From its very early stages in the 18th century, Russian psychiatric theory viewed mental disorders as the result of “functional changes in cerebral activity or brain injuries” (Miller, 15). Although Stalin’s social reorganization condemned and politicized psychoanalytic theory and practice, the 1930s saw vital development in psychopathology, especially in the field of clinical symptomatology thanks to the work of P.B. Gannushkin. One of Gannushkin’s successors, G.E. Sukhareva, suggested an alternative classification model for the diagnosis and treatment of schizophrenia, rejecting Kraepelin’s original system (Miller, 16).
Essentially, the new model suggested that by examining the lifelong course of schizophrenia, as opposed to simply the symptoms, the disorder could be divided into two distinct types: ‘sluggish’ or ‘chronic’ on the one hand, and on the other, ‘acute’ or ‘periodic’. Sluggish schizophrenia referred to the continuous form, “which developed at varying levels of severity with periodic remissions during the life history of the patient”(Miller, 16). Soviet psychiatrists believed that there is usually a biogenetic, biochemical, neurological and physiological etiology for schizophrenia, which is triggered by the environment and manifested as a psychotic episode. The patient’s realization of his disorder’s facets and roots was considered critical to Soviet psychotherapy and, as a result, therapies aimed to be “short-term, supportive and very specific” (Miler, 17).
Critics have argued that this classification system of schizophrenia often leads to misdiagnosis or overdiagnosis because genetic inheritance with physiological manifestation is assumed more often as the etiology than cultural or individual causes (Miller, 20). Furthermore, Soviet psychiatry is often criticized for labeling its patients by “imposing an unsubstantiated diagnosis on a patient which will itself have negative consequences, both on the patient’s conception of self and in terms of the suspicious way he will then be regarded at home and at the workplace” (Miller, 20). This is largely due to the fact that any Russian, who was politically oppositional to Soviet authority and power, was in general deemed insane. Therefore, sluggish schizophrenia was thought to be manifested as a distortion of political reality by minds that were slow to realize the perceptions of Soviet reality. Substantial evidence is found for this in the establishment of special psychiatric hospitals for their ‘re-education’.
Patients were thus often regarded as political adversaries on top of being looked down upon for being insane by both the public and doctors, when they were not even mentally ill. In my view, this is what is insane. When the general population accepts that standing up or questioning political authority is always a sign of madness, then the population has evidently been tricked by those whose wealth would be threatened by any exposure of the existing established system’s injustice. This is what leads me to believe that the labeling impact of sluggish schizophrenia was merely an immoral scare tactic employed to condemn any act of resistance as madness and to label any person unsatisfied with the political structure as mad. Fear and prevention of political dissent or an uprising could well be the underlying factors behind the phenomenon of labeling discussed above.
Nevertheless, it is unfair to condemn the entire profession even though it was abused to a certain extent, for one must keep in mind that a lot of propaganda was in play at the time, and consequently people were mostly exposed to one-sided and exaggerated portrayals of what was actually going on. Moreover, despite its drawbacks, it is undeniable that Soviet psychiatric theory & practice made some genuine and fruitful attempts to explore numerous explanations and treatments for mental illness.
Miller, Martin A. The Theory and Practice of Psychiatry in the Soviet Union. 1985.