Ab Imperio, 4/2014

Benjamin ZAJICEK

SOVIET MADNESS
Nervousness, Mild Schizophrenia, and the Professional
Jurisdiction of Psychiatry in the USSR, 1918–1936*

No psychiatric diagnosis is quite so linked with the repressiveness of

the Soviet government and the corruption of the medical profession as the
diagnosis of “schizophrenia.” From the late 1950s through the 1980s, Soviet
psychiatrists systematically diagnosed political dissidents as suffering from
“sluggish schizophrenia,” [vialo-tekushchaia shizofreniia], an allegedly
profound mental illness that was also extremely difficult to differentiate
from “normal” states of mental health.1 This practice was condemned by the
World Psychiatric Association and culminated in the Soviet Union withdraw-
ing from this international body in 1983 rather than face expulsion.2 This

*
An earlier version of this paper was presented at “Sciences de l’homme, sciences sociales,
sciences de la nature: Russie, XIXe − premier tiers du XXe siècle,” held at the Centre
d’études des mondes russe, caucasien et centre-européen, Paris, October 4-5, 2013. I
want to thank the conference participants, and Susan Gross Solomon in particular, for
their feedback. I also want to thank the anonymous reviewers at Ab Imperio for their
extremely useful and substantive comments on the manuscript.
1
R. A. Nadzharov. Formy techeniia // A. V. Snezhnevskii (Ed.). Shizofreniia:
Mul’tidistsiplinarnoe issledovanie. Moscow, 1972. P. 33.
2
Sidney Bloch and Peter Reddaway. Psychiatric Terror: How Soviet Psychiatry Is Used
to Suppress Dissent. New York, 1977; Theresa C. Smith and Thomas A. Oleszczuk. No
Asylum: State Psychiatric Repression in the Former USSR. New York, 1996; Vladimir
167
Benjamin Zajicek, Soviet Madness
was not, however, the first time that Soviet psychiatrists had been accused
of blurring the boundaries between sickness and health, or of misusing the
diagnosis of schizophrenia. During the 1930s, some psychiatric hospitals in
the USSR were diagnosing 80 percent of their patients with schizophrenia,3
while at the same time claiming that up to 60 percent of schizophrenics
remained undetected, living and working in the community.4 One critic,
denouncing these practices in 1936, described the situation as so out of hand
that “psychiatry as a science has begun to turn into ‘schizophren-ology.’”5
Strikingly, it was not international pressure or criticism by dissidents that
brought an end to this Stalin-era vogue for the schizophrenia diagnosis: it
was instead the Soviet government itself.
What was being diagnosed in the 1930s was not one of the major rec-
ognized subtypes of schizophrenia such as hebephrenic schizophrenia,
catatonic schizophrenia, or paranoid schizophrenia; nor was it “sluggish
schizophrenia.”6 Rather what was being diagnosed in the 1930s was some-

Bukovskii. Psikhiatricheskii GULAG // Idem. Moskovskii protsess. Paris and Moscow,

1996. Pp. 144-161.
3
G. G. Karanovich. Organizatsiia nevro-psikhiatricheskoi pomoshchi v sviazi s zadachami
postroeniia tret’ego piatiletnego plana // GARF. F. r-8009. Ministerstvo Zdravookhrane-
niia SSSR. Op. 1. D. 47. Stenogramma s’ezda psikhiatrov i nevropatologov. L. 144.
4
L. M. Rozenshtein. Psikhiatriia i profilaktika nervno-psikhicheskogo zdorov’ia //
I. S. Davydenkov and L. M. Rozenshtein (Eds.). Profilaktika nervnykh i psikhicheskikh
zabolevanii. Moscow, 1928. P. 15.
5
A. B. Aleksandrovskii. Shizoformnyi sindrom i shizofreniia // M. B. Krol’ and
A. O. Edel’shtein (Eds.). Trudy 2-go vsesoiuznogo s’ezda nevropatologov i psikhiatrov.
Moscow, 1937. P. 477.
6
A comprehensive history of the sluggish schizophrenia concept has yet to be writ-
ten. It was first proposed in the Soviet Union in the 1930s by child psychiatrist Grunia
Sukhareva. At the time she emphasized that her “vialo-tekushchaia shizofreniia” was an
altogether different disease concept than Rozenshtein’s “miagkaia shizofreniia.” David
Joravsky has argued that the later revival of “vialo-tekushchaia shizofreniia” by Andrei
Snezhnevskii and Oleg Kerbikov owed at least as much conceptual debt to Kerbikov’s
1930s-era views on mild schizophrenia as to Sukhareva’s concept. G. E. Sukhareva and
I. V. Shur. Kliniko-psikhopatologicheskie osobennosti vialo tekushchei shizofrenii (na
podrostkovom materiale) // Nevropatologiia, psikhiatriia, i psikhogigiena. 1935. No. 11.
Pp. 1-14; David Joravsky. The Stalinist Mentality and the Treatment of Schizophrenia //
William O. McCagg and Lewis H. Siegelbaum (Eds.). The Disabled in the Soviet Union:
Past and Present, Theory and Practice. Pittsburgh, 1989. Pp. 119-149; Helen Lavretsky.
The Russian Concept of Schizophrenia: A Review of the Literature // Schizophrenia
Bulletin. 1998. Vol. 24. Pp. 537-557; K. W. M. Fulford, A. Y. Smirnov, and E. Snow.
Concepts of Disease and the Abuse of Psychiatry in the USSR // British Journal of Psy-
chiatry. 1993. No. 162. Pp. 801-10.
168
 Ab Imperio, 4/2014
thing referred to as “mild schizophrenia,” a form of the disease that was,
according to the psychiatrists who diagnosed it, quite unique to the USSR. In
1936 the Commissariat of Health intervened, dissolving the research institute
most associated with “mild schizophrenia” and fundamentally reorienting
the discipline of psychiatry away from “borderline illness” and problems of
psychological adjustment and toward major mental illness and its biologi-
cal causes. Why did the Soviet government see “mild schizophrenia” as a
problem? More broadly, what does this tell us about the relationship between
psychiatric expertise and the Stalin regime?
* * *
In the late nineteenth and early twentieth centuries, Russians, like other
Europeans, were obsessed with ways in which modern industrial civiliza-
tion seemed to be causing an epidemic of mental illness and “nervousness.”
As Susan Morrisey has described, “Most fundamental in the Russian case
was its association with the achievements, identities, vices, and mores of
modern, urban civilization. Second was its focus upon the interlocking
problems of exhaustion and fatigue, stress, overstrain, and irritability, and
weakness.”7 In Russia conservative physicians used these findings to critique
modern urban life, while left-leaning physicians used it to critique the tsarist
regime. Morrisey notes, however, that all of them “located the solution less
in a repudiation of modernity, than in its advancement: the development of
medical science; the empowerment of its representatives to act in the public
interest; and the fashioning of modern, rational, health-conscious citizens.”8
Psychiatric knowledge employed in this way became more than just asylum
medicine, it became a way of holding citizens to scientifically imposed norms
of behavior, medicalizing deviance, and shaping the modern sense of self.
What emerged was a system that integrated rules derived from professional
expertise with the legal norms of the modern state, a phenomenon that has
been identified by sociologists and cultural theorists as one of the hallmarks
of modernity.9
7
Susan Morrisey. The Economy of Nerves: Health, Commercial Culture, and the Self
in Late Imperial Russia // Slavic Review. 2010. Vol. 69. P. 649. See also: Laura Goer-
ing. “Russian Nervousness”: Neurasthenia and National Identity in Nineteenth-Century
Russia // Medical History. 2003. Vol. 47. Pp. 23-46.
8
Morrisey. Economy of Nerves. Pp. 652-653.
9
Michel Foucault. Madness and Civilization. New York, 1965; Nikolas S. Rose. The
Psychological Complex: Psychology, Politics, and Society in England, 1869–1939.
London, 1985; Jan Goldstein. Framing Discipline with Law: Problems and Promises of
the Liberal State // American Historical Review. 1993. Vol. 98. Pp. 364-375.
169
Benjamin Zajicek, Soviet Madness
In 1917, Russian psychiatrists saw the new socialist government as a
natural ally in this endeavor. The Bolsheviks, they believed, would support
their efforts to use psychiatric knowledge to transform an irrational and
inhumane social system into a modern, rational, mentally healthy society.10
In his 1928 history of psychiatry, Dr. Iurii Kannabykh described the ideal
expert in this new system as
an entirely new type of physician-psychiatrist: a public servant [ob-
shchestvennik], a social pathologist, a practical psychophysiologist and
active psychotherapist, an involved participant in the fight to change
the daily lives of people with the goal of the possible total destruction
of the causes of personal, family, property, and social conflicts, and
in the name of a more perfect organization of human energy and the
invigoration of collective labor.11
Psychiatrists, in short, would use the tools of their profession to
medicalize social life, conceptualizing “normal” or “healthy” according
to objective standards of normal physiological and mental function. “So-
cialist construction,” Dr. Aaron Zalkind declared in 1930, “requires the
maximal, planned use of all sciences connected with questions of human
psycho-neurology.”12
Though Soviet psychiatrists liked to claim that they were building a
uniquely socialist approach to mental health, in fact very similar projects
could be found throughout Europe and the United States. Psychiatrists in
Germany in the 1880s and 1890s, inspired by the ideal of preventative medi-
cine, had begun to develop a public mental health system they referred to as
“psycho-hygiene.”13 A similar effort began in the United States in 1909 with
the foundation of the National Committee for Mental Hygiene. Over the next
two decades, mental hygiene became an international phenomenon, inspir-
ing reform legislation throughout the United States and Europe.14 In short,
there was nothing distinctly “Soviet,” or even distinctly “socialist,” about
10
Irina Sirotkina. Diagnosing Literary Genius: A Cultural History of Psychiatry in Russia,
1880–1930. Baltimore, 2002; Julie Vail Brown. Revolution and Psychosis: The Mixing
of Science and Politics in Russian Psychiatric Medicine, 1905–1913 // Russian Review.
1987. Vol. 46. Pp. 283-302.
11
Iu. Kannabikh. Istoriia psikhiatrii. Moscow, 1994 [1928]. P. 505.
12
Quoted in: David L. Hoffmann. Cultivating the Masses: Modern State Practices and
Soviet Socialism, 1914–1939. Ithaca, 2011. P. 107.
13
Eric J. Engstrom. Clinical Psychiatry in Imperial Germany: A History of Psychiatric
Practice. Ithaca, 2003. Pp. 174-198.
14
Shorter. History of Psychiatry. Pp. 160-161; Frankwood E. Williams (Ed.). Proceedings
of the First International Congress on Mental Hygiene. Vol. 1. New York, 1932. Pp. 86-143.
170
 Ab Imperio, 4/2014
the Soviet approach to preventative psychiatry. As historian David Hoff-
man has pointed out, this was typical of many early Soviet social programs.
Marxist-Leninist ideology, Hoffmann argues, “offered little guidance on how
to produce a socialist society,” thus leaving Bolshevik leaders dependent on
experts to provide the tools that would enable them to give content to the
gauzy notion of socialism.15 As a result, the specific programs and policies
that provided the foundations for the Soviet state were remarkably similar
to the programs and policies being developed by other modernizing states
around the same time, programs that would ultimately produce the modern
welfare state. “Building socialism was not only indebted to specialists,”
Hoffmann concludes, “… it realized their dreams of refashioning the social
order, albeit in an extremely brutal manner.”16
In the short run, “building socialism” looked as if it would indeed re-
alize the dreams of Soviet psychiatrists. In the 1920s, the newly created
Commissariat of Health provided support for plans to institutionalize a
system of preventative medicine, and psychiatrists succeeded in gaining
jurisdiction not only over the insane but also over cases of “nervousness”
and alcoholism.17 In the 1930s, however, psychiatrists found their authority
challenged by other stakeholders within the Stalinist system. Their focus on
prevention was severely criticized, as was their attention to cases of “ner-
vousness” and “Soviet exhaustion.” By 1936 it was becoming increasingly
clear that “building socialism” would not mean realizing the dreams of the
psychiatrists. Why did the Soviet government turn on psychiatry, and what
(if anything) does this tell us about the status of psychiatric knowledge in
the Soviet Union and about Stalinist methods of governance?
Historian David Joravsky has argued that the 1930s shift away from
“nervousness” and prevention and toward problems of major mental illness
should be understood mainly as a practical matter, a logical reallocation
of resources that “one would reasonably expect of a very small profes-

15
Hoffmann. Cultivating the Masses. P. 311. For an analysis of this prerevolutionary
professional discourse in Russia, see: Daniel Beer. Renovating Russia: The Human Sci-
ences and the Fate of Liberal Modernity, 1880–1930. Ithaca, 2008.
16
Hoffmann. Cultivating the Masses. P. 2.
17
Irina Sirotkina. Toward a Soviet Psychiatry: War and the Organization of Mental Health
Care in Revolutionary Russia // Frances Lee Bernstein, Christopher Burton, and Dan
Healey (Eds.). Soviet Medicine: Culture, Practice, and Science. DeKalb, 2010. Pp. 28,
37; Susan Gross Solomon. David and Goliath in Soviet Public Health: The Rivalry of
Social Hygienists and Psychiatrists for Authority over the Bytovoi Alcoholic // Soviet
Studies. 1989. Vol. 41. Pp. 254-275.
171
Benjamin Zajicek, Soviet Madness
sion in a very large and backward country.”18 David Hoffmann makes
much the same argument in regard to the broader field of social medicine.
While their more ambitious schemes were abandoned in the near term, he
argues, their goals and modus operandi remained unchanged.19 Though
scarce resources were certainly significant, this article argues that, at least
in the case of psychiatry, ideology played a no less important a role. The
authority of psychiatric knowledge rested on a particular epistemology and
a particular way of conceptualizing society, and these proved incompatible
with the Leninist revivalism and neotraditionalism of the Stalin era. Over
the course of the 1920s and 1930s, the Soviet state developed a complex
(and sometimes contradictory) system for cataloging and managing its
population. The system that emerged was one that emphasized the rela-
tionship between people and the regime, both at the level of social groups
(kulaks, proletarians, “former people,” and so forth), and at the level of
individuals, where what mattered was conscious dedication to the cause
of building socialism.20 Through technologies of policing, registration,
public witnessing, and mutual surveillance, the Stalin regime created a
highly articulated mechanism for controlling and shaping norms of social
life and individual behavior. Psychiatric knowledge was not among these
mechanisms. Soviet psychiatrists employed a “regime of truth” that rested
on a statistical conception of normal human capacities and asserted the
ability of the clinician to use this knowledge to place the individual into
his or her natural position within the social body. These claims of authority
over what kind of action was “normal” for each individual clashed with the
Leninist notion that class consciousness and individual willpower could
overcome physical limitations, and also clashed with the “neotraditionalist”
concept that ascribed one’s status in society based on one’s relationship
with the regime. The controversies over “Soviet exhaustion” and “mild
schizophrenia” demonstrate the ways in which psychiatric knowledge in the
Soviet Union was shaped and reshaped by the ideological and institutional
demands of the Stalin era.

18
Joravsky. Russian Psychology. P. 420. See also: Idem. The Construction of the Stalinist
Psyche // Sheila Fitzpatrick (Ed.). Cultural Revolution in Russia, 1928–1931. Bloom-
ington, 1978. Pp. 105-128.
19
Hoffmann. Cultivating the Masses. Pp. 12-13.
20
David Priestland. Stalinism and the Politics of Mobilization: Ideas, Power, and Terror
in Inter-War Russia. Oxford, 2007. Pp. 35-49; Sheila Fitzpatrick. Ascribing Class: The
Construction of Social Identity in Soviet Russia // Journal of Modern History. 1993.
Vol. 65. Pp. 745-770.
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 Ab Imperio, 4/2014
* * *
The key figure in shaping the Soviet Union’s psychiatric system dur-
ing the 1920s and 1930s was a man named Lev Rozenshtein. Born in
1884, Rozenshtein was the son of a physician in provincial Ukraine. He
attended gymnasium, studied at Odessa University, and was arrested there
for “revolutionary activity” in 1905. He subsequently studied psychiatry in
Moscow under famed professor Vladimir Serbsky.21 It was in Moscow that
Rozenshtein developed his interest in the “dispensary” as an institution that
could be used to combat “nervousness” in the Russian population. Rozen-
shtein was active in organizing conferences and professional organizations
before the war, and was well connected to leading figures within Russian
academic psychiatry. During the war he worked as a frontline psychiatrist,
publishing extensively on “traumatic neurosis” and psychotherapy. In 1919
he was part of the group that established Narkomzdrav’s Neuropsychiatric
Section and helped write the mental illness sections of the RSFSR’s first
legal code. Rozenshtein’s revolutionary bona fides and his enthusiasm for
social hygiene made him appealing to leaders of Narkomzdrav, and they
helped him to establish a special clinic in Moscow to study early “borderline
cases” of mental illness.22 By the mid-1920s, Rozenshtein was serving as
the scientific secretary of Narkomzdrav RSFSR.23
The relationship between professionals and the new Soviet state was by
no means easy in the 1920s. Two research institutes, the Neuropsychiatric
Institute and the Institute of Experimental Psychology, were initially cre-
ated under the Commissariat of Enlightenment (Narkompros) in 1920. They
brought together innovative psychologists, psychiatrists, and neurologists
who were particularly interested in developing methods of studying “ner-
vousness” and its relation to the social environment.24 By 1923, however,
the leaders of these institutes had made clear that they would not go along
with a “Marxist reconstruction” of psychology, and they were removed from
their posts.25 In 1924 the Neuropsychiatric Institute was transferred to the
21
Rozenshtein, Lev Markovich // Bol’shaia meditsinskaia entsiklopediia. Moscow, 1984.
Vol. 22. P. 366.
22
Iu. S. Savenko. 120-letie L’va Markovicha Rozenshteina// Nezavisimyi psikhiatricheskii
zhurnal. 2004. http://npar.ru/journal/2004/3/rozenschtein.htm. Last visit: May 5, 2014.
23
Sirotkina. Diagnosing Literary Genius. P. 173.
24
The institute was directed by neuropathologist V. V. Kramer, psychiatrists A. N. Ber-
nshtein and F. E. Rybakov, and psychologist A. P. Nechaev. T. I. Iudin. Ocherki istorii
otechestvennoi psikhiatrii. Moscow, 1951. P. 405.
25
Joravsky. Russian Psychology. Pp. 223-224. Savenko. 120-letie L’va Markovicha
Rozenshteina.
173
Benjamin Zajicek, Soviet Madness
Commissariat of Public Health (Narkomzdrav), where it was reorganized as
the State Neuropsychiatric Dispensary. In 1928 it became the Kramer Insti-
tute of Neuropsychiatric Prophylaxis.” Lev Rozenshtein was its director.26
As its name implied, Rozenshtein’s institute sought to realize the prerevo-
lutionary ideal of prevention. Rozenshtein and his colleagues called their
field psikhogigiena, a term that they explicitly translated as “mental hygiene,”
acknowledging their debt to the movement founded in the United States by
Clifford Beers and Adolf Meyer in 1909.27 (Meyer visited the Soviet Union
several times over the course of the 1920s and 1930s, declaring in 1934 that
“they know what they are about.”28) For Rozenshtein and his colleagues,
the goal was to establish social facts about the mental health of society and
to create rational, targeted interventions that sought to end “nervousness”
and prevent mental illness, especially schizophrenia. The goal, Rozenshtein
wrote in 1925, was “not only a ‘renovation of labor’ but also a ‘revolution
in daily life.’”29 Assessing their successes and failures from the perspective
of 1931, another leader of the movement summarized their program as “the
organization of the new man in the new social order.”30
Rozenshtein explicitly sought to develop new medical institutions that
aimed to radically improve the mental health of the Soviet population. Rather
than “passively” waiting for patients to come to psychiatrists for help, Soviet
psychiatrists would now actively monitor the population and seek to maintain
the mental health of citizens.31 The institutions responsible for this would
be “neuropsychiatric dispensaries.” These small units bore some similarity
to outpatient psychiatric clinics, but their primary goal was to undertake
26
Iudin. Ocherki istorii. P. 405. Rozenshtein, Lev Markovich // Bol’shaia meditsinskaia
entsiklopediia. P. 366.
27
L. M. Rozenshtein. Psikhiatriia i profilaktika nervno-psikhicheskogo zdorov’ia //
I. S. Davydenkov and L. M. Rozenshtein (Eds.). Profilaktika nervnykh i psikhicheskikh
zabolevanii. Moscow, 1928. Pp. 22-29.
28
Dr. Adolf Meyer Gives Forum Audience Picture of Russia // The Sun. Baltimore.
1934. January 23. P. 14.
29
Rozenshtein. Osnovnye problemy nevro-psikhiatrickheskoi dispanserizatsii // A. I.
Miskinov, L. A. Prozorov and Rozenshtein (Eds.). Sovetskaia meditsina v bor’be za
zdorovye nervy. Samara, 1926. P. 146.
30
L. A. Prozorov. Nevro-psikhiatricheskie dispansery i nevro-psikhiatricheskie otdeleniia
dispansernykh ob’edenenii v 1929, 1930 g. // Zhurnal nevropatologii i psikhatrii. 1931.
No. 1. P. 74.
31
Rozenshtein. Dispanserizatsiia i psikhiatriia // Sbornik posviashchennyi Vladimiru
Mikhailovichu Bekhterevu. K 40-letiiu professorskoi deiatel’nosti (1885–1925). Len-
ingrad, 1926. Pp. 633-637. See also: Sirotkina. Psikhopatologiia i politika: Stanovlenie
iedei i praktiki psikhogigieny v Rossii // Voprosy istorii estestvoznaniia i tekhniki. 2000.
No. 1. Pp. 154-177.
174
 Ab Imperio, 4/2014
medical surveillance of the population.32 Multidisciplinary groups were or-
ganized to “dispensarize” people in specific regions or institutions. In order
to prevent and treat neuropsychiatric disorders, they argued, they needed to
“undertake a preventative registration of psychophysical health.” This would
enable them to identify common psychological problems and psychiatric ill-
nesses, “deviations from health,” and to “determine the need for changes and
improvements of one sort or another in conditions of labor and daily life.”
Continual medical surveillance and repeated dispensarization would allow
them to measure and track the transformation of neuropsychiatric health.33
The first neuropsychiatric dispensaries opened their doors in 1925.
They were envisioned as interdisciplinary enterprises, encompassing social
work, psychology, education, psychiatry, industrial psychology, and even
sociology. Each would be assigned a region with a population of around
200,000 that they would “dispensarize,” a process that involved studying
the environmental and social conditions of the neighborhood, working up
“sanitary passports” for workplaces and schools, and conducting physical and
psychological examinations of individuals.34 These examinations focused
particularly on past history of “frights, household conflicts, mental trauma,
nervous shocks, and head injuries,” and repeatedly prompted respondents
to discuss symptoms of fatigue. Physical proportions and psychological
function (memory, reaction time, etc.) were measured carefully.35 These
“dispensarizations” were sometimes conducted jointly with closely re-
lated disciplinary groups, particularly the psychotechnics specialists at the
Obukhov Institute of Vocational Illnesses. Together they brought together
physical exams, personality tests, questionnaires, and medical inventories
of psychological and psychiatric symptoms.36
The initial results of neuropsychiatric dispensarization suggested “mas-
sive nervousness.”37 A study of workers at the Stalin Metallurgical Factory,
32
The neuropsychiatric dispensary was modeled on the tuberculosis dispensary, an orga-
nization that was embraced by tuberculosis specialists in the USSR but had its origins in
nineteenth-century France. Michael Zdenek David. The White Plague in the Red Capital:
The Control of Tuberculosis in Russia, 1900–1941/ Ph.D. dissertation; University of
Chicago, 2007. Pp. 64-68, 225-268.
33
Rozenshtein. O nevro-psikhiatricheskoi dispanserizatsii // Miskinov, Prozorov and
Rozenshtein (Eds.). Sovetskaia meditsina v bor’be. P. 22.
34
Ibid.
35
Ibid. Pp. 30-31.
36
Ibid. P. 29.
37
On the “crisis of nervousness” in the 1920s, see: Frances Lee Bernstein. The Dictator-
ship of Sex: Lifestyle Advice for the Soviet Masses. DeKalb, 2007. Pp. 73-99.
175
Benjamin Zajicek, Soviet Madness
for instance, concluded that 42.9 percent of workers were suffering from
neurasthenia, and that among crane operators the figure was 75 percent.38
At the Ukrainian Institute of Marxism-Leninism, 88.7 percent had “injuries
of the nervous system,” 75 percent had cardiovascular problems, 45 percent
had problems with their lungs, and 42 percent had digestive tract problems.39
A study of 1,500 students at the Timiriazev Agricultural Academy (TSKhA)
in Moscow found that a majority had some sort of nervous condition. The
most common symptoms were headaches, dizziness, irritability, increased
fatigue, sleepiness, and insomnia. When asked to describe their symptoms
of fatigue, students talked about feeling “physically broken down,” “apa-
thetic,” “sluggish,” and “sleepy.” Symptoms of nervousness particularly
showed up in “the emotional sphere (depressed mood), tendency toward
obsessive behaviors, hallucinations, sleep disorders, and autonomic nervous
system disorders.”40
What did these symptoms mean? In the case of the Agricultural Acad-
emy, Rozenshtein and his team concluded that these symptoms were largely
caused by living conditions. Among their practical recommendations were
the suggestions that the Academy begin to clean away garbage, fix the water
supply, provide the dormitories with proper heat, and provide shelving and
some sort of electric lamps to students. Students were to be given courses
in basic hygiene and more fresh vegetables to eat.41 In this view, symptoms
like fatigue or headaches, or even paranoia and obsessions, could best be
understood as normal responses to difficult conditions. As one staffer at the
Institute of Neuropsychiatric Prophylaxis wrote, they were best understood
“not as illness, but as reactions.”42 Each individual had different physical and
psychological tolerances, and thus each individual would react differently as
“the subject attempts to adjust to surroundings that he is not equipped for,
and in relation to which he feels weak.”43 “Nervousness” was conceptual-
38
E. M. Zalkind, A. I. Ponizovskaia, and I. E. Finkel’. Psikhonevrologicheskoe obsle-
dovanie podzemnykh rabochikh rudnika “Oktiabr’skaia revoliutsiia” // Sovetskaia
nevropatologiia, psikhiatriia i psikhogigiena. 1932. No. 9-10. P. 472.
39
L. L. Rokhlin. Psikhogigienicheskaia rabota sredi partaktiva // Zhurnal nevropatologii
i psikhiatrii. 1930. No. 3. Pp. 24-30.
40
Rozenshtein. Nervno-psikhicheskoe zdorov’e studentov Timiriazevskoi sel’sko-kho-
ziastvennoi akademii // I. S. Davydenkov and Rozenshtein (Eds.). Profilaktika nervnykh
i psikhicheskikh zabolevanii. Moscow, 1928. Pp. 109, 118-119, 131, 138.
41
Ibid. P. 136.
42
S. A. Liozner. Obshchie printsipy profilaktiki nevrozov // Davydenkov and Rozenshtein
(Eds.). Profilaktika nervnykh i psikhicheskikh zabolevanii. P. 68.
43
Ibid. P. 74.
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 Ab Imperio, 4/2014
ized as a quantitative variation from the norm, not a qualitatively different
state. The frequency and magnitude of symptoms like exhaustion, apathy,
or obsession were problematic, but the reactions themselves were normal.
The role of the expert was to assess the relationship between the individual
and the environment. In cases such as the dormitory at the Agricultural
Academy, the environment might be fixable: lighting could be improved,
schedules could be regularized, and diet could be raised to meet the needs of
workers. Students’ bodies would respond to these improved conditions and
they would become more productive, more focused, and more physically fit.
Another study, this one focusing on students at the Ukraine Institute of
Marxism-Leninism, found that Party activists were under a different type
of environmental strain. Most worked at least twelve hours a day, had no
regular working schedule, never took a day off, and slept less than six hours
a night. As the report’s author diplomatically wrote, these Party workers
experienced “emotional saturation, combined with constant feeling of
responsibility.” 44 These pressures might be enough to overwhelm anyone,
but the researchers found that most of these activists had a history of physi-
cal and psychological injuries going back to the prerevolutionary period.
Half of them had been “repressed” by the tsarist regime for revolutionary
activity, and during the war most of them had spent years at the front. Most
(69.8 percent) had experienced starvation, 56.1 percent had been infected
with typhus, 30 percent had suffered physical trauma, 15.8 percent had
suffered concussion, and 38.1 percent had suffered psychological traumas
[psikhicheskie travmy].45 In most cases, the author argued, the damage could
be cured. The activists needed rest, regular sleep, and a consistent schedule
of work. Most students could be taught how to successfully adapt to the
physical and social demands of the job. The exceptions were those who
were physiologically more “reactive” than others. These students’ bodies
simply could not be made to function effectively in a noisy factory, a high-
pressure university, or stressful Party leadership job. For them, the pressures
of constructing socialism were simply too much. The mental hygienists’ job
was to identify these individuals and to match them with professions and
working environments where they could function successfully.46 By studying
the interaction between human physiology and the environment, experts in
the psychological sciences could determine where and how an individual
was best suited to work.
44
Ibid. Pp. 24-26.
45
Rokhlin. Psikhogigienicheskaia rabota sredi partaktiva. Pp. 25-26.
46
L. L. Rokhlin. Trud, byt i zdorov’e partiinogo aktiva. Dvou, 1931. Pp. 136-137.
177
Benjamin Zajicek, Soviet Madness
One controversial theory argued that, in certain cases, nervousness could
cease to be a temporary “reaction” and become a permanent state of disability.
In the mid-1920s, Moscow psychiatrist P. B. Gannushkin claimed to have
discovered a syndrome he called “acquired mental disability” [nazhitaia
psikhicheskaia invalidnost’]. These were people between twenty and thirty
years old who were had symptoms of “resistant weakening of the psyche.”
They were irritable, depressed, and often had problems related to past psy-
chological traumas that “were not registered at the time.” Unlike people with
“functional neurasthenia,” Gannushkin claimed, these people were not helped
by rest. He blamed the “tempo of our time,” and the “excessive strain both
mental and physical,” particularly on the still-developing bodies of young
people. The result, he concluded, was that the brain was simply worn out.
What had begun as normal strain and developed into a permanent condition.47

* * *
The Institute of Neuropsychiatric Prophylaxis understood its task to be
extraordinarily broad. A mental hygiene poster that the institute placed in
Moscow factories illustrates the range of problems that they sought to take
on. The poster read:
In order to protect the mental health of the workmen, the Institute
has opened a Central Mental Hygiene Consultation Clinic to which
you may go for advice from the physician on the following: 1. Fatigue,
nervousness, and how to deal with it; 2. How to stop smoking and
drinking; 3. Sex life and health; the hygiene of marriage; 4. Marriage
and children for those who intend to get married; 5. The selection of
a profession; 6. Work and rest.48
All aspects of life could be rationalized, and each individual and each
environment could be adapted to one another. Between 1921 and 1932,
roughly 600 books and articles were published on subjects that could be
broadly classified as “social psychoneurology and mental hygiene.”49 With
the help of scientific expertise, Soviet citizens could become healthy, well-
adjusted, and productive contributors to socialist society.
47
P. B. Gannushkin. Ob odnoi iz form nazhitoi psikhicheskoi invalidnosti // Idem (Ed.).
Trudy psikhiatricheskoi kliniki (Devych’e Pole). Vol. 2. Moscow, 1926. Pp. 52-60. See
also: Joravsky. The Construction of the Stalinist Psyche.
48
Williams (Ed.). Proceedings. P. 152.
49
Bibliograficheskii ukazatel’ sovetskoi literatury po voprosam sotsial’noi psikhonevrolo-
gii i psikhicheskoi gigieny s 1921 po 1932 g. // Sovetskaia nevropatologiia, psikhiatriia
i psikhogigiena. 1933. No. 10. Pp. 163-178.
178
 Ab Imperio, 4/2014
By the early 1930s Rozenshtein had reason to be optimistic that his
vision of “neuropsychiatric prophylaxis” was becoming a reality. Twenty-
nine neuropsychiatric dispensaries had been opened, most of them in the
RSFSR. The city of Moscow, where neuropsychiatric dispensaries had first
been established in the 1920s, was divided into forty districts and served by
ninety-seven psychiatrists who were actively seeing patients and studying the
people under their jurisdictions. In 1930 most neuropsychiatric dispensaries
reported an average of about 15,000 visits, representing between 2,000 and
6,000 individual patients per dispensary. (There were outliers. The dispensary
in Kostroma, for instance, reported seeing only 1,504 patients in a year, but
they visited on average 26.8 times, for a total of 39,865 visits.).50 In addition,
mental hygiene offices were opened in some factories – particularly those
in Moscow, and in unified medical dispensaries and hospitals.51
During the First Five-Year Plan, cadres of young psychiatrists and psy-
chologists – Rozenshtein among them − seized control of the “psychoneu-
rological front.” Rozenshtein’s Institute of Neuropsychiatric Prophylaxis
was catapulted into a leading role within Soviet psychiatry.52 In September
1930, the institute was designated as the “leading institute” in the field of
psychiatry, responsible for all issues of mental hygiene, alcoholism, and the
treatment of alcoholics.53 In 1931 the institute took over the publication of
the Korsakov Journal of Neuropathology and Psychiatry. The cover, which
had retained its prerevolutionary graphic design until 1930, was symbolically
replaced by a modern, constructivist-inspired layout, and the journal’s name
was changed to Soviet Neuropathology, Psychiatry, and Mental Hygiene.
According to the lead article in the first issue, the new title reflected the
importance of mental hygiene as the most pressing task of psychoneurology
in the Second Five-Year Plan.54

50
L. A. Prozorov. Nevro-psikhiatricheskie dispansery i nevro-psikhiatricheskie otdeleniia
dispansernykh ob’edenenii v 1929, 1930 g. // Zhurnal nevropatologii i psikhatrii. 1931.
No. 1. Pp. 76-77.
51
Williams (Ed.). Proceedings. P. 152.
52
Moskovskoe obshchestvo nevropatologov i psikhiatrov im. Kozhevnikova pri 1
MGU. Reorganizatsiia obshchestva // Zhurnal nevropatologii i psikhatrii. 1930. No. 3.
Pp. 99-100.
53
Rozenshtein and G. Karanovich to M. F. Vladimirskii. O rekonstruktsii nevro-psikhi-
atricheskogo dela v RSFSR // GARF. F. a-482. Ministerstvo Zdravookhraneniia RSFSR,
1918–1991. Op. 24. D. 3. L. 304.
54
Resheniia XVII partiinoi konferentsii i zadachi zhurnala // Sovetskaia nevropatologiia,
psikhiatriia i psikhogigiena. 1932. No. 1-2. Pp. 8-9.
179
Benjamin Zajicek, Soviet Madness
* * *
In 1931 the fortunes of the Institute of Neuropsychiatric Prophylaxis
began to change. That year Joseph Stalin signaled a change in the priori-
ties of the regime, and the Commissariat of Public Health began to shift
away from social hygiene and preventative medicine and toward a medical
system that prioritized the needs of heavy industry.55 In the spring of 1931
the new Commissar of Public Health, M. F. Vladimirskii, publicly rebuked
psychiatrists for publishing studies that suggested that Party work was caus-
ing “nervousness” and “early acquired invalidism” in Party activists.56 In
December 1931 Rozenshtein was brought to the Commissariat to explain
how he planned to fix the problems in psychiatry, but his presentation failed
to impress his audience.57 The young Communist psychiatrists who wrote
the public editorial condemning Rozenshtein made clear that his mistake
involved more than just a misallocation of resources. The entire project of
“mental hygiene” had sought to use scientific expertise to assert jurisdiction
over a vast range of social and personal problems, bringing these experts
into direct competition with the Party itself. Rozenshtein was accused of
“crude theoretical and practical deviations in the area of mental hygiene” and
blasted for his uncritical acceptance of the ideological assumptions embed-
ded in American mental hygiene. He was quoted as having written that “in
the new society [mental hygiene] should be the organizer of interpersonal
relations.”58 Such a claim was beyond the pale, and labeled as a form of
“left deviation.” Socialist construction, not mental hygiene, was the tool that
the Party had chosen to create a new man. In so far as it had a role at all,
mental hygiene was to be subordinated to the needs of the working class.59
Mental hygienists had assumed that their goal of bringing “rational hab-
its” and “hygiene” to every part of Soviet life was the same as the Party’s goal
of creating a socialist society. But their claims to unique expert knowledge
about problems of work, study, and everyday life brought them into direct
conflict with the priorities of industrial managers, collective farm chairmen,

55
Chris Burton. Medical Welfare During Late Stalinism: A Study of Doctors and the Soviet
Health System, 1945–1953 / Ph.D. dissertation; University of Chicago, 2000. Pp. 69-123.
56
Joravsky. The Construction of the Stalinist Psyche. Pp. 115-117.
57
GARF. F. a-482. Op. 24. D. 3. O rekonstruktsii nevropsikhiatricheskoi pomoshchi. Ll.
303-317; Rozenshtein. O rekonstruktsii nevropsikhiatricheskoi pomoshchi // Sovetskaia
nevropatologiia, psikhiatriia i psikhogigiena. 1932. No. 3-4. Pp. 63-64.
58
D. E. Stolbun and A. S. Shmar’ian. Pis’mo t. Stalina i zadachi nevropsikhiatricheskogo
fronta // Sovetskaia nevropatologiia, psikhiatriia i psikhogigiena. 1932. No. 1-2. P. 19.
59
Ibid. Pp. 20-21.
180
 Ab Imperio, 4/2014
and Communist Party activists. Experts on the “psychoneurological front”
were told to make their work “more concrete” – to acknowledge that their
expertise gave them jurisdiction over specific types of illness, not over so-
cial relations in general. Schizophrenia – particularly in its “acute and early
forms” – was singled out as an example of the concrete disease entities that
required increased concern. The goal was to use neuropsychiatric dispen-
saries to catch schizophrenia very early on, enabling psychiatric hospitals
to being treatment at the earliest possible stage of illness.60
Chastened, Rozenshtein, announced that during the Second Five-Year
Plan his institute would focus on providing care to people suffering from
major mental illness, not on treating people who were simply overworked
or unmotivated. Their new goal would be to eliminate the term “nervnost’”
altogether and to replace it with clear, unambiguous language. “Usually,”
he wrote, “mildly developing mental illness is called ‘nervousness’ and
only extreme cases are called ‘mental illness’ [psikhicheskaia bolezn’];
we need to be done with this once and for all.” If a problem was caused
by actual damage to nerves, then experts needed to clearly describe it as a
neurological problem. If it was a problem of fatigue, it should be called that.
If the problem was mental illness, then it should be called mental illness,
even if it was extremely mild.61 Under Stalinism, psychiatrists were to have
professional jurisdiction over people suffering from specific disease entities,
conditions that were qualitatively different from normal health. Fatigue,
headaches, problems of social adjustment, and other “normal” reactions
to difficulty were to be the jurisdiction of industrial managers, teachers,
and Party activists, not psychiatric professionals. The job of psychiatrists
was to study and treat specific mental diseases, not to study and treat the
society as whole.
During the period between 1931 and 1936, the Institute of Neuropsy-
chiatric Prophylaxis continued to operate as the “leading” research institute
in Soviet psychiatry, and mental hygiene and psychiatric dispensarization
continued to be actively practiced. But psychiatrists were now on guard:
they were careful to stress the ways in which Soviet mental hygiene was
different from American mental hygiene; they stressed the goal of improving
mental health in order to speed up production and socialist construction, not
60
M. O. Gurevich and A. S. Shmar’ian. Itogi konferentsii po shizofrenii, pri IVND
Komakademii i Obshchestve nevropatologov i psikhiatrov v Moskve, 20-23 Iuliia
1932 g. // Sovetskaia nevropatologiia, psikhiatriia i psikhogigiena. 1932. No. 8. P. 455.
61
Rozenshtein. O rekonstruktsii nevropsikhiatricheskoi pomoshchi // Sovetskaia nev-
ropatologiia, psikhiatriia i psikhogigiena. 1932. No. 3-4. P. 70.
181
Benjamin Zajicek, Soviet Madness
to safeguard the neuropsychiatric health of the individual.62 Psychotechnics
and pedology were under pressure during the same period, particularly after
the Nazi seizure of power in Germany in January 1933. Intelligence test-
ing in particular was criticized as a Fascist technology, and along with it
other psychological tests that quantified human qualities in a dimensional
perspective around a statistical norm. 63 In May 1935 Ordzhonikidze spoke
publicly about the ways “in which technical norming held back the devel-
opment of [heavy industry] and the example of shock workers should be
used to overcome its impeding influence.”64 The Stakhanovite movement
that was announced shortly thereafter stood as a repudiation to the whole
idea of refraining from overstressing the human body.
It was during this period that Rozenshtein and his colleagues began to
publish about a new disease entity, “mild schizophrenia.” Schizophrenia,
according to the 1933 edition of the Great Soviet Encyclopedia, was “the
most common mental illness, and brings about profound changes in the
whole mental personality with … particular splitting of the psyche with loss
of its wholeness and internal unity.”65 According to the standard textbooks
of the time, schizophrenia usually began slowly. The sufferer began to
fail at work, “to lose willpower,” to develop delusions, and to suffer from
a “separation between ideas and affect.” At first parents or friends might
pass these symptoms off as laziness, shyness, or daydreaming. Eventually,
though, the schizophrenic would develop profound problems in relation to
other people, cease to function at work, and withdraw from society.66
The definition of schizophrenia was clear enough in its broad outlines,
but the concept itself was actually fraught with problems. Stated simply,
schizophrenia was confusing because there were no identifying symptoms.
All the symptoms most associated with schizophrenia could be found in
other types of mental illness. Hallucinations, delusions, emotionlessness,
disorganized thought: none of them could be used to definitively diagnose
schizophrenia. Some psychiatrists even argued that there was no such thing
62
L. L. Rokhlin. Itogi raboty i zadachi psikhogigieny v SSSR // L. L. Rokhlin and
O. I. Vol’fovskii (Eds.). Trudy pervogo ukrainskogo s’ezda nevropatologov i psikhiatrov.
Khar’kov, 1935. Pp. 571-596.
63
Nikolai Kurek. Istoriia likvidatsii pedologii i psikhotekhniki. St. Petersburg, 2004.
Pp. 97-111.
64
The paraphrase of Ordzhonikide is Kurek’s. Kurek. Istoriia likvidatsii pedologii i
psikhotekhniki. P. 108.
65
V. A. Giliarovskii. Shizofreniia // Bol’shaia sovetskaia entsiklopediia. 1933. No. 62.
Moscow, 1933. Pp. 383-384.
66
M. O. Gurevich and M. Ia. Sereiskii. Uchebnik psikhiatrii. Moscow, 1928. Pp. 307-308.
182
 Ab Imperio, 4/2014
as schizophrenia – it was simply a word that indicated lack of knowledge,
not a word that corresponded to a real phenomenon.67 The majority of psy-
chiatrists argued that schizophrenia did exist, but they did not agree on how
it was to be recognized. The result was that two psychiatrists might both
use the word “schizophrenia,” but in fact have in mind two very different
diseases. In an influential article, historians of psychiatry German Berrios,
Rogelio Luque, and Jose Villagran have argued that no continuity should
be assumed between the diseases described by various researchers, even if
they used the same terms to describe their objects of study. “The history of
schizophrenia,” they conclude, “can be best described as the history of a
set of research programs running in parallel rather than seriatim and each
based on a different concept of disease, of mental symptoms and of mind.”68
The term “schizophrenia” was itself very new in the 1920s. Until the
late nineteenth century, psychiatrists in Russia, like their counterparts in
Europe, had diagnosed psychotic patients with a bewildering array of differ-
ent illnesses. Some of these illnesses were defined by their most prominent
symptoms (mania, melancholy), while others were defined by their causes
(febrile delirium, neurosyphilis).69 In the 1890s, German psychiatrist Emil
Kraepelin had drastically simplified this approach. Kraepelin started from
the assumption that the cause of most psychiatric diseases was unknown.
Rather than group them by cause, he instead gathered large numbers of
patient files and grouped them by age of onset, course of illness, and
outcome. Individual patients might have symptoms that were specific to
them, and these symptoms might change over time, but the identity of the
underlying disease entity could be discerned despite this surface variability.
For Kraepelin, what mattered was the pattern of change over time: the age
and manner of onset, the course of illness, and the outcome. These distinct
patterns enabled researchers to reveal the presence of a specific biological
“disease entity.”70
67
G. E. Sukhareva. K probleme edinstva shizofrenii // Sovetskaia psikhonevrologiia.
1935. No. 6. Pp. 122-139.
68
German E. Berrios, Rogelio Luque, and Jose M. Villagran. Schizophrenia: A Conceptual
History // International Journal of Psychology and Psychological Therapy. 2003. Vol. 3.
No. 3. P. 134. Scientific consensus about the nature and causes of schizophrenia remains
elusive. For the most recent large-scale meta-analysis of schizophrenia research, see R.
Tandon, M. S. Keshavan, and H. A. Nasrallah. Schizophrenia, “Just the Facts”: What We
Know in 2008. Part 1: Overview // Schizophrenia Research. Vol. 100. 2008. Pp. 4-19.
69
For a short history of psychiatric classification in Russia, see V. P. Osipov. Kurs obsh-
chego ucheniia dushevnykh bolezniakh. Berlin, 1923. Pp. 592-619.
70
Shorter. History of Psychiatry. Pp. 99-109.
183
Benjamin Zajicek, Soviet Madness
Kraepelin used this method in the textbook that he published in 1896,
and refined it in the edition published in 1899. Psychoses with clearly es-
tablished biological causes were each given their own category. Psychoses
without known cause were reduced to two basic categories. The first, manic
depression, began later in life, went through cyclical periods of improvement
and decline, and ended in recovery. The second, “dementia praecox,” began
early in life, grew progressively worse over time, and ended in “profound
defect.”71 These categories drastically simplified psychiatrists’ work, gave
them a framework for scientific research, and enabled them to give their
patients a prognosis. In the case of dementia praecox, however, the prognosis
was bleak. It was, by definition, both irreversible and profoundly debilitat-
ing. It was widely assumed to have hereditary causes and to be exacerbated,
or perhaps caused, by the stresses of modern life. Psychiatrists were unable
to do much more than offer palliative care. Their best hope, they admitted,
was to find cases of dementia praecox as early as possible and to attempt to
prevent the disease from fully developing by sending the patient to a healthy,
unstressful rural location.72
Kraepelin’s dementia praecox concept was quickly and widely adopted
in Russian psychiatric practice in the 1890s and early 1900s, and it became
one of the most widely diagnosed forms of illness. Even in this early period,
however, the validity of the dementia praecox concept was challenged. Many
psychiatrists, including Kraepelin himself, pointed out that some patients
developed dementia praecox later in life and that some recovered. In 1908
Swiss psychiatrists Eugen Bleuler and Carl Jung proposed an alternate con-
cept. They posited a disease that was characterized by a loss of connection
between mental faculties (thought, feeling, volition). This “splitting,” they
argued, presented the mind with sensations that were strange and difficult
to interpret, and in its struggle to cope, the mind produced “secondary
symptoms,” such as hallucinations, delusions, lack of emotion, and demen-
tia. Just what caused the initial “splitting” of mental faculties was unclear.
Bleuler assumed that some “toxin” was physically affecting the biological
substrate of the mind.73

71
Ibid. Pp. 101-106; Richard Noll. American Madness: The Rise and Fall of Dementia
Praecox. Cambridge, MA, 2011. Pp. 58-64.
72
V. M. Maliavinskii. Review of B. I. Vorotynskii. “K ucheniiu o tak nazyvaemoi demen-
tia praecox. (Dementia primaria degenerativa).” Russkii Vrach 1913, No. 5 // Zhurnal
nevropatologii i psikhatrii im. S. S. Korsakova. 1913. No. 2. P. 343.
73
Noll. American Madness. Pp. 237-242. Edward Shorter. A Historical Dictionary of
Psychiatry. Oxford, 2005. Pp. 267-272.
184
 Ab Imperio, 4/2014
Bleuler’s “schizophrenia” concept was rapidly adopted in Russia. Its
utility was clear: where a definitive diagnosis of Kraepelin’s disease had
required longtime observation of a pattern of change over time, Bleuler’s
disease simply required careful clinical observation of symptoms and be-
havior at a single moment in time. Furthermore, “schizophrenia” helped to
bring clarity to a much broader range of disorders, essentially any case of
bizarre or disordered thinking where the clinician could detect the primary
symptoms of psychological “splitting” through psychological testing and
observation.74 As the authors of a 1928 Soviet psychiatry textbook noted,
“Bleuler not only gave dementia praecox a new name, he also significantly
expanded its boundaries.”75 Bleuler’s concept offered more complexity, at
the cost of loss of clarity.
Unlike Kraepelin, Bleuler also offered some hope for patients: he found
that about 20 percent were expected to recover spontaneously. Even so,
most sufferers would be left with serious or even profound mental “defect.”
The pessimism that this engendered led late imperial psychiatrists to focus
on possible methods of prevention. The only real hope was to catch it in
its early stages, and they sought to educate the public about the many bad
habits and risk factors that might provoke its development, among them
alcohol abuse, overwork, poor living conditions, and, above all, bad hered-
ity. Those who had already developed early symptoms of the disease were
told to take work that was “low in responsibility,” with “minimal mental
stress,” and to get plenty of fresh air and fresh food.76 As a result, the “fight
against schizophrenia” was caught up in broader questions about the causes
of mental illness in modern society, and about the role of medical experts
in crafting social policy.
In the early twentieth century, Russian psychiatrists interested in “bor-
derline illness” and personality disorders [psikhopatii] had theorized that
everyone possessed “schizophrenic traits,” which under most circumstances
were experienced as normal parts of psychological life such as introversion,
shyness, or “scattered thoughts.” In some people these qualities might be
more pronounced than in others, and under certain circumstances they
might become heightened, evoking “schizophrenic reactions.” In these cases
people might begin to act in seemingly bizarre ways and find normal life
difficult – they had developed schizophrenia, or perhaps “schizoid neuro-
74
M. O. Gurevich and M. Ia. Sereiskii. Uchebnik psikhiatrii. 5th ed. Moscow, 1946. P.
113; Noll. American Madness. Pp. 236-238.
75
Gurevich and Sereiskii. Uchebnik psikhiatrii. P. 288.
76
Ibid. P. 310.
185
Benjamin Zajicek, Soviet Madness
sis” – but their symptoms were not different in kind from the normal mental
phenomena found in healthy individuals, and their reactions themselves
might be understood as “normal” responses to abnormal circumstances.77
This idea found support in Blueler’s concept of “latent schizophrenia,” and
was bolstered in the 1920s by a growing body of international literature,
particularly the work of Ernst Kretchmer and Adolf Meyer.78 Soviet neu-
ropsychiatric dispensaries used a standard form that included the category
“schizoid neurosis,” a concept used by both Gannushkin and Kretchmer as
a way of making sense of this type of symptom.79
Rozenshtein first described his concept of “mild schizophrenia” at a
conference held in June 1932, just three months after he was publicly cen-
sured by the Commissariat of Public Health. Rozenshtein reported that he
and the psychiatrists at the Institute of Neuropsychiatric Prophylaxis had
discovered a new disease. Sufferers were described as withdrawn or asocial,
they had feelings of “sluggishness,” “apathy,” “depression,” and irritability,
and experienced odd bodily pains and “neurotic reactions.” In the past, they
had often been diagnosed as suffering from neurasthenia or exhaustion.80
Rozenshtein and his team now disputed this diagnosis. He claimed that by
watching patients perform various activities, such as working, drawing,
and engaging in group games, he was able to detect signs of an underlying
disease process. Their “schizophrenic creations” revealed the “splitting”
that was affecting their psyche.81 According to Rozenshtein, these were not
simply people who were introverted, shy, or overworked.82 Nor were they
people suffering from the early stages of what would later become full-blown
schizophrenia. Rather they were suffering from “mild schizophrenia,” a
distinct disease caused by underlying psychopathological processes. “Mild
schizophrenia,” Rozenshtein wrote, was “sui generis … with its own methods

77
P. B. Gannushkin. Postanovka voprosa o shizofrenicheskoi konstitutsii // Izbrannye
Trudy. Rostov n/D, 1998. Pp. 325-350.
78
Kannabikh. Istoriia psikhiatrii. Pp. 473-486; Idem. K istorii voprosa o miagkikh formakh
shizofrenii // Sovetskaia nevropatologiia, psikhiatriia i psikhogigiena. 1934. No. 5. Pp.
6-13; M. O. Gurevich and M. Ia. Sereiskii. Uchebnik psikhiatrii. P. 288.
79
Rozenshtein. O nevro-psikhiatricheskoi dispanserizatsii // Miskinov, Prozorov and
Rozenshtein (Eds.). Sovetskaia meditsina v bor’be. P. 33.
80
Rozenshtein. Problema miagkikh form shizofrenii // P. B. Gannushkin, et al. (Eds.).
Sovremennye problemy shizofrenii: Doklady na konferentsii po shizofrenii v iiune 1932.
Moscow, 1933. Pp. 91-92.
81
Ibid. P. 95.
82
B. D. Fridman. Osnovnye voprosy postroeniia miagoi formy shizofrenii // Sovetskaia
nevropatologiia, psikhiatriia i psikhogigiena. 1934. No. 5. P. 24.
186
 Ab Imperio, 4/2014
of study, its own particular prognosis and social significance.”83 Rozensh-
tein speculated that these were perhaps people who might have developed
full-blown schizophrenia under different social circumstances. Under the
benign effects of Soviet socialism, however, the devastating disease was
transformed into something benign, “mild,” prepsychotic, easily mistaken
for quirk of personality. “It has become clear that the new social base not
only can give new content to psychosis, but causes a different formation of
even an endogenous disease process in one or another concrete personality.”84
Soviet conditions produced distinctly Soviet madness.
In developing this disease concept, Rozenshtein explicitly rejected Krae-
pelin’s focus on onset, course, and outcome. Kraepelin had been limited
by the type of clinical studies he was able to do, Rozenshtein explained.
Working in “a clinic … that was in essence a psychiatric hospital without
ambulatory material,” Kraepelin had only been able to study people with a
“formal diagnosis of mental illness.” Soviet neuropsychiatric dispensaries
had new possibilities that had been unavailable to Kraepelin. They had
collected data for more than a decade, conducting “long-term observation
of psychopathological formations on the border of health and nonhealth.”85
No single symptom could be used to diagnose mild schizophrenia. Their
symptoms, in fact, might even “appear in the forms that are of a different
sort [from schizophrenia], even symptoms that are mutually exclusive of
schizophrenia.” But the experienced clinician would notice “microsymp-
toms” that, when seen as a whole, would alert the attentive psychiatrist to
the presence of a developing disease process.86
Rozenshtein went out of his way to show that he had taken to heart the
message that psychiatrists were to study specific diseases. And yet the people
who fell into this new category were strikingly similar to those who had pre-
viously been described as “nervous.” Like people who had been described as
“nervous,” these patients suffered from “inadequate pathological reactions
to normal life situations.”87 Now, however, rather than presenting these as
normal reactions to bad circumstances, Rozenshtein reconceptualized the
symptoms as signifiers of a discrete disease process. It would not matter if
the individual were moved to a different social environment, or if the environ-
ment around him were changed. The problem was internal to the individual.
83
Rozenshtein. Problema miagkikh form shizofrenii. P. 91.
84
Ibid. P. 90.
85
Ibid. P. 87.
86
Ibid. P. 91
87
Fridman. Osnovnye voprosy postroeniia miagoi formy shizofrenii. P. 18.
187
Benjamin Zajicek, Soviet Madness
Trauma and the memory of trauma were important as well. Like the “ner-
vous” Party activists who had been studied in the 1920s, people suffering
from “mild schizophrenia” were often found to have a history of physical
and psychological injuries, and to recall them vividly. A person with mild
schizophrenia could be profoundly affected by past events. In these patients
in particular, one of Rozenshtein’s colleagues wrote, “A random attack by
thieves in childhood can leave … an unsettling memory of that for the rest
of his life.”88 While the activists of the 1920s had been particularly affected
by the events of 1914–21, those suffering from “mild schizophrenia” in the
1930s seem to have been particularly affected by the upheavals caused by
early 1930s collectivization and industrialization. In one case, for instance,
the director of a sovkhoz had worked doggedly to transform his sovkhoz and
to put it into “first place” in his region, “practically not sleeping over the
course of two months.” While in Leningrad to receive a medal he went to a
clinic for a checkup and they diagnosed him with mild schizophrenia. Rather
than treating his condition as a “normal” reaction to an extreme situation,
psychiatrists instead had reconceptualized the physical and psychological
toll of collectivization as a distinct form of madness.89
Between 1932 and 1936, Soviet psychiatrists far beyond the Institute
of Neuropsychiatric Prophylaxis adopted and used the concept of “mild
schizophrenia.”90 Articles presenting research findings and case studies on
“mild schizophrenia” appeared in the medical press quite regularly alongside
other research on schizophrenia. Rozenshtein himself did not live to see this
success. He died unexpectedly in 1934, and was eulogized by his colleagues
and students for his contributions to clinical psychiatry, psychopathology,
and mental hygiene.91 At the same time, however, other Soviet psychiatrists
were openly expressing alarm. While Leningrad psychiatric hospitals were
diagnosing 30.7 percent of patients with schizophrenia, Moscow hospitals
were diagnosing 50.8 percent with schizophrenia, and one Moscow hos-
pital had gone as high as 80.6 percent.92 The editors of Nevropatologiia i
88
Ibid. P. 19.
89
V. P. Osipov. O raspoznavanii skhizofrenii // M. B. Krol’ and A. O. Edel’shtein (Eds.).
Trudy 2-go vsesoiuznogo s’ezda nevropatologov i psikhiatrov. 25-29 dekabria 1936 g.
Moscow, 1937. P. 463.
90
V. A. Giliarovskii. Spornye voprosy v sovremennom uchenii o shizofrenii // Nevropa-
tologiia, psikhiatriia, i psikhogigiena. 1936. No. 10. Pp. 1597-1598.
91
Lev Markovich Rozenshtein: 1884–1934 // Problemy nevrastenii i nevrozov. Moscow,
1934. P. 1.
92
G. G. Karanovich. Organizatsiia nevro-psikhiatricheskoi pomoshchi v sviazi s
zadachami postroeniia tret’ego piatiletnego plana // GARF. F. r-8009. Ministerstvo
188
 Ab Imperio, 4/2014
psikhiatriia published a cautionary note in 1934,93 and in 1935 Leningrad
psychiatrist Victor Osipov published an article titled “The Borders of
Schizophrenia, Its Mild Forms, and Their Careless Diagnosis.” He expressed
extreme skepticism about diagnosing schizophrenia on the basis of so-called
microsymptoms, and was particularly dismissive of “schizophrenia without
schizophrenic symptoms,” concluding that “Surely we cannot take this turn
of phrase literally.”94
The critics pointed out that “mild schizophrenia” had been defined in a
profoundly vague way. Perhaps a clinician as experienced as Rozenshtein
could find symptoms of disease hidden beneath the nonschizophrenic ex-
terior, but less-skilled psychiatrists tended to rely on shortcuts, particularly
their sense that a patient demonstrated “incomprehensibility” [neponiat-
nost’] or “atypicality” [netipichnost’].95 Just what was “incomprehensible”
or “atypical” was never clearly defined – clinicians were expected to know
it when they saw it. But this obviously opened the door for both mistaken
diagnosis and intentional abuse, and by 1936 critics had accumulated ex-
amples of both. In one case, a twenty-two-year-old peasant from an isolated
village had come to Moscow for military service. He suffered from extreme
shyness, and when his sister came to visit him he refused to come out to
meet her, fearing, apparently, that she would make fun of him. “This was
enough,” according to the report, “that he was labeled with schizophrenia
and ‘not fit for military service.’”96 In a more sinister example, a Party ac-
tivist clashed with the teachers and commanders at his military school. His
commander sent him to a medical commission, which claimed that he was
suffering from a “disorder of comprehensible thinking,” and certified him
as suffering from mild schizophrenia.97
The Party’s July 1936 ban on psychological testing in education and its
subsequent orders in September about labor selection underscored its rejec-
tion of the possibility of scientific technologies for the scientific administra-
tion of individuals and populations in terms of their mental attributes and
Zdravookhraneniia SSSR. Op. 1. D. 47. Stenogramma s’ezda psikhiatrov i nevropa-
tologov. L. 144.
93
Fridman. Osnovnye voprosy postroeniia miagoi formy shizofrenii. P. 14.
94
V. P. Osipov. Granitsy shizofrenii, ee miagkie formy i ikh legkomyslennoe raspozna-
vanie // Sovetskaia nevropatologiia, psikhiatriia i psikhogigiena. 1935. No. 7. Pp. 16-18.
95
A. O. Edel’shtein. K suzheniiu granits shizofrenii // M. B. Krol’ and A. O. Edel’shtein
(Eds.). Trudy 2-go vsesoiuznogo s’ezda nevropatologov i psikhiatrov. 25-29 dekabria
1936 g. Moscow, 1937. P. 493.
96
Osipov. O raspoznavanii skhizofrenii. P. 463.
97
Ibid. P. 462.
189
Benjamin Zajicek, Soviet Madness
capacities. No direct mention was made of mental hygiene or psychotechnics,
but the Party directive explained that the impersonal expertise derived from
tests should not be allowed to subvert the power of school teachers and prin-
cipals. The same logic could obviously be extended to psychotechnics and,
despite the efforts of psychotechnics researchers to defend their discipline,
their society was closed and their labs were liquidated.98
Psychiatrists understood the pedology decree to have direct application
to their discipline as well, and the discussions of “mild schizophrenia” that
had begun in 1935 and spring 1936 were now revisited.99 At their All-Union
Congress in 1936, psychiatrists spent an entire day debating the problem of
schizophrenia and working out just how the pedology decree applied. Psy-
chiatrist Akim Edel’shtein argued that pedology’s mistake was in treating a
test taken on a given day as indicative of the essential and immutable qualities
of the child. “The same symptom seeking and microscope-ism,” he claimed,
could be found “when we approached the problem of schizophrenia.”100
Leningrad psychiatrist Victor Osipov made the parallel between pedology
and mental hygiene explicit in a 1939 article, appropriately titled, “Questions
of Norm and Pathology in Psychiatry.” What educational psychologists had
done, he said, was to assume that their tests revealed a continuum between
norm and pathology, one in which being a “disruptive” or “difficult” child
could be conceptualized as a medical problem. But such children were not
sick, Osipov emphasized. They were simply difficult. The same could be said
of people who were introverted, shy, and easily traumatized. Such people
were not suffering from an illness. Dealing with such people was the domain
of bosses, factory committees, party activists, and other authorities in the
realm of public and private life. The domain of psychiatry was illness, and
illness was a qualitatively different state from health.101 This qualification
was embedded in later editions of Soviet psychiatric textbooks. Thus the
1946 edition of Gurevich and Sereiskii’s Textbook of Psychiatry defined
schizophrenia as a “formal disorder of the psyche … leading to a qualitative
degradation of the whole personality.”102
The two central modes of expert knowledge that had been used by psy-
chiatrists and mental hygienists in the 1920s and 1930s had been repudiated.

98
Kurek. Istoriia likvidatsii pedologii i psikhotekhniki. Pp. 118-119.
99
Edel’shtein. K suzheniiu granits shizofrenii. P. 489.
100
Ibid. P. 490.
101
Osipov. Voprosy normy i patologii v psikhiatrii // Nevropatologiia i psikhiatriia. 1939.
No. 1. Pp. 10-11.
102
Gurevich and Sereiskii. Uchebnik psikhiatrii. 5th ed. P. 331.
190
 Ab Imperio, 4/2014
The impersonal statistical claims about normal human qualities were no
longer accepted. The alternative advanced by Rozenshtein and the Institute
of Neuropsychiatric Prophylaxis had been a fine-grained phenomenological
reading of psychopathology. While the authority of mental hygiene, psy-
chotechnics, and applied psychology more broadly rested in impersonal sta-
tistics allegedly derived from nature itself, the phenomenological approach
of clinical psychiatry derived its authority from the subjective judgment
of the clinician. While a virtuoso like Rozenshtein might see through the
layers of normal psychological debris and find hidden disease processes,
other clinicians examining “borderline” conditions might easily diagnose
neurasthenia, hysteria, or simply fatigue. The results were neither replicable
nor verifiable.
What was left? Osipov emphasized the importance of Kraepelin’s origi-
nal concept – the mandatory progressive development of dementia ending
in “profound defect.” Schizophrenia was by definition an organic disease,
probably caused, he speculated, by a “multiglandular dysfunction,” which
disturbed the body’s endocrine system, causing “toxins” to spread through
the body, affecting the tissues of the nervous system and the brain. The
progressive damage done by these toxins could account for the usual pro-
gressive course of the disease. Changes in the amount or rate of toxin could
account for oddities, of course. Some people might have nervous systems or
brain tissue that was simply hereditarily more resistant to the toxin or less
susceptible to damage, and thus schizophrenia could develop at different
rates and did not always have a fatal outcome.103 Psychiatrists needed to
stop fetishizing symptoms and “microsymptoms,” Osipov concluded, and
focus on the biological essence of the disease. The key was for psychiatrists
to avoid making diagnoses on the basis of symptoms seen in one moment.
Only if we study the course of the illness and the personality of the
patient, the origins of every symptom … can we conclude that at its
cause lies a developing process with an organic basis.104

* * *
In a speech given shortly after Rozenshtein’s death in 1934, one of his
close collaborators wrote that,

103
Osipov. Granitsy skhizofrenii. P. 8. The theory that schizophrenia was caused by
“autointoxication” was common in the United States and Europe during the same period,
and had been particularly promoted by Kraepelin. Noll. American Madness. Pp. 116-124.
104
Osipov. O raspoznavanii skhizofrenii. Pp. 464-465.
191
Benjamin Zajicek, Soviet Madness
mental hygiene strives to bring psychoneurological competency beyond
the narrow circle of the stunted, the anomalous [nepolnotsennykh,
anomalii]… and apply that psychoneurological competence to the
organization of behavior of individuals and, particularly, to the orga-
nization of the concrete surrounding environment, the organization of
production, labor, and daily life.105
Psychometric statistics collected through organizations like neuropsychi-
atric dispensaries were used to define a normal range of human capacities,
and experts proposed to use these figures to control the way that workers
worked and students studied. In certain social and cultural contexts, such
as the United States, this approach was extremely successful, and mental
hygiene helped to enormously expand the role of psychological expertise,
psychiatry, psychometrics, and related disciplines in the twentieth century.106
In the Soviet Union, however, this approach ran counter to the way in which
the Party conceived of “normal.” In the context of Stalinism, populations
were classified according to their relationship to the regime, not according
to their physiological capacities. People suffering from physical “anomalies”
could be ceded to the jurisdiction of psychiatrists; the “organization of the
concrete surrounding environment, the organization of production, labor,
and daily life” could not. Class-conscious workers could not be limited by
the constraints of fatigue. The concept of “mild schizophrenia” had been
developed as a way for psychiatrists to retain professional jurisdiction over
everyday problems while still limiting themselves to “disease” narrowly
construed. In the short run this failed; the Stalin regime jealously guarded
the boundaries of its own control. In the long run, the concept provided a
tool that was picked up by the Soviet psychiatrists of the 1950s and 1960s.
That the post-Stalin regime found it useful to “depoliticize” dissent by cat-
egorizing it as illness highlights one of the differences between the Stalin
regime and the regime that came after.

105
Rokhlin. Itogi raboty i zadachi psikhogigieny v SSSR. P. 579.
106
Hans Pols. Managing the Mind: The Culture of American Mental Hygiene, 1910–1950 /
Ph.D. dissertation; University of Pennsylvania, 1997; Rose. Psychological Complex;
Theodore M. Porter. Measurement, Objectivity, and Trust // Measurement. 2003. Vol.
1. No. 4. Pp. 241-255.
192
 Ab Imperio, 4/2014
SUMMARY

Between 1931 and 1936, psychiatrists in the Soviet Union diagnosed

large numbers of people with “mild schizophrenia,” a “neurosis-like” form
of schizophrenia that was allegedly unique to the USSR. In 1936 the USSR
Commissariat of Public Health intervened, dissolving the research institute
most associated with “mild schizophrenia” and fundamentally reorienting
the discipline of psychiatry away from “borderline illness” and problems of
psychological adjustment and toward major mental illness and its biologi-
cal causes. This article examines the origins of the “mild schizophrenia”
concept and seeks to understand why the Soviet government saw “mild
schizophrenia” as a problem. More broadly, it examines the relationship
between psychiatric expertise and the state during the period of high Stalin-
ism. The author finds that the concept of “mild schizophrenia” was closely
associated with psychiatrists at the Institute of Neuropsychiatric Prophylaxis,
particularly its director, Lev Rozenshtein. In the 1920s these psychiatrists
sought to create a new discipline, psikhogigiena, which they identified as
part of the international mental hygiene movement established by Ameri-
can psychiatrist Adolf Meyer. The Soviet mental hygienists envisioned a
countrywide network of “neuropsychiatric dispensaries” that would study
environmental and social conditions in order to improve mental health and
prevent mental illness. This work brought Rozenshtein and his colleagues
into conflict with the Communist Party authorities. Using the category of
“mild schizophrenia,” psychiatrists were attempting to define normalcy in
terms of psychometric and social indices, not in terms of political or ideo-
logical consciousness. Party authorities insisted that medical expertise gave
jurisdiction only over specific types of illness, not over conditions of work
and life in general. In response Rozenshtein and his colleagues reformulated
their claims in the form of a biological disease entity, “mild schizophrenia.”
By disbanding Rozenshtein’s institute and denouncing the concept of “mild
schizophrenia,” authorities reestablished firm jurisdictional boundaries for
psychiatrists. As a result, Soviet psychiatry was oriented firmly toward a
conception of psychiatric illness as biological disease.

Резюме

В 1931−36 гг. советские психиатры диагностировали многочислен-

ные случаи “мягкой шизофрении”, т.е. шизофрении по типу невроза,
которая предположительно являлась характерной именно для СССР. В
193
Benjamin Zajicek, Soviet Madness
1936 году в ситуацию вмешался Народный комиссариат здравоохране-
ния, распустив исследовательский институт, развивавший концепцию
“мягкой шизофрении”. Комиссариат здравоохранения фундаментально
переориентировал психиатрическую науку с изучения “пограничных
заболеваний” и проблем психологической адаптации на исследова-
ния базовых психических заболеваний и их биологических причин.
Настоящая статья прослеживает эволюцию проблематики “мягкой
шизофрении” в контексте противостояния психиатрической экспер-
тизы и государства в годы высокого сталинизма. Концепцией “мягкой
шизофрении” активно интересовались психиатры из Института не-
вропсихиатрической профилактики под руководством директора Льва
Розенштейна. В 1920-х годах они пытались создать новую дисциплину
– психогигиену, которую понимали как составляющую международ-
ного движения за психическую гигиену, основанного американским
психиатром Адольфом Мейером (Adolf Meyer). Советские психогигие-
нисты мечтали о сети “невропсихиатрических пунктов”, разбросанных
по всей стране. Эти учреждения должны были изучать природные и
социальные условия на местах с целью улучшить душевное здоровье
и предотвратить заболевания. Деятельность в этом направлении при-
вела к конфликту Розенштейна и его коллег с партийными органами.
Работая с понятием “мягкой шизофрении”, психиатры стремились
выразить нормальность в психометрических и социальных индексах,
а не в терминах политического и социального сознания. Партийные
власти, напротив, настаивали на том, чтобы юрисдикция медицинской
экспертизы относилась только к специфическим типам заболеваний,
но не к условиям работы и жизни в целом. Постулирование “мягкой
шизофрении” как биологического заболевания и было ответом Ро-
зенштейна и коллег на партийную позицию. Распустив руководимый
им институт и разоблачив концепцию “мягкой шизофрении”, власти
установили жесткие границы юрисдикции психиатров. В итоге со-
ветская психиатрия оказалась четко ориентированной на концепцию
психиатрического заболевания как биологического феномена.

194