Rose. Kateřina Lišková took particular issue with Rose’s assessment of the role of the psy-ences in Eastern Europe. She highlighted his argument that psychology, psychiatry and psychotherapy play an important role in the constitution of modern societies as they are constitutive of how modern subjects understand and govern themselves. She disagreed, however, with Rose’s claim that the psy-ences assume this role exclusively in Western liberal democracies, and more specifically, with his prediction that psy-disciplines will only assume this role in Eastern European countries once they transitioned into Western societal arrangements. This claim, Lišková argued, relegates state-socialist Eastern Europe to an unsophisticated “other” “presumably ruled solely through brute force, an arena where Foucauldian scripts of self-disciplining and power/knowledge apparatus supposedly do not apply.” Instead, as Lišková argued in her presentation on sexology advice literature (see above), the psy-ences were not secondary latecomers, but rather an important agent in communist Czechoslovakia.
In contrast, in her commentary Susanne Cohen stressed Nikolas Rose’s work as rather helpful – despite his focus on liberal democracies – in that it enables us to further reflect on how science is linked to socio-political imaginaries. One member of the audience added to this discussion that Lišková’s paper could be read with or against Rose because the main question is: When do the Psy-ences become the Psy-ences? For Rose, he said, it requires a self-referential depth in the self-making of a subject. Lišková responded that the main criteria for a psy-ence to be called such is the “therapeutical moment”, which in the case of Czech sexology is no different than in the West, starting in the 1960s.
The Psy-ences on the Global Stage: Post-socialist Renderings
The frequently chosen comparative angle between Eastern and Western forms of psy- knowledge was additionally complicated through presentations that focused on the global dimension through which the psy-ences in Eastern Europe and Eurasia are currently re-configured, namely the framework of what has been called Global Mental Health. The movement for Global Mental Health (GMH) was first brought forward in a special series of the Lancet in 2007 in which a group of psychiatrists proposed a global agenda to establish mental healthcare services and human rights for the mentally ill on a global scale, with particular emphasis on “low and middle income countries”. However, the movement has also elicited significant criticism from scholars and mental health professionals who question the feasibility of a “global” approach to mental health care as they see both mental illness and its treatment inextricably entangled with locally and culturally specific knowledges, idioms of distress, and healer-patient relationships. Such newly arising tensions between concrete clinical practices, the demands of evidence-based medicine and the ambitious GMH project aiming to formulate global standards, were identified as a new source of conflict at the conference. One audience member, for example, pointed out that a prominent Ukrainian dissident psychiatrist who vigorously opposed the practices of punitive psychiatry during Soviet times, now turned his critique against the push for standardization through evidence-based medicine in psychiatry.
As mentioned above, Jack Friedman’s and Tomas Matza’s presentations touched on such mental healthcare reforms undertaken in the name of “modernization” (Russia) or adaptation to the E.U. (Romania) through which existing mental health services are re-structured and transformed based on Western treatment paradigms. Shelly Yankovsky explored the tentative and yet to be realized reforms of mental health care in Ukraine involving deinstitutionalization and the shift from public to private health insurance among others. Her ethnographic work with mental health practitioners revealed their ambivalence towards such changes in the face of scarce resources, the lack of “community” care infrastructure and known abuses of patients by their families. Yankovsky stressed that the Westernization of diagnostic criteria encourages Ukrainian psychiatrists to frame mental health problems as biomedical in nature, which typically disregards environmental and societal factors acting on individuals and communities. Instead of further highlighting the differences between Soviet and Western approaches, however, Yankovsky, pointed out that both mental health care systems medicalized social problems and are equally to blame for not paying attention to the underlying structural and social causes.
Global vs. Local Idioms of Distress: Trauma Care in Humanitarian Settings
Through the additional lens of a global dimension in the production of psy-knowledge, the lines of difference were no longer predominantly drawn between an Eastern/Western legacy, but rather shifted towards the dichotomy between “local” vs. “global” forms of psy-interventions, and towards the study of their encounter, re-negotiation and effect within concrete, situated settings. As exemplified in a number of presentations, humanitarian interventions provide a typical site in which GMH models of care engage with local forms of knowing, experiencing and therapeutically addressing mental distress and suffering.
Hanna Kienzler referred to Global Mental Health as a global “project” in Elizabeth Povinelli’s sense, by which she describes how diverse “projects” of world-making confront and engage one another, while at times override and foreclose each other’s possibilities. Approaching such conflicting projects through the rarely asked question of accountability for “lost” possibilities, foreclosed alternatives, and “missed encounters”, Kienzler drew a multifaceted picture from her fieldwork in post-war Kosovo where the encounter between war widows and humanitarian mental health interventionists led to a reframing of their suffering into narratives of post-traumatic-stress-disorder (PTSD). Locally existing therapeutic “projects” and strategies thus went unrecognized in their own potential for productive change. Kienzler further showed how these women, in the face of social inequalities and structural violence imposed by their families, communities and the Kosovo state, often felt humiliated by the psychiatric diagnoses and treatments they received. Thus, she argued, we as researchers need to ask ourselves “who then is accountable for repressing alternative voices and projects” in such messy global settings, and we need to reflect on the role our own research plays in realizing or foreclosing other people’s projects and ways of meaningful world-making.
Similarly, Peter Locke’s work on post-war Sarajevo drew the attention to the spaces, stories and experiences that exceed and escape a classification of trauma and PTSD. Such labels, he argued, render complex forms of affect in the postwar milieu of Bosnia-Herzegovina “less visible – or at least less politically potent – by defining them as symptoms of past damage.” Psychiatric categories do not capture the continued social and economic suffering that has turned into a chronic, routinized and seemingly endless crisis. Drawing on rich ethnographic examples from his fieldwork Locke called for the exploration of the unrecognized possibilities for care and political transformation to develop a new understanding of post-war forms of suffering. In response, one audience member wondered about the often-assumed imaginary of an endless crisis in post-socialist countries. Locke’s response was that it is exactly the task of the anthropologist to explore the spaces between and beyond a uniformly depressed rhetoric, to highlight new possibilities of becoming. He added that we as researchers need to be aware of how we help to produce the imaginary of such crises, by asking particular kinds of questions which our informants know how to answer in order to access resources. A traumatic narrative in such a context can become a unit of exchange.
Namrita Singh’s qualitative study on the informal mental health support system among internally displaced persons (IDP) in Georgia foregrounded the people’s strength, resources and priorities within their own community in the temporary housing complexes they had been living in for many years. Emphasizing the importance of notions such as “belonging” for refugee mental health, Singh moved beyond the markers and approaches commonly used in public health. One of the audience members reflected on the way in which public health in general, but Global Mental Health in particular, classifies people and populations as “low resource”, not recognizing that people often have many social resources that amount to an “incredible possibility to do things, to be each other’s support system and care for each other.”
For discussant Michael Rasell, these three papers came together in their focus on how lived social experiences of suffering are irreducible to existing psychiatric illness categories. To him, this raised the ethical question of the extent to which we, as social scientists, are not only contributing to a critique, but also to the construction of something positive. Rebecca Reich wondered in this regard whether psychiatric language, such as the notion of “trauma” gives people a language to express an already existing experience of distress, or whether mental illness categories are truly imposed. Hanna Kienzler responded that trauma must be recognized as a “learned category” that was brought to Kosovo by international humanitarian agencies and subsequently became a vehicle that shaped suffering. Kosovar widows found themselves in a situation where they had to learn to express themselves in this language to be recognized by psy-practitioners (and by extension, resources). If they reported other forms and idioms of distress the women were regularly constructed as uneducated “somatizing village women” who are not “health literate” enough to express mental suffering and thus retreat into symptoms of the body.
Stepping entirely out of the secular realm of psy-treatments, Khashayar Beigi presented an analysis of video footage showing a spiritual healing session that sought to interrogate and evict a jinn from a Tajik migrant in Russia. Over the course of the interrogation – in which two clergy engage verbally with the jinn inhabiting the restrained men on the ground – the three are seen negotiating and translating between Russian, Tajik and Arabic. But, as Beigi argued, such interrogative speech “neither unites strangers nor mediates exchange among them”. The increasing primacy of Russian that emerges from this exchange, however, “actualizes the Soviet ideal of inter-ethnic harmony” and produces the “shared linguistic and cultural heritage as the site for emergence of madness, alterity, and religious subjectivity.”
Treating drug addiction in context
Another arena in which differences between global and local treatment strategies prevail were the negotiations surrounding the treatment of drug addiction in formerly socialist-countries. Eugene Raikhel outlined how over the recent past a fierce struggle unfolded regarding the introduction of opiate substitute treatment (OST) resulting in some countries tentatively allowing for such programs while Russia is continuing to ban OST entirely. Further illuminating the situation in Russia psychiatrist Vladimir Mendelevich presented his survey findings on health professionals’ attitude towards drug treatment and users. While Russian psychiatry, he argued, has adopted the same nosology as the West and sees itself as “part of the world psychiatry again”, narcology – a subdiscipline of psychiatry – has continued to follow an “unscientific” trajectories of treatment. He hypothesized that the stark differences between Russian and Western paradigms may be due to the ethical attitudes of Russian narcologists, who, for example, widely view drug addiction as a criminal behavior (65.5%) rather than an illness (34.4%). Furthermore, he explained, addiction treatment is guided by a moralistic and clerical paradigm influenced by the Orthodox Church, which is reflected in 54.5% of all professionals naming religion as the most effective treatment for opiate addiction.
Adding an analysis of the public perceptions of drug addiction in Russia, Peter Meylakhs media discourse analysis showed how rising drug use in Russia is met with an unprecedented moral panic, while other substance use such as alcohol is viewed as an unproblematic part of Russian culture. Following Mary Douglas, he argued that drugs are conceived of as polluting substances, symbolically tainting the pure child after first use. Drug use is hence perceived as incurable in a symbolic sense, independently of the frequency or type of drug consumed.
In Ukraine, one of the few countries that introduced OST programs, Jennifer Carroll found through ethnographic work with drug users and health staff, that drug addiction therapy is framed as a problem of the will. This is expressed in the central trope of zhelanie – which she glossed as desire, wanting or, more broadly, motivation – which is seen as essential to the treatment of drug addiction. For the addict, displaying zhelanie, the desire to exit the addiction and re-inhabit desirable social roles and subjectivities thus becomes a crucial performance to reclaim social acceptability. Health professionals, she argued, see such desire as the most important factor determining the success of treatment and a focus of their efforts (i.e., “lighting a fire in a person”).
As underscored by the rich presentations and discussions at this conference, the psy-ences form complex assemblages with the institutional, political, and scientific legacies and infrastructures within the countries of Eastern Europe and Eurasia. And as such, psy-knowledge practices continue to play a crucial role in the articulation and negotiation of contemporary stakes. Drawing on a very recent example, Rebecca Reich observed that the increasing popularization of psy-discourse in Russia became apparent in the discourses surrounding the arrest of the band Pussy Riot. Not only were all three women diagnosed with mixed personality disorder, which may bring back questions of punitive psychiatry, but witnesses watching the performance – in real life, or on YouTube – reported having experienced a “light state of shock” through which the events were further framed in psychological language. (Most recently, the specter of politically-motivated psychiatric diagnosis has been further raised in the case of Mikhail Kosenko who was arrested during a 2012 protest march and subsequently sent by a court for compulsory in-patient treatment in a psychiatric hospital, after having been diagnosed with paranoid schizophrenia by specialists from the Serbsky Psychiatric Institute). Tomas Matza, in response to Reich, drew attention to the ambiguity and maybe even potential subversive effect of psy-knowledges: psychological discourses – in contrast to psychiatric discourses – also provide new “flowering spaces of interiority” which are less desired by the system. Sonja Luehrmann added to this that in the case of Pussy Riot the cooperation between the Orthodox Church and the state showed the church’s refusal to provide a space for such newly emerging interiority, from which political critique can be articulated (in this case against Putin).
Dörte Bemme is a PhD student in the Department of Social Studies of Medicine and Anthropology at McGill University. Her doctoral work focuses on the emerging concepts and infrastructures that facilitate the globalization of psychiatric knowledge. Specifically, she is interested in the ways in which the movement for Global Mental Health (GMH) operationalizes a conception of the human mind as an object of treatment that stays true both to global and local forms of knowledge, and investigates the encounter and re-negotiations of psychiatric practices that occur during projects of “knowledge translation” and “capacity building” in the context of Russian psychiatry. She can be contacted at: firstname.lastname@example.org
* The event was co-sponsored by a number of units at the University of Chicago, including the Center for East European and Russian/Eurasian Studies (CEERES), the Franke Institute for the Humanities, the Center for International Studies Norman Wait Harris Fund, the International House Global Voices Program, the Department of Anthropology, and the Department of Comparative Human Development.
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