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
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