Month: October 2019

Rebecca Reich. State of Madness: Psychiatry, Literature and Dissent After Stalin; DeKalb, IL: Northern Illinois University Press, 2018; 280 pages; hardback £45.00; ISBN: 0875807755

By Hannah Proctor

Rebecca Reich’s State of Madness focuses on discourses surrounding punitive psychiatry in the Soviet Union in the years between Stalin’s death in 1953 and the collapse of the Soviet Union in 1991. Much of the existing literature on the pathologisation of dissent, stories of which began to emerge and spread via samizdat in the 1960s, has an institutional emphasis, whereas Reich focuses on relationships between literature and psychiatry. In the context of a state system of psychiatry that understood dissent as a form of insanity and attributed ‘political resistance to a distinctive state of mind’ (p. 62), resistance was imagined by those resisting as a sane response to a mad system. Dissidents–a broad term that does not necessarily imply engagement in political activism–worked to ‘validate a norm of inakomyslie, or “thinking differently”’ by challenging the state’s authority to diagnose insanity (p. 217). Reich demonstrates that literature was a key site for contesting psychiatric diagnoses, becoming a ‘source of diagnostic authority’ in its own right (p. 6). State of Madness is always working with and through contested dichotomies; there is neither dissent nor madness without a norm. Sanity then becomes a question of who is responsible for defining and assigning the diagnostic categories.

State of Madness examines literature from a range of genres produced during the period after Stalin’s death that challenged the theoretical frameworks and practices of psychiatry. In the case studies considered by Reich the boundaries between the aesthetic and the psychiatric  – along with those between sanity and insanity – are often blurred. Reich does far more than merely analyse aesthetic representations of psychiatry, however. Not only does she discuss how psychiatrists themselves deployed aesthetic conventions in their clinical documents, but her analysis of the interplay between literature and psychiatry is grounded in an understanding of life in the Soviet Union as thoroughly aestheticised: ‘the state went about constructing socialism by applying its creative principles to reality itself’ (p. 50). The question of identifying distinctions between art and life was an urgent one for some of the figures she discusses precisely because it was so hard to discern.

In her introduction, Reich traces the ‘deceptive similarities’ between Soviet dissident narratives and the works of Michel Foucault, noting that although his discussions of the normative impulses of psychiatry echoed Soviet concerns, his analyses pertained to liberal societies and thus cannot fully account for the authoritarianism of the Soviet Union. (Though it could be noted that this does not mean dissent has not been pathologised in the kinds of societies Foucault was analysing, as Jonathan Metzl’s The Protest Psychosis: How Schizophrenia Became a Black Disease demonstrates with regard to Ionia State Hospital in Michigan in the 1960s.) In addition to identifying such theoretical convergences and divergences, Reich later situates Soviet abuses of psychiatry in relation to contemporaneous Western critiques of psychiatry, often bracketed together under the baggy and contested term ‘antipsychiatry’. News of the pathologisation of Soviet dissidents emerged in the West at the very moment these ideas were at their most popular, and chimed with the notion that psychiatric institutions and nosologies were inherently oppressive. More interestingly, Reich also discusses how the repudiation of antipsychiatry in mainstream Soviet psychiatry journals ironically led to those ideas circulating in the Soviet Union. She discusses examples of people who acquainted themselves with this material and found that it spoke to the Soviet experience: ‘trickling down through sanctioned and unsanctioned channels, Western antipsychiatric ideas informed the critical vocabulary through which Soviet dissidents exposed abuse’ (p. 65).

Reich begins by discussing the literary discourses Soviet psychiatrists themselves engaged with, underlining that the psychiatric norms dissidents were reacting against were expressed in terms that were congruent with Soviet literary conventions. She thus establishes from the very beginning that the lines of influence between psychiatry and aesthetics flowed in both directions. By applying a formal literary analysis to clinical documents, Reich convincingly demonstrates that the discipline of psychiatry was structured according to an ‘established aesthetic framework’ borrowing from the ‘literary doctrine of Socialist Realism’ (p. 27, p. 29). Psychiatrists framed their diagnostic practices as a kind of artistic endeavour and pathologised aesthetic modes that deviated from the standards of Socialist Realism.

According to Reich, diagnostic categories furnished psychiatrists with ‘predictive templates for narrating’ the lives of dissidents (p. 43). The psychiatrist drew out the ‘essence’ of a patient’s life story through a spoken discussion and effectively muffled the patient’s own account in the process, which Reich frames, drawing on the work of Soviet literary scholar Bakhtin, as a shift from dialogue to monologue (p. 44). A further stage of mediation then occurred when the ‘essence’ extracted verbally was converted into writing in the form of a clinical report in which the subjective interpretations of the psychiatrist, along with the aestheticising qualities of diagnosis, tended to be obscured by the neutral tone of medical objectivity. Yet Reich argues that in spite of their authors’ impartial intentions, forensic reports nonetheless amplified the always partial voices of Soviet psychiatrists, whom Reich argues narrated their patients’ conditions in a manner that conformed to the teleology of the Socialist Realist ‘master plot’, situating syndromes and processes of recovery in a progressive narrative.

Psychiatrists also turned their diagnostic gaze on the artistic and literary outputs of their dissident patients. In line with state-sanctioned understandings of art, figurative work was associated with sanity and aesthetic harmony was associated with mental healing. Normative aesthetic judgments and literary categories were transferred from artworks to individual psyches which, Reich argues, betrayed a failure to understand the sophisticated artistic movements of the period – such as Moscow Conceptualism or Sots-Arts – that relied heavily on irony, kitsch and parody, and self-consciously critiqued Socialist Realist tropes.

But literature was – conversely – a site for contesting psychiatry’s art of diagnosis, which Reich moves on to discuss in the book’s second chapter and in three subsequent case studies. The ambiguities of psychiatric discourse and diagnostic categories facilitated their punitive use, but writers also played with these ambiguities for their own ends: ‘their psychiatric narratives reveal a shared perception that psychiatric abuse had resulted both from the ambiguity psychiatric discourse itself and from the state’s conflation of inakomyslie, or ‘thinking differently’, with insanity’ (p. 60). The monologism Reich identifies as characteristic of Soviet psychiatry in the first chapter is replaced in the second by the dialogue introduced by dissidents ‘that embraced singularity, irony, and open-endedness’ (p. 93). If psychiatrists had absorbed the conventions of Soviet Socialist Realism as part of their pathologisation of dissidents in these counter examples, by contrast, ‘literary discourse assimilates psychiatric discourse to depathologize inakonmyslie and to pathologize both society and the state’ (p. 96).

The book’s first ‘case’ focuses on Joseph Brodsky with an argument animated by his reversal of Marx’s dictum ‘existence conditions consciousness’. Here dialogism becomes literalised through a discussion of his narrative poem ‘Gorbunov and Gorchakov’, set in a psychiatric hospital, which takes the form of a discussion between two characters embodying different concepts. Brodsky is not deemed to have been hospitalised for punitive reasons and, unlike the dissidents discussed in the previous chapter, was not a political activist. But the significance of his diagnosis and institutionalisation for Reich is ‘the sense it appears to have given the poet that the primary purpose of the psychiatric profession was to enforce a linguistic regime of existence’ (p. 108).

Andrei Siniavskii (along with his pseudonymous alter ego Abram Terts) is the second of Reich’s three case studies. In 1965 he was arrested and found imputable by psychiatrists who examined his literary output for evidence of pathology, thus enacting the very melding of life and art that his previous works critiqued. Siniavskii developed an understanding of the aesthetic process at odds with that espoused by the state, which propounded a vision of creativity in line with Lenin’s ‘reflection theory’ [teoriia otrazheniia]. This extended the dictum of Marx, that Brodsky drew upon, by claiming that consciousness and existence – or humanity and nature – existed in a mutually transformative relationship with one another; people were shaped by their circumstances but could also intervene in the world to transform it. This, Reich explains, had a counterpart in psychiatry in the form of reflex theory [reflekornaia teoriia]. According to Reich, mirrors and other reflective surfaces litter Terts’s works, figuring as surfaces that distort the reality they claim to show: ‘It was by concealing rather than revealing reality’s essence… that the state had driven society mad.’ (p. 184). His works imagined art, alternatively, as the site where it might be possible to promote a deeper awareness of reality by highlighting its strangeness and artifice, departing from Lenin and drawing instead on Viktor Shklovskii’s notion of ‘defamiliarization’ [ostranenie] as an ‘antidote to creative madness’ (p. 153). For Siniavskii/Terts, who developed a form of Fantastic Realism as a counterpart to the officially sanctioned conventions of Socialist Realism, the antidote to reflection in art was not achieved through a greater fidelity to reality but, paradoxically, through estrangement from it.

Reich’s concluding ‘case’ focuses on Venedikt Erofeev, a writer whose chaotic and often inebriated life paralleled the social deviance of his literary heroes, who also bore his name. Here the smudged line between life and art and Erofeev’s self-conscious attempts to play with this blurriness, returns in the guise of a tussle between madness and its simulation. The theatrical feigning of mental illness as a means of avoiding imprisonment was a practice Soviet psychiatrists were aware of, and Reich situates Erofeev’s work in this context arguing that it ‘captures the risks of simulating madness in an irrational world of ever more meaningless diagnostic categories’ (p. 188).

Alcohol was Erofeev’s primary material in his performative experiments which danced along the border between sanity and insanity, a pair of categories that had a counterpart in the relationship between simulation and dissimulation: at what point does the performance become a reality? Or does simulating madness as it is defined by a ‘mad’ state paradoxically stave off real madness? Erofeev eventually lost control of his own experiment and sought out treatment as the alcohol induced hallucinations and delirium that had characterised his writing became a part of his lived experience. The staged pathologisation soon became inseparable from life.

As in other chapters of State of Madness, in Erofeev’s work distinctions are constantly breaking down: between sanity and insanity, simulation and dissimulation, the theatrical and the real, the asylum and society, and, ultimately, between literature and real life. The mask of madness gradually became indistinguishable from the face beneath. Yet if, as Reich argues, Erofeev’s play Walpurgis Night exposes ‘the fact that it is society that has lost its mind’ (p. 203), the question remains whether sanity can ever really exist or even be defined within a crazy world: ‘how were they to calibrate their health in a society where, as they so frequently portrayed it, madness was the psychological norm?’ (p. 15) Ultimately for Erofeev, ‘the only certainty is the theatricality with which both categories [sanity and insanity] manifest themselves’ (p. 205). Reich describes dissidents stuck in a ‘discursive trap’ and the examples she considers describe these traps from within or sometimes construct new ones but they struggle to find ways of escaping altogether (p. 61). It’s enough to drive anyone mad.

If dissent is the norm then what happens when society changes? I would have been intrigued to read an epilogue considering what became of these discourses after the Soviet Union – and its attendant master plots and meta-narratives – collapsed. Of the three writers Reich discusses in most detail, Brodky and Siniavskii both lived past 1991. Brodsky left the Soviet Union in 1972 but the implication is that this geographical displacement did not lead to a sudden sanity and he instead experienced ‘the maddening freedom of exile’ (p. 20). The Soviet ‘state of madness’ may have had particular contours but this suggests that there may be no such thing as a ‘state of sanity’. The dissident writers Reich discusses ‘assumed the role of psychiatrists to an authoritarian state that had lost its mind’ (p. 19), but the lingering anxiety remains that identifying this madness could provide neither an individual nor societal cure. Reich’s book attests that literature nonetheless remained a privileged site for contending with the impasse. As Brodsky wrote in ‘A Part of Speech’ (1975-76):

It may be the heel that’s slipping on ice, or it may be the earth

that’s turning beneath the heel. (p. 137)

Hannah Proctor is Wellcome Trust Research Fellow at the Centre for the Social History of Health and Healthcare at the University of Strathclyde.