G. Dufaud, Ph.D. in History, Researcher
Center for research in medicine, science, health, mental health, and society (CERMES3)
National Committee for Scientific Research (CNRS), Paris (France)
This article explains how a marginal method for the provision of health care became public policy in Soviet Russia and shows the role of psychiatrists within the Soviet transformative project. In Russia, as in the West, asylums were chosen as the nucleus around which to develop psychiatry. On the eve of the First World War, few psychiatrists were demanding that the network of hospitals be completed by more socially-integrated institutions whose aim would be not only to provide care in the community but also to develop prevention. Only after the October Revolution did the Commissariat for Health (Narkomzdrav) of the Russian Republic begin to address this issue. N.A. Semashko, the Commissar for Health, believed in a preventive conception of health care present in all the spheres of daily life with the aim of regenerating society. Moscow benefited more than other cities from the measures taken regarding outpatient psychiatry and mental hygiene. This town served both as a laboratory and as a model for these measures. The importance of outpatient psychiatry was nevertheless very limited during the period of the New Economic Policy (1921‒1928). The Narkomzdrav sought above all to increase the number of psychiatric institutions and to improve their medical “productivity”. Outpatient psychiatry was decreed to be a priority in 1929 as a means to help those suffering from psychological and nervous conditions caused by the country’s upheaval, but this priority did not last long: in 1931, barely two years later, the Narkomzdrav again concentrated its efforts on a network of hospitals and, in this sense, returned to the course which it had been following in the 1920s. Thus, the leading role of outpatient psychiatry proved to be short-term. Changes in health care policy indicated what role was given to psychiatrists in the Soviet transformative project and how the organized care of the population was involved in the construction of a new society based on collectivism.
Keywords: Galen, surgical technique, dissection, experimentation, neurosurgery