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Before the revolution and i n the years immediately following it, psycho-
therapy in Russia developed i n close contact with Western psychotherapy.
This situation changed abruptly in the 1930's after Stalin's rise to power
and the beginning of a period of repression and the isolation of Soviet sci-
ence and medicine. Any research i n the field of personality psychology be-
came dangerous i n the state where only one personality existed, "the great
and wise leader of the people" and where everyone was seen as a cog i n the
state machine.
Throughout the Soviet era, psychotherapy has been subjected to strict
Party pressure and control since the authorities believed that psychotherapy
was influenced by "bourgeois antimaterialist theories" and "reactionary
Freudianism." As a result, the theoretical development of psychotherapy
was inhibited even more than that of other fields of psychiatry. For many
years psychotherapy was the "Cinderella" of Soviet psychiatry due to the
suspicious attitude on the part of the authorities, the neglect of so-called
"minor psychiatry" (the psychiatry of neuroses, nonpsychotic, and sexual
disorders) and the popularity of a clinical (descriptive) and physiologic ap-
proach. Psychotherapy was only mentioned wth disdain and i t enjoyed
little prestige in the eyes of psychiatric authorities (for example, i n the only
Soviet psychiatric journal articles on psychotherapy are seldom to be found).
Research on this subject has been almost nonexistent and young psychi-
atrists have stayed away, preferring to study more popular and less danger-
ous fields such as the course of the various forms of schizophrenia, physiol-
ogy, and psychopharmacology.
I t should also be considered that the state system of psychiatric care has
503
504 AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
PSYCHOTHERAPY A N D I D E O L O G Y
Some Western experts studying different aspects of Soviet psychiatry try
to analyze these problems separately from ideological, political, and social
conditions of Soviet society. However, psychiatry like other institutions in
that country serves not only medical aims, but it protects the social and
political interests of the establishment. O n the other hand, ideology still
continues to play a great role in Russia, in spite of the beginning of prag-
matization of society. Myasishchev, a well-known Soviet psychotherapist
and leader of the so-called Leningrad school, has stated thajt "the rebirth of
Soviet science after the October revolution, particularly of human physiol-
ogy and psychology, based on Marxism-Leninism, is a prerequisite for a
genuine scientific system of psychotherapy" (11). His articles praised "the
wise Party." For instance, one of them quotes in full "the moral code of
communism" from the official "Program of the Communist Party of the
USSR."
Another eminent Soviet psychotherapist, M . S. Lebedinsky (Moscow)
supports h i m : "The problem of psychotherapeutic theory should be decided
in accordance . . . with the ideology of society. . . . I n the Soviet Union
psychotherapy developed and is developing on the basis of Marxist-Leninist
philosophy" (11). The head of the third psychotherapeutic "school," I . Z.
T H E THEORETICAL BASES 6tf S O V I E T PSYCHOTHERAPY 505
Velvovsky (Kharkov) pledged "socialistic obligation" in the collection of
papers on psychotherapy, devoted to his jubilee; he emphasizes that he is
happy to serve the Motherland, following the directions of "the Great
Communist Party."
I t is necessary to note that these ultra-orthodox statements are character-
istic of representatives of the old generation who grew up during the time
when such statements were the means of survival. Contemporary works are
more moderate although they too are based on the same ideological pre-
mises.J
Thus Soviet psychotherapists, like all Soviet scholars, must solve one of
the riddles of present-day Communist ideology, which on the one hand
declares the primacy of matter (brain) over mind (consciousness) and on
the other hand states that an individual's psychology and behavior are the
product of social experience (Lenin's theory of reflection).
That is the first important contradiction. However, there is another
serious problem here. I f , according to Marx, any manifestations of indi-
vidual life are "a manifestation and affirmation of social life" (13) then
the psychologic disorders such as neouroses, alcoholism, and crime which
afflict Soviet society are the result of its social structure; but official ideology
and propaganda can in no way tolerate such a conclusion. Therefore, offi-
cials insist that these social problems are a survival from capitalism in the
human consciousness. I n recent years, Soviet theorists also have combed
the writings of classical Marxism for clues to the role of biologic factors in
the development of personality. They are probing Marx for some words
about "natural connections" in man (14). A. A. Zvorykin writes that
"attempts to find a comprehensive approach in the unity of biologic, psycho-
physiologic, and social factors are a sign of the times" (15).
Genetic research is no longer prohibited in the Soviet Union particularly
since it has become clear to the authorities that it is more useful to explain
the growth of neuroses, alcoholism, and crime by genetic factors and not by
the distinctive features of the Soviet social system.
THE CONCEPT OF P E R S O N A L I T Y
THE PRINCIPLE OF A C T I V A T I O N
I n the 1920's and 1930's a number of Soviet psychiatrists began to work
out the "principle of activation" in psychotherapy. I n doing so they fre-
quently alluded to Lenin's statement that "human consciousness not only
reflects the objective world, but creates it as well."
Yu. V . Kannabikh, one of the proponents of the principle of activation
wrote that its goal was to call forth in the patient's mind definite impres-
sions, emotions, values, tendencies, reactions, and habits (21). This can be
accomplished only by impelling the patient to activity in the widest sense of
the term. Through activity, principally work, he gains new and useful ex-
perience. New conditions and creative work make it possible to compensate
for disorders; Kannabikh and others point out the patient's capacity for
growth and make clear his current of light from life and society. V . A.
Gilyarovsky's principle of "psycho-orthopedics" resembled this concept (22).
S. I . Konstorum states that " I n the final account activation psychotherapy
leads to the reconstruction of the psyche not by a verbal appeal to the in-
tellect or to the emotional sphere but by changes i n the patient's attitudes
and relationships to his milieu" (23). Konstorum considered this to be the
watershed separating activation therapy from Dubois' rational therapy and
from psychoanalysis.
M . S. Lebedinsky writes that neurosis, pathologic reactions, and mental
illness are always related to the impairment of conscious, willfull, rationally
directed activity. Therefore one of the psychotherapist's most important
tasks is to make the patient more active. The psychotherapist himself must
consider his own activity.
We oppose passivity in the therapist. The principle of activating the patient
opposes the principle of taking him away from real life to the distant past and
508 AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
dreams. We favor a situation where the doctor's influence and basic attention
will be directed to the patient's present and future. The psychotherapist
should help the patient correctly evaluate his responsibilities to his family and
society, his service duty, his potentials, his expectations, his personal worth, his
shortcomings, and his interrelationships with his surroundings. In his interac-
tions with the patient, the doctor should exert an influence which is defined by
the medical task, the principles of our medicine, the ideology of our society, its
morals and science (12, p. 26-27).
As can be seen from these quotations, the important task of social activating
therapy is essentially psychagogica (A. Kronfeld), that is, the education and
reconstruction of personality based on the demands of society, ideology, and
the state.
This theoretical approach underlies several methodological procedures
being used in Soviet psychotherapy, particularly its didactic tendency (re-
gardless of all talk about the activity of the patient himself), its moralism,
its attempt to instill in the patient feelings of responsibility, duty, and social
obligation (superego, as psychoanalysts would say).
As Kolb said, "Soviet psychiatrists have relied and continue to rely upon
the strengthening, development, or reconstruction of the ego function" ( 4 ) .
The principle of activating therapy especially emphasizes the important role
of work. I t is so-called work therapy which roughly corresponds to occupa-
tional therapy. Soviet psychiatrists have also recommended "culture ther-
apy" (music, art, physical exercises). But, in reality, only work therapy has
been used more or less widely in the practice of psychiatric dispensaries and
hospitals and discussed i n the several works from a clinical or methodolog-
ical point of view (24-26).
At the present time, Soviet authors prefer to talk about "social and work
readaptation and rehabilitation." However, the articles dealing with this
subject continue to describe this only as a process modifying various psycho-
pathologic syndromes (27, 28).
that i n the corrupt West, particularly i n the United States, some naive fools
and swindlers were asserting that "something sexual" lay at the root of
mental disorders. The "critique" of Freudianism was reduced to ridiculing
incidental, isolated quotations taken out of context from the works of for-
eign authors whom the critics themselves rarely read (quotations were sim-
ply copied from one article to the next).
This situation began to change very slowly and with difficulty i n the
post-Stalin years. Although Western psychologic and psychiatric literature
remained inaccessible to a wide circle of psychiatrists and psychologists, the
tone of some contemporary works of criticism became more serious. Cau-
tious attempts are now being made to separate the "rational element of psy-
choanalysis" from the "idealistic philosophy" which Soviet science should
reject (29-33). A . G. Spirkin, a philosopher, writes i n Consciousness and
Self-Consciousness that "the method of psychoanalysis permitted Freud to
comprehend an extremely confused tangle of unhealthy conditions and to
reveal the sources of certain neurotic experiences" (32). However, he has-
tens to add, Freud then incorrectly used this method to study human psy-
chology i n general and historical processes in the development of society and
culture. He concludes by saying that this makes psychoanalysis not only
scientifically unsound, but also fallacious. I . S. K o n , the well-known sociol-
ogist, uses many Freudian concepts, particularly defense mechanisms, al-
though from a Marxist viewpoint (19).
psychotherapy comes from changing an existing set and creating a new set,
thanks to modifying the patient's relationship with the environment.
Why were the attacks on psychoanalysis directed not only at Freudian
"pansexualism" but at his concept of the unconscious as well? This is en-
tirely understandable. Soviet Party leaders were reluctant to recognize
that irrational forces and egoistical aspirations motivate man, since from the
official point of view behavior is determined by social factors which have
been comprehensively analyzed by Marx and Lenin and have been "real-
ized" by the "working masses." For a totalitarian society, the uncontrolled
and irrational unconscious is extremely dangerous.
Soviet psychotherapists have attached central importance in the etiology
of neuroses to actual experiences and have defined neurosis as an illness of
personality characterized by disturbed relationships to the environment (11,
12, 17, 20, 38). I t is not necessary to search for any "deep mechanisms" in
the process of psychotherapy. They affirm that psychotherapeutic work
should help to bring out the physiologic mechanism behind a particular
symptom. O f course, psychotherapists should not completely ignore the
study of the genesis of emotional disorders, the anamnesis of disease. But
it is emphasized that Soviet psychiatrists understand the analytic method to
be the careful analysis of the concrete influences of the external environ-
ment "containing both social factors directly acting on the conscious and
factors changing the somatic condition" (39). They deduce a process of
realization as a reconstruction of associative connections with the center of
the pathologic dominant (17). Most psychotherapists, afraid of reprisals,
shunned the term "analysis" in general and preferred to avoid studying
traumatic experiences from the patient's childhood. They denied repres-
sion, sublimation, projection, and other protective mechanisms of the ego.
The works of the Leningrad psychologist V . N . Myasishchev, who deals
with structures of personality, are an exception. Myasishchev and his
"school" recognize the need for an analysis of the sources giving rise to
neuroses, although from a Marxist and anti-Freudian position (11, 17, 20,
38). A recent article by R. A. Zachepitsky was devoted to the importance
of childhood psychotraumas in the genesis of hysteria (40). However, My-
asishchev emphasizes that sexual trauma is usually an "external aspect" and
covers other experiences of the mature personality (17, 18).
N . V . Ivanov writes that "works by Soviet psychiatrists do not give at-
tention to the unconscious because of an ignorance of the social conditions
which form the personality and a dogmatic deciphering of different sym-
bols" (39, p. 420).
Soviet authors write that psychotherapists should study the patient as a
holistic conscious personality. " I n opposition to the views which see psycho-
therapy as only a stimulus for the transition from the realm of the uncon-
THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 511
scious to the realm of the conscious, they see the basis of the psychother-
apeutic process in the reconstruction of consciousness as knowledge and
attitudes which not only reflect but safeguard the directed activity of the pa-
tient's role" (12, p. 20). "The conscious person can act under the influence
of his instincts, but these instincts have already been reconstructed and they
possess new, human qualities" (10). With the doctor's asistance the patient
should "realize" a good deal, but by this word, Soviet psychotherapists have
in mind "understand correctly." The essence of the matter is not repression
but simply the failure to understand. Thus the patient should come to un-
derstand his responsibility for his incorrect behavior; he should recognize
his mistakes, understand how his incorrect life position influenced the de-
velopment of his neuroses, how he should change his relationship and atti-
tudes to his surroundings. I n other words, realization does not mean an
emotional conviction of the need for change, but only an intellectual process.
I t is true, as mentioned above, that in recent times some authors, fre-
quently not psychiatrists, but rather psychologists and philosophers (19, 30¬
33), are beginning to recognize, albeit with reservations, that the uncon-
scious exists and that its suppression is a possibility (and Pavlov himself is
said to have recognized this).
The ideas of Jung, Adler, and the so-called neopsychoanalysts (Horney
Sullivan, and others) have received a similarly critical evaluation i n the So-
viet Union. The only difference is the fact that the more recent psycho-
dynamic work is even less well known to Soviet authors. Therefore crit-
icism of that work is even more superficial and groundless.
To some extent the psychosomatic trend in psychology is an exception to
this rule since in some respects it is similar to a branch of Pavlovian doc-
trine developed by K . Bykov—"corticovisceral pathology" (41). However,
in speaking about psychosomatic relationships, Soviet psychotherapists point
to the ideological incorrectness of this theory based on its similarity to psy-
choanalysis. Soviet authors write that although we should welcome the idea
that the somatic and psychic are related, one cannot agree with the attempt
to interpret functional disorders in a particular organ as a symbolic expres-
sion of psychic processes. And the trend toward a psychosomatic interpre-
tation is seen as a means for masking the true causes of disease, ignoring
the basic social causes behind the high rate of mental illness in the United
States. The thesis that there is a high rate of disease in capitalist countries,
particularly in the United States, is obligatory in the Soviet press. How-
ever, Soviet statistics conceal the true figures on the spread of socially based
disease in the Soviet Union.
Other foreign psychotherapeutic methods based on new philosophical
and psychologic conceptions are also unacceptable to Soviet psychotherapists.
For instance, it has been said that existentialism only evolved from a ten-
512 AMERICAN JOURNAL OF PSYCHOTHERAPY
dency to isolate the internal world from objective reality in foggy formula-
tions which are passed off as preordained necessities.
DEPTH P S Y C H O L O G Y A N D G R O U P PSYCHOTHERAPY
tually limit themselves to two old methods: suggestion and persuasion (ra-
tional therapy). Autogenic training is the only exception. This method
has become more widespread because it is free of psychoanalytic explora-
tion and is closely connected with hypnosis which is popular in the Soviet
Union, especially among patients. Autogenic training does not demand
much time; it is widely used in state medical care as well. The effect of
autogenic training, as well as the effect of hypnosis, is discussed in Soviet
works from a physiologic viewpoint (45-47) but very rarely from a psycho-
logic one (48).
P A V L O V ' S T E A C H I N G S A N D PSYCHOTHERAPY
"When I think of Freud and myself, I imagine two teams of miners who
have begun to dig a railroad tunnel through the foot of a great mountain,
the human psyche. The difference is that Freud started somewhat below
and buried himself in the depths of the unconscious, while we have already
reached the light" (49). These words are Pavlov's.
M y task is not to review Pavlovian theory. I will briefly touch only on
its importance for psychotherapy today. Believing psychology to be unsci-
entific, Pavlov based his views of the psyche on his teachings on conditioned-
reflex activity. Psychic processes and disorders were the result of the inter-
action of processes of excitation and inhibition in the cortex.
Most important for psychotherapists was Pavlov's conception of the ac-
tion of the second-signal system. Pavlov's students studied the influence of
"verbal signals" on the brain's functioning and on the flow of physiologic
processes. According to Pavlov, a hypnotic condition is a partial sleep.
Rapport with the hypnotist or "contact" comes about through the inhibition
of the cerebral cortex, while a "center of alertness" is preserved.
The role of Pavlovian theory in Soviet psychotherapy and psychiatry has
changed during the last 50 years. Immediately following the revolution it
was popular but not dominant. After the sadly celebrated sessions of the
Soviet Academy of Sciences and Academy of Medicine in the 1950's, Pav-
lovian doctrine was declared to be the brilliant discovery of Russian science.
I n accordance with Stalin's dictates, it was to become the leading doctrine
in psychiatry and medicine. A n orgy of reprisals against the "enemies" of
this doctrine and "cosmopolitans" (mainly Jews) was begun. This move
was accompanied by organized purges and persecution of scientists and doc-
tors, by dismissals and arrests.
A group of ignorant Party careerists who endlessly quoted Stalin, Ly-
senko, and Pavlov emerged as the "heads" of Soviet psychiatry. Psychiatric
and psychotherapeutic terminology was altered and made to conform to
Pavlovian terminology. A doctrinaire, dogmatic mood reigned which Pav-
lov himself had tried to avoid. As mentioned above, not only psychoanal-
514 AMERICAN JOURNAL OF PSYCHOTHERAPY
situations which cause neuroses can be eased if there are changes in the
patient's "system of orientation." Therefore the goal of psychotherapy
should be to change the patient's orientation i n relation to the situations
which give rise to his neurosis.
The author of the present article and his associates discussed some aspects
of the theory of psychotherapy i n the form of a study of personality, the
motives for activity, goals, teachings about the "psychologic field," the
ecological environment, and interpersonal relationships (57). I n this work
they dealt with the effect of establishing strict treatment regimes for anxious
patients, thus transforming the uncertain future into a likeness of the known
past. I t analyzed the role of small groups, the effect of a group on treat-
ment, the role of conformity and leaders i n the therapeutic process, the
structure of relationships in the group, the role of discussions, and feelings
of group responsibility. I n conclusion we examined the problem of com-
munication between doctor and patient. ( I t should be noted that these
efforts to use contemporary Western theories, both psychodynamic and
sociopsychologic, are encountering resistance; the group's report to the Fifth
Congress of Psychiatrists was condemned by some leading psychologists as
a "return to personalism"). Nevertheless, new articles on this subject have
appeared (58).
The work of A. M . Svyadoshch, who has discarded his former con-
ditioned-reflex hypothesis of psychotherapy, provides an example of in-
formation theory (59). He now writes that psychotherapy is treatment by
information. From his point of view suggestion supplies the patient with
basic or semantic information and also transfers to the patient supplemen-
tary or verified information which enhances the basic information. Causal
psychotherapy (analysis) can be examined as the exchange of information
between doctor and patient which leads to the development of an aware-
ness of psycho traumatic experiences.
P. V . Simonov proposes the following hypothesis based on his informa-
tion theory of emotions (60). Since negative emotions (fear, depression)
are generated by unfulfilled strivings, psychotherapy should change or trans-
form socially unacceptable needs (in other words, sublimate). Negative
emotions can arise as a result of errors of anticipation i n a given situation
as well. I n this case the therapist's task is to eliminate the deficit of in-
formation (for example in preparing a woman for labor). As can be seen,
this hypothesis restates widely known psychotherapeutic methods in terms
of information theory.
A. A. Brudny and V . V . Solozhenkin have analyzed the heuristic com-
ponents of mental activity (61). They have proposed that the mechanism
of psychotherapeutic influence can be linked to the activity of a "compre-
hension operator"—a hypothetic organ which serves as the functional center
T H E T H E O R E T I C A L BASES OF SOVIET PSYCHOTHERAPY 519
SUMMARY
REFERENCES
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520 AMERICAN JOURNAL OF P S Y C H O T H E R A P Y