New approach to madness: the development of the outpatient psychiatry in Soviet Russia in the 1920s and in the early 1930s
Keywords:
Soviet Union, Outpatient psychiatry, public health policy, psychiatrists, mental diseasesAbstract
This article examines how a marginal method for providing health care became public policy in Soviet Russia, highlighting the role of psychiatrists within the broader Soviet transformative project. In Russia, as in the West, asylums were initially chosen as the central institutions around which psychiatry was developed. On the eve of the First World War, only a few psychiatrists advocated for a more socially integrated network of institutions that would not only provide community care but also focus on prevention.
It was only after the October Revolution that the Russian Republic's Commissariat for Health (Narkomzdrav) began to address these concerns. N.A. Semashko, the Commissar for Health, supported a preventive approach to health care that permeated all aspects of daily life, aiming to regenerate society. Moscow, more than any other city, benefited from measures related to outpatient psychiatry and mental hygiene, serving both as a laboratory and a model for these initiatives.
However, during the New Economic Policy (NEP) period (1921‒1928), the importance of outpatient psychiatry remained limited. The Narkomzdrav primarily focused on increasing the number of psychiatric institutions and improving their medical "productivity." Outpatient psychiatry was declared a priority in 1929 to address the psychological and nervous conditions caused by the country's upheavals. Despite this, the priority was short-lived; by 1931, the Narkomzdrav shifted its focus back to expanding the hospital network, reverting to the approach of the 1920s.
Thus, the leading role of outpatient psychiatry proved to be temporary. The changes in health care policy reflected the role assigned to psychiatrists in the Soviet transformative project and demonstrated how organized care was involved in constructing a new society based on collectivism.
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