The History of Russian Therapy at the University of Oxford

Pavel Vasilyev at the Max Planck Institute for Human Development in Berlin recently let us know about a brilliant conference which took place at the Wellcome Trust Unit for the History of Medicine at the University of Oxford over the summer on the theme of ‘therapy’ or ‘lechenie’ in Russian culture through history. Many thanks to Pavel, and to Dan Healey for permission to reprint his conference report here.

Continuity and Change in Russian Therapy, St Antony’s College, University of Oxford, 5-6 June 2014
A workshop on the history of Russian medicine, convened by: Dan Healey, St Antony’s College, Oxford Fran Bernstein, Drew University Chris Burton, University of Lethbridge
Participants:
Andy Byford, Durham University; Johanna Conterio, Harvard University; Michael David, University of Chicago; Don Filtzer, University of East London; Susan Grant, University College Dublin; Claire Griffin, University of Cambridge; Simon Pawley, University of Oxford; Kenneth Pinnow, Allegheny College; Matthew Romaniello, University of Hawaii; Irina Sirotkina, Institute for the History of Science and Technology, Russian Academy of Science; Susan Gross Solomon, University of Toronto; Tricia Starks, University of Arkansas; Anna Temkina, European University of St Petersburg; Pavel Vasilyev, Max Planck Institute for Human Development; Ben Zajicek, Towson University.

The workshop was held over two days, with an energising opening discussion about the theme of “lechenie” (therapy, treatment) in the social and cultural history of Russian medicine, followed by five two-hour sessions in which fourteen pre-circulated research papers were discussed. We closed with remarks from Professor Susan Gross Solomon and another general conversation on Russian and Soviet therapy, and prospects for studying its history.

As ever in the history of Russia, we found much continuity across the “revolutionary divide” of 1917. As well, we noted many commonalities with international practices. Russia’s connections with transnational and global circuits of knowledge and trade were well developed from the time of Ivan the Terrible. Clare Griffin showed how courtiers in sixteenth- and seventeenth-century Muscovy had access to medical substances from extensive global trading networks, while Matthew Romaniello demonstrated how even in the early nineteenth century Russian sailors still suffered from acute scurvy despite educated elite knowledge of preventative measures.

More commonalities emerged in papers on the late-nineteenth and twentieth-century treatment of social diseases, where personal morality, failure of willpower, and economic forces were perennial factors for tsarist and Soviet doctors combatting drug and tobacco addiction, discussed by Pavel Vasilyev and Tricia Starks, respectively. Similarly, as Michael David demonstrated, tuberculosis treatment in the Soviet era underwent a politicised evolution that elevated this classic social disease of the working class to a priority while at the same time evoking embarrassment as living conditions deteriorated catastrophically during the Five-Year Plans of the 1930s-40s. Therapy was both a set of practices and a metaphor for individual and social transformation.
In papers by Andrew Byford, Kenneth Pinnow, and Christopher Burton the changing nature of the Russian and Soviet doctor-patient relationship, and the ethics of that encounter, was tracked from the late nineteenth century to the 1950s. This session explored the shifting nature of therapy and concepts close to it: the relationship between diagnosis, therapy and consequence (Pinnow); the interaction between medical and non-medical jurisdictions in the case of “defectologists” and “pedologists” in tsarist and Soviet education (Byford); and the contingency and ambiguity of the “medical mistake” under Late Stalinism (Burton).
A significant cluster of papers focused on psychiatry and the care of mentally ill patients; this subfield remains a highly productive one in critical histories of Russian and Soviet medicine. The asylum environment, and occupational therapy, drew attention in papers by Simon Pawley, Irina Sirotkina, and Susan Grant. These scholars identified the therapeutic setting, patient sub-cultures, and the relationship between patients and lower-level medical staff as new and compelling areas of research. Labour therapies were widely discussed in numerous papers; the contrast with Benjamin Zajicek’s compelling paper on Soviet psychopharmacology was striking. Intriguingly, despite the rise of a Soviet psychopharma, its defects did not allow for wholesale de-institutionalization in the USSR.

 
As historians of Russian medicine we still find accessing patient voices challenging. Two very different papers sought out these voices. Johanna Conterio’s study of Soviet Black-Sea medical sanatoria clients of the 1930s-1940s discovered tensions between patients’ expectation of full cures and the medically prescribed ‘treatment without cure’. Sociologist Anna Temkina’s interviews with today’s users of maternity clinics offered patient perspectives on the quality of care and how this is structured by inadequate levels of information and trust. In Russia the doctor-patient relationship reflects the difficulties of restructuring social relationships in a time of economic and political transformation.

 
The workshop identified many directions that future research could take. Susan Solomon pointed out how therapy sat within a nest of contexts: of the chain of medical processes, as well as within a wider social and cultural ‘non-medical surround’. She asked how portable therapies were in the Russian context – given the huge size of the country – and how detachable from context therapeutic practices were. More attention needs to be paid to disputes over therapies, to patient bodies, emotions, and responsibility. Further research to uncover patient voices would enable us to understand how Russians made sense of modern medicine in the context of the world’s first socialist state.
The convenors are editing selected contributions for publication and are making plans to bring this network of social and cultural historians of Russian and Soviet medicine together for future research initiatives.

 

Dan Healey, St. Antony’s College, Oxford

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Facing the interwar crisis: eugenics and ‘racial’ history in Bulgaria

By Gergana Mircheva

The emergence of eugenic ideas in Bulgaria can be dated to the beginning of the twentieth century, but the sense of an overall social crisis after 1918 radicalized projects for ‘national redemption’ by preserving and increasing the health capital of the Bulgarian people.

Bulgarian eugenic discourse can be explored as a multiform hygienic utopia, having certain points of intersection with biology, anthropology, social and mental hygiene, preventive medicine and ‘folk psychology’. What linked all of these discourses were various combinations of organicist concepts and visions of social change elaborated for solving communal issues within the common field of biopolitics. Bulgarian eugenic and biopolitical projects, therefore, can be addressed as a contribution to the heterogeneous cultural and political strategies of reconstructing modernity, national identity, and the forms of experiencing time during this period.

Identity formation and representation are always linked to a ‘regime of historicity,’ perceived as ‘the method of self-awareness in a human community’ and ‘the way in which a society considers its past and deals with it’[i]. Eugenics in Bulgaria implied a broader project for national identity. Within this framework, the interwar crisis was transcribed in biomedical terms as ‘degeneration,’ that is, as a kind of ‘illness’ of the nation envisaged as an organism. The concept of degeneration thus marked the interwar crisis of national identity. From Benedict Morel (1809–73) onwards, degeneration was conceived as a hereditary process of consecutive regression of humans from a normal type. The early ‘symptoms’ of alleged decay, however, dated back to the fin-de-siècle, when the first signs of social criticism against the negative effects of modernization in Bulgaria appeared. Thus, degeneration also signified the crisis of Bulgarian modernization, which, in turn, referred in a complex way to the Western crisis of modernity. Eugenics represented a specific version of what Roger Griffin called ‘programmatic modernism,’ that is, a socially transformative reaction to modernity perceived as decadence[ii].

With regard to collective identity projects, the concept of race was used by most Bulgarian eugenicists in the broad meaning of ‘biological community.’ The racial–anthropological theory of the prominent Bulgarian biologist, Prof. Metodiy Popov (1881–1954) was widely shared by eugenicists. Popov, who graduated in natural sciences from the University of Sofia and [iii]received a doctoral degree at the University of Munich, denied the existence of pure races. He claimed that all European nations had originated from the mixing of five main races. The specific ratio of the different racial elements formed the European national bodies and determined their racial physiognomies[iv]. Following the work of the German psychiatrist Ernst Kretschmer (1888–1964), Popov considered the mixing of races beneficial, if carried out between racial elements of equal or superior quality. Hence, in eugenic usages the concept of race was more or less ‘fluid,’ for it functioned as a synonym of ‘tribe,’ ‘people,’ and ‘nation.’ ‘Race’ signified the biological substrate or quintessence of the Bulgarian people.

popov

Under the theoretical framework of Metodiy Popov, who did not use the notion ‘degeneration,’ but implied a reference to it, social decay was not an independent process of consecutive regression. It was part of a repetitive cyclical structure, which was described as ‘a sine wave of the progress and decline of nations’ (p. 139). The biologized explanation of Bulgarian history that Popov (p. 148) provided aimed to strengthen the destabilized national identity: ‘an endless hereditary chain unites us,’ he wrote; ‘it links us spiritually to our past and shows us the way to our future.’ The meanings of the social could therefore be illuminated and mastered by ‘exact’ biological knowledge. The problem of history and its genealogy was reconceptualized as a problem of inheritance that concerned the genetics of the nation.

In France, where the theory of dégénérescence was created, the medical concern with hereditary social pathology was conflated with ‘fears about a fundamental disorder of national history’[v]. A sense of the pathological repetition of revolutionary time, after 1848, put the optimism of liberal progressivism at stake and signaled a crisis of linear time (p. 54). Following a similar pattern, Popov’s writings presented selected periods of historical time as biological cycles of rise and fall, depending on the quality and intensity of racial mixtures among the population, as well as on the natural selection of social elites. Thus, the traditionally high historical value of Tsar Simeon’s reign (893–927)[vi] was reinforced as a later ‘biological consequence’ of the amalgamation of Slavic, proto-Bulgarian, and Thracian tribes; these tribes formed the ‘racial’ substrate of the Bulgarian state. The wars of the First Bulgarian Kingdom[vii] had exhausted the state, Popov (p. 127) argued, but the territorial expansion achieved created conditions for ‘salutary’ racial mixtures. Ottoman rule limited the mobility of the population and the opportunities for marriages between Bulgarians from different parts of the former Bulgarian lands. Even though the ‘Turkish yoke’ did not considerably change the racial proportions of the national body, national decay was inevitable, given the extermination of the social elite. Centuries were needed for positive selection among the broad masses to create the new distinguished families who were to take the lead in the National Revival[viii] (pp. 127–9). This period was a sublime point of Popov’s grand narrative of race history, in which a mythologization of the historical past was carried out in organicist terms.

For Popov (p. 147), Bulgarians were in possession of quite valuable racial proportions, which made them equal to the rest of the European nations and even provided them with certain advantages, especially within the group of the Slavic nations. Moreover, according to Popov, the historical dynamics of the National Revival were preserved in a latent form after 1878. The re-establishment of the Bulgarian state enabled new shifts and mixtures of the population from the state and the neighboring territories. Bulgarians were, therefore, a ‘rising nation’ on the threshold of great spiritual advancement (p. 129).

But what were the suggested means for Bulgaria to pass over the threshold and out of the crisis? Popov claimed that the underdevelopment of a given nation was a temporary phenomenon, because the results of selective self-regulation within a given biological community were unpredictable. He did not accept Spengler’s pessimism about the end of civilizations. Despite his belief in the effectiveness of the processes of natural selection, however, Popov was also convinced of the low birth rate of the social elites and of the high birth rate of the lower classes and the hereditarily inferior. These biological regularities, Popov argued, could be corrected through positive and negative eugenic measures. While the former aimed to encourage the reproduction of the normal and gifted members of society, the latter were to restrict the reproduction of the ‘unfit.’

It was hoped that the accomplishment of national health regeneration policies would re-establish the link that had been broken with a glorious national history. This would lead to a ‘new revival’ inspired by the National Revival period, which brought about the political independence of the country from the Ottoman Empire. Daskalov[ix] has argued that the historical period of the Bulgarian Revival functioned as a founding myth within various political and conceptual strategies, a myth of the origin of the Bulgarian nation. The Revival, therefore, had a ‘double temporality’: it was a past period of linear (historical) time, but also a transcendent model for (any) present time (p. 321). The second mode of the concept enabled a continuous reproduction of an ‘ongoing revival’ (p. 356). Hence, it may be argued that ‘the Revival’ functioned as a palingenetic myth. In Bulgaria, as in other European countries, visions of degeneration and versions of the palingenetic myth appeared as a response to the disintegration of the primordial value system caused by modernization. Therefore, eugenic palingenesis in particular mobilized certain traditional attitudes but was unthinkable without the development of modern science and state power. In the case of Popov, nation-rebuilding was imagined in organicist terms and accompanied by a reinvention of Bulgarian national history. The language of biosocial decline was used to describe the ‘unwanted’ past. The images of regeneration, on the contrary, ‘naturalized’ the ideological values of the model past. The notion of revival was not simply a reference to a concrete historical epoch that had to be repeated. In the only possible way to think of time, that is, through metaphors[x], M. Popov utilized ‘revival’ as a metaphorical implication of the palingenetic myth. The ‘new revival’ could thus embrace, within a cyclic structure, other periods of past time, which were considered authoritative for a regenerated nation of the future.

The way out of the temporal crisis was thus seen in a reconstruction of the national ‘regimes of historicity’. In the search for new identities, Bulgarian eugenic and race discourses produced hybrid temporalities in between historia magistra (where ‘the exemplary linked the past to the future’)[xi] and the future-oriented modern regime of historicity. Popov mythologized history, but also used a progressivist language of national (under)development. The selection of the exemplary periods of the national past, and the elimination of the cultural burden of the periods of ‘ill time’ were part of complex biopolitical strategies. They linked the projects of identity recreation, health rehabilitation, and temporal renewal.

[i] Hartog, F. (2005). ‘Time and Heritage’, Museum International, 57 (227), pp. 7–18.

[ii] Griffin, R. (2008). ‘Modernity, Modernism, and Fascism: A “Mazeway Resynthesis” ’, MODERNISM/Modernity, XV (1), pp. 11–12.

[iv] The following reconstruction of some of Popov’s concepts is based on his publication Наследственост, раса и народ. Расова принадлежност на българите [Heredity, Race and People: Racial Belonging of Bulgarians] Sofia: Pridvorna pechatnitsa, 1938.

[v] Pick, D. (1993) Faces of Degeneration: A European Disorder c. 1848-c. 1918, Cambridge: Cambridge UP, p. 40

[vi] During the rule of Simeon I the Bulgarian state reached its greatest territorial expanse. The period is also known as the ‘Golden Age of Bulgarian Culture.”

[vii] According to the commonly accepted historical view, the First Bulgarian Kingdom was founded by Khan Asparoukh in 681 and lasted until 1018, when Emperor Basil II conquered Bulgaria and it became a province of the Byzantine Empire.

[viii] The concept of the Bulgarian Revival addresses the nation-building processes among Bulgarians under Ottoman rule. According to the prevailing historical periodization, the Revival took place from the eighteenth century until the establishment of the modern Bulgarian state in 1878.

[ix] Daskalov, R. (2002). Как се мисли българското възраждане: историографско проучване [How Bulgarian Revival is conceptualized: A Historiographical Study]. Sofia: Lik, p. 355.

[x] Koselleck, R. (2002 ‘ “Progress” and “Decline”: An Appendix to the History of Two Concepts’, in The Practice of Conceptual History: Timing History, Spacing Concepts, trans. by T. S. Presner, T. S., Stanford: Stanford UP, pp. 218-235.

[xi] Hartog, F. (1996) ‘Time, History and the Writing of History: The Order of Time’, KVHAA Konferencer, 37, Stockholm, p. 97.

Gergana Mircheva is a doctoral student in the Department of Cultural Studies at Sofia University St. Kliment Ohridsky and lectures at the University of Plovidv Paisiy Hilendarski. This blog post is based on her recent publication: Gergana Mircheva “Regimes of ‘Degeneration’ and ‘Regeneration’: Eugenics and Modernization in Bulgaria before the Second World War” (2014), in Mishkova, D.; Trencsényi, B.; and Jalava, M. (eds.), Regimes of Historicity in Southeastern and Northern Europe, 1890-1945: Discourses of Identity and Temporality, Basingstoke: Palgrave Macmillan, pp. 188-209.