--------------------- Several years ago, I found in a used book store a collection of issues for the radical journal "Masses & Mainstream" which was a continuation of the earlier "New Masses." Like the "New Masses," "Masses & Mainstream" was avowedly pro-Soviet (and hence pro-Stalin) and many of its editors and contributors were members of the CPUSA while most of the contributors who were nonparty members were still nevertheless "fellow travelers." The collection that I purchased contained issues from 1949 and 1950 and were reflective of the concerns of American Communists of that time. One piece that attracted my attention was George Stewart's review of the book *Soviet Psychiatry* by Joseph Wortis, which appeared in the September 1950 issue, which follows.
Jim F. ____________________________________ When a unique book makes it appearance - a trailblazer in its field - there is always the temptation to describe it as long overdue. Yet in the case of Dr. Wortis' survey of psychiatric theory and practice in the USSR it is impossible to imagine a more apposite comment. Those American Marxists who have been engaged, in recent years, with an increasingly critical estimation of psychiatric practices and doctrines current in our country have always found themselves confronted with a question to which their own ignorance was a dusty answer: "Well, what do they do in the Soviet Union?" Many other individuals who have developed the sensible habit of looking to the Soviet Union for progressive work in the fields of science and social management have so far found their questions regarding Soviet psychiatry largely unanswered. As a result of this lack of relevant material - in English, of course - and in the face of anti-Soviet propaganda many curious opinions have developed even among progressives as to the provisions for the care of the emotionally and mental disordered in the first socialist country.
There are those who, while sympathetic to the aims of socialism, are so convinced that a collective society does not concern itself about the individual that they cannot imagine the socialist Soviet Union paying much attention to what is, in their eyes, an individual-oriented science. There are those who, quite mechanically, appear to believe that the successful establishment of socialism in a country automatically solves all personal problems and abolishes the need for psychiatry. Such a view is that of the economic determinist, who is able to overlook the heavy inheritance of capitalist ideology which must be struggled against during the entire period of transition from capitalism to the final stage of communism. There are those who remain obdurately convinced as to the unchangeableness of "basic human nature" and blandly assume that a socialist society must meet the same psychiatric problems and deal with them in the same way as a capitalist society. Finally, there are those who are convinced that the emotional problems of people are different (and very likely less severe) under socialism and that psychiatric care must also be different, but simply have little information on the actual details of Soviet psychiatric theory and practice. Wortis' book should go a long way toward clearing up mistaken viewpoints and supplying us with a great quantity of badly needed information in the process.
Since any review of so rich a book can only deal adequately with a limited number of problems, we wish to touch on only two or three which should be of the greatest interest to the American reader. First, on the general trend of Soviet psychiatry. The Soviet psychiatrist is essentially a materialist and an environmentalist. There is no room in his conceptual storehouse for instinctual drives, innate abilities or purely "psychological" explanations of human behavior. As A.N. Leontiev puts it:
". . . Only the anatomical and physical traits of the organism are innate.
These traits do not in themselves determine directly one's abilities;
abilities are formed only in the process of development of appropriate
activities. Consequently, they are dependent on the concrete
conditions which make a give activity possible."
From this it is easy to see why Soviet psychiatry stands squarely on the two pillars of neurophysiology and social manipulation (work therapy, emphasis on out-patient care rather than prolonged hospitalization, occupational re-training etc.), with pure psychotherapy playing a relatively minor role. From this also we see why the work of Pavlov has had such a deep influence on Soviet psychiatry, since while this work is not free from typical mistakes of the mechanical materialist variety, it possesses the virtue of being consistently materialist (it continuously has sought for physiological explanations of psychological phenomena) and is generally oriented toward an understanding of the learning process. It was Pavlov's influence also (combined with the basically materialist outlook of Soviet psychiatry) which, in Wortis' opinion, accounts for the enormous emphasis that Soviet psychiatrists place on physiological methods of treatment - shock treatments, neurosurgery, chemical dosage, etc. - even for those disorders which the bulk of American psychiatrists regard as purely functional (non-organic).
On the other hand, the Soviet psychiatrist is also a social scientist and engages in massive alterations of the social environment of the patient, both in management and treatment. Wortis points out that the emphasis in the Soviet Union is on out-patient care, with the hospital reserved only for the most acute and dangerous patients. It is felt that isolation from normal human society and separation from productive social labor serve to aggravate mental illness. Naturally, there is a great concentration on preventive psychiatry, and a whole network of community clinics, sheltered workshops, training and retraining facilities and elaborate systems of foster care. From this it also follows that the field of child psychiatry is enormously developed in the Soviet Union as compared as compared to the insignificant role this field plays in American psychiatry.
Thus, the general trend of Soviet psychiatry is in the direction of neurophysiology on the one hand, and social influence on the other, with the individualized, purely psychotherapeutic methods of treatment (see the discussion of psychoanalysis below) squeezed into a minor and increasingly subordinate position. To those who are familiar with the basic Marxist view of human personality, and are also aware of the immense possibilities afforded by a socialist society for environmental manipulation, this over-all direction of Soviet psychiatry appears quite logical and inevitable.
A second problem of quite general interest is, of course, the attitude of Soviet psychiatry to psychoanalysis, particularly the Freudian doctrines which today dominate in American psychiatry. It should not be news that Soviet psychiatrists are sharply critical of psychoanalysis, regarding its theories as reactionary and obscurantist and its therapeutic methods as wasteful of time and relatively ineffective. As Wortis summarizes the opinions of the leading Soviet psychiatrists, their criticisms of psychoanalysis are as follows: (1) it is ultra-individualistic, explaining social life as the sum of the behavior of individuals, rather than individual behavior as a social product; (2) Freud has no understanding of the social conditions of human behavior; (3) Freud minimizes the role of consciousness, which Soviet psychology regards as the highest product of evolution and to which it assigns the dominant role over unconscious impulses; (4) as a method of treatment it is uneconomic and wasteful since only a small number of patients can be covered by it and it "fixes the attention of the patient on intimate personal experiences," thus turning his attention away from society; (5) Freud's biologism leads him to subjective idealism, to a "negation of social influences and an explanation of the behavior of man by exclusive internal forces, through his psychological and biological drives." As E.T. Chernakov puts it:
"The constant theme of bourgeois psychology is the
problem of inner personality conflicts; the eternal
struggle of two entities: - the human and the animal;
the conscious and the unconscious; the rational and
the instinctual; the social and the biological, and so
on. . . The tenacity with which these theories persist
can be largely attributed to their usefulness to the
scientific lackeys of the ruling classes, who
utilize them for the purpose of concealing the real
contradictions which beset a class society. This
is done by presenting these contradictions as
inner conflicts, by reducing social contradictions
to the contradictory nature of the human soul."
As one reads through Wortis' book, it becomes clear that the real "doctor" in the Soviet Union is the socialist society itself, that the abolition of exploitation of man by man and, with this, the possibility of the disappearance of man's inhumanity to man provide the most important conditions for mental health. Scattered throughout the book are comments which give glimpses of the amazing possibilities inherent in a socialist society for the development of healthy personality and the treatment of the disordered, opportunities which simply do not exist in our dog-eat-dog social system. We are told, for example, that "it is the doctor's role to help the patient to rearrange his life so that he has a better schedule of work, sleep, recreation, etc.,' and we reflect wryly how rarely this is practically possible in our own country. Repeatedly it is pointed out that productive and creative work on the part of the patient is a basic therapeutic tool in the Soviet Union, and we reflect on how inappropriate such a device would be in America, where labor is most often meaningless, degrading, for the benefit of the private proprietor alone. Again, we are informed that "the cardinal virtues inculcated in children are 'love of work' and 'love of people.' In the Soviet Union it is believed that lack of these is basically responsible for most juvenile delinquency," and we comprehend why juvenile delinquency destroys thousands of youngsters annually in our country but has almost vanished as a problem in the socialist Soviet Union.
It is a real weakness of Wortis' book that much more emphasis that much more emphasis is placed upon the physiological and chemical methods of treating seriously disordered (psychotic) patients than upon the unique social arrangements of the new society. In this he may, perhaps, be mirroring the past of Soviet psychiatry, but his own account suggests that this does not yield an adequate picture of the past and present. At the end of his book he presents us with several interesting appendices, which consist of a series of translated documents from current controversy in Soviet psychiatry and psychology. From these documents, it is clear that Soviet psychiatry is passing through the same phase of searching criticism and self-criticism as has been taking place in the fields of philosophy, biology, literature, art and music. From these sharp critiques, we gather that many leading Soviet psychiatrists and psychologists have not been able fully absorb and apply in their work the basic principles of dialectical materialism, have uncritically incorporated many wholly bourgeois psychological concepts and, worst of all from the socialist point of view, have not taken as the object of their study the new Soviet man "who acts and develops under the conditions of our Soviet reality, but some human personality in general, taken abstractly and in isolation from concrete socio-economic conditions." Again and again, in these critiques, it is pointed out that Soviet psychology has not been sufficiently partisan, that it has not criticized bourgeois psychology but merely borrowed from it, that it has been eclectic. Above all, the criticisms point out that the main problem of Soviet psychology must be to study how different socio-economic conditions affect the development of personality. It is impossible to study "man in general" but only concrete men who live under concrete conditions: "the psychology of Soviet man must become the central problem of the Soviet science of psychology."
Thus, Wortis' book appears to stand on its head, and we learn, with some sense of bafflement, only when we read the last few pages that much of what has been reported to us throughout the volume about the theories and practices of Soviet psychiatry is currently under assault within Soviet psychiatry itself. This reviewer feels that Wortis' report on Soviet psychiatry is itself insufficiently dialectical, that he does not present us with an all-rounded picture of Soviet psychiatry as a living science which has passed through various phases, which has made mistakes but struggles to correct them, which has tried to purge itself of bourgeois ideology but has done so, as yet, only incompletely. The one-sided emphasis on neurophysiology in Wortis' account of Soviet psychiatry may reflect the kind of mechanical materialism with which a science newly turned towards Marxism often attempts to counter the idealist trends of bourgeois science. Thus, one feels somewhat disappointed at an account of Soviet psychiatry which spends many pages summarizing the various types of shock treatments for the psychotic patient but only a paragraph or two on the massive social effort that wiped out prostitution and has virtually eliminated juvenile delinquency as a serious problem.
Despite this shortcoming, Wortis' book is a contribution of great value to the discussions now going on in Marxist circles with regard to psychiatric theory and practice; and it provides an effective answer to the notion that a collective society ignores the welfare of the individual. The reader will be well advised, however, to read the Appendix first, so that the remainder of the book will be in proper perspective.
Above all, at a time when every medium of communication in our country is attempting to convince us that the Soviet Communists are nothing but a gang of bloodthirsty cannibals, it is enlightening to read a serious account of the considerable time, thought and energy which the socialist Soviet Union invests in the well-being of its citizens. What a contrast to our country, which reserves its most highly regarded therapeutic method for a limited number of private patients with the money to pay for it, and permits the overwhelming bulk of its people to struggle along almost without assistance in the face of the terrible pressures of a decaying society!
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