The priority given to outpatient psychiatry

As a result of the socialist offensive, outpatient psychiatry saw its status enhanced. Starting in the spring of 1928, with power concentrated at the top of the Soviet Union, Stalin imposed collectivization, rapid industrialization and an intensified class struggle. A draft decree of the Central Executive Committee and of the Council of People’s Commissars spoke of the damage that socialist construction would ipso facto cause to the nervous and mental health of the population. The archives contain nothing on the conditions in which this document was drafted. One should however note that it intervened after several alerts were triggered in 1927. On one hand, a survey by the department of moral statistics underlined the scale of suicides in the country, and therefore the fragile state of the population.^[1] On the other, psychiatrists noted that the people had never been so nervous. In this regard, Grombakh pointed to a number of factors: the ‘economic situation’, ‘destitution’, ‘overwork’, ‘fighting to maintain one’s place’, ‘unemployment or the fear thereof’ and ‘the need for more housing’.^[2] The draft decree states:

Socialist construction, in step with the country's industrialization, must, by the brutal raising of the cultural level of the masses, by the rapid rhythm of this development, inevitably increase the number of those suffering from nervous disorders and of ailments close to mental illnesses, for this construction involves groups of people who, carried by a great wave of enthusiasm and sparing themselves no effort, are simply unsuited to such intense, stressful and constantly changing levels of work.^{[3] [4]}

In order to prevent the onset of nervous and mental disorders, a Council of People’s Commissars order of April, 1929, required that priority in matters of public health policy would from then on go to outpatient psychiatry rather than to psychiatric hospitalization.³'' The reform was to be carried out by the Institute for Prophylaxis in Neurology and Psychiatry, the former State Health Center of

Neurolog)' and Psychiatry, which had been renamed one year earlier. This pivotal shift in psychiatry can be attributed to the initiative of doctors who had managed to make a persuasive case for the importance of outpatient psychiatry in constructing the new society thanks to a series of shifts towards new matters for enquiry, ranging from the influence of political convulsions upon mental health to that of work and social conditions. The significance of these shifts was, however, solely due to the fact that a number of persons passed on the conclusions of studies carried out among patients up a chain that rose all the way to high-ranking soviet dignitaries.

However, this translation was dependent upon the transformation of the political landscape. The socialist offensive was based upon the idea that willpower can achieve anything, and that every person must devote himself fully to the cause. This individual effort on behalf of society as a whole required a sense of collective responsibility among all concerned. The socialist offensive must not only result in the country’s economic transformation, but must also enable the individual to become a social being, one adapted to the environment whose construction he has contributed to: the process that the offensive seeks to initiate must transform individuals and society simultaneously. Indeed, the socialist offensive aspires to ‘create a person who foresees great freedom by placing himself entirely at the disposal of society and who feels embarrassed to abandon the latter without permission’.³' But the promise it represents can sometimes not become a reality. The diaries studied by Jochen Hellbeck reveal that many people felt a gap between their ‘will’ and the ‘ideology’.^{[5] [6]} Psychiatry was to deal with those incapable of reducing this gap. But such a goal is likely to lead to the indexation of forms of pathological behaviour with the capacity of individuals to devote themselves to the construction of socialism.

The pre-eminence given to outpatient psychiatry bears witness to the fear among political leaders that the social world might remain beyond their control due to the efforts required of individuals for the country’s industrialization. This fear, although updated in the circumstances, was, however, not at all characteristic of the late 1920s: the historiography of the New Economic Policy has shown that decisions made at the time were more usually dictated by doubts than by utopian ambitions.^[7] This can be explained by the aporia intrinsic to the revolutionary project, whose ambition was to build something new from that which pre-existed it — but both the individual and his social environment have turned out to be delicate materials to work with and shape. The persistence of suicide — a phenomenon seen as a ‘relict’ of the ancient regime — appears to reveal the difficulties the new state encountered in its attempts to gain control over its subjects and their bodies.⁴¹¹ Outpatient psychiatry was therefore one of the tools used to further this goal, at least among those whose probity and involvement were recognized. As for the others, an arsenal of repressive measures was deployed: its targets were certain categories of individuals that were hitherto tolerated, but were now deported and subsequently resettled in work camps and colonies located in hostile regions on the edges of the country’s borders.

• [1] Published in 1927, the study considers suicides between 1922 and 1925. Kenneth Pinnow, Lost to the Collective. Suicide and the Promise of Soviet Socialism, 1921—1929, Ithaca, Cornell University Press. 2010, pp. 159-167.
• [2] TsGAMO f. 2129, inv. 1, d. 330, f. 384.
• [3] GARF f. 393, inv. 74. d. 126, ff. 4, 6.
• [4] ‘Postanovlenie soveta narodnykh komissarov RSFSR o meropriiatiiakh po ulutshcheniiu dela psikh-iatritcheskoi pomoshchi v RSFSR [08.04.19291’, *n Zhurnal nevropatologii i psikhiatrii itneni S.S. Korsakova, n° 3, 1930, pp. 110-112.
• [5] Vladimir Velichkin, ‘Pravo na smelt’, in Sovetskii vrach, n° 17—18,1930, p. 766. Quoted by Kenneth Pinnow, Lost to the Collective, op. cit., p. 233.
• [6] Jochen Hellbeck, Revolution on my Mind. Writing a Diary Under Stalin, Cambridge. Harvard University Press. 2009, pp. 67-73.
• [7] Sheila Fitzpatrick, 'The Bolsheviks Dilemma: Class, Culture, and Politics in Early Soviet Years', in Slavic Review, 47. n° 4. 1988, pp. 599-613; Eric Naiman, Sex in Public: The Incarnation of Early Soviet Ideology, Princeton, Princeton University Press, 1997; Anne E. Gorsuch, Youth in Revolutionary Russia: Enthusiasts, Bohemians, Delinquents, Bloomington. Indiana University Press, 2000; Golfb Alexo-poulos, Stalin's Outcasts: Aliens, Citizens, and the Soviet State, 1926—1936, Ithaca, Cornell University Press, 2002.