Review of: Soviet Psychiatry. By Joseph Wortis, M.D. (Pp. 314. £1 18s. 6d.) London: Baillière, Tindall and Cox, 1950.
British Medical Journal, 1 March 1952, p. 473
Soviet psychiatry is dominated by the figure of Pavlov. In the terms of Pavlovian physiology the neuroses are intelligibly described as disturbances of cortical function produced by the breakdown of conditioned reflexes under excessive or conflicting stimuli. This mode of approach has found a number of followers in Britain, and proved especially useful in the clinical analysis and treatment of the acute neurotic reactions of wartime. Pavlovian concepts are, however, also applied in Russia to the endogenous psychoses. Schizophrenia, for instance, is regarded as a depression or inhibition of cortical function with the partial escape of lower centres from the control of the upper ones, with consequent development of such symptoms as stereotypies. Together with the physiological approach, Soviet psychiatry also favours psychotherapy in the form of persuasion, re-education, and social therapy. Neurotic symptoms may be due to a conflict between the ideas implanted in the course of a faulty (e.g., insufficiently Communist) education and the demands of society in the Communist world. Treatment therefore will be along those lines. Russia was one of the first countries to take up with energy the insulin treatment of schizophrenia, but it also encourages the pedagogic treatment of nervous symptoms in re-educative therapies. Freud and the unconscious are almost totally disregarded, and, though Freud himself is not without honour, psycho-analysis is obsolete. The treatment of the neurotic child is almost exclusively along pedagogic lines and in the hands of teachers; emphasis is even more on prevention and the treatment of causes than on sick individuals.
Dr. Wortis is to be congratulated on having provided a very useful summary of psychiatric development in Russia. His task was not easy, for he had to rely exclusively on publications. No personal visit to Russian centres of teaching and research was possible. The total impression one gains is that Russia has made enormous advances in the provision of adequate medical services since Czarist days, that the clinical practice of psychiatry and the organization of treatment are of a sound standard, but that little new work is being done along research lines. Original thought, in psychiatry as elsewhere, has to be along the lines laid down by dialectical materialism.