a medical discipline that studies the causes, character, symptoms, and course of mental diseases; methods of treatment and prevention; and organization of care for mental patients. Clinical observation is the principal method in psychiatry, but neurophysiological, biochemical, immunological, genetic, psychological, epidemiological, and other methods are also used.
General psychiatry (general psychopathology), which investigates the basic general patterns of mental disorders, is distinguished from special psychiatry, which deals with specific mental disorders. The psychiatry of “minor” or borderline disorders is a branch of special psychiatry that studies psychopathies, neuroses, and reactive states. Among the independent branches of psychiatry are pediatric psychiatry; gerontological psychiatry; and forensic psychiatry, which deals with the question of responsibility and fitness for work of mental patients. Independent associations and journals of social and biological psychiatry have been established in the USA, Great Britain, and the Federal Republic of Germany (FRG). Among the more recently established branches of the discipline are military psychiatry and narcology, which studies narcomania.
Medical descriptions of mental disorders are found in the works of the ancient Greek physician Hippocrates and in the works of the ancient Roman physicians Aretaeus, Soranus, Celsus, and Galen. Mystical views of the character of mental diseases prevailed in Western Europe during the Middle Ages. Some Oriental physicians sought the natural causes of mental diseases. For example, Avicenna attributed them to disturbances in the body fluids. With the growth of cities, it became increasingly urgent to isolate and care for mental patients. At first, these functions were performed by monasteries (”charitable homes”) and even by prisons. Specialized institutions were established in the 13th through 16th centuries (for example, Olmütz [Olomouc] in Czechoslavakia and Bedlam [Bethlehem Hospital] in London). In Russia the Stoglav (Hundred Chapters) Synod (1551) drew up special regulations for the monastery care of those suffering from mental disorders.
The development of psychiatry as an independent discipline (late 18th and early 19th centuries) is associated with a number of physicians, including the Italian V. Chiarugi. P. Pinel reformed psychiatric care in France and advocated the humane treatment of patients, who were customarily kept in chains. His student J. Esquirol was the founder of psychiatric research. W. Griesinger substantiated the interpretation of mental disorders as brain diseases and founded the German school of psychiatry, which overcame the influence of the “psychicists” and the “somaticists,” adherents of the argument that the immortal soul cannot get sick. The English psychiatrist H. Maudsley developed the evolutionary approach in psychiatry and was a pioneer in pediatric and forensic psychiatry.
In Russia psychiatric clinics were organized in the second half of the 19th century at the St. Petersburg Academy of Medicine and Surgery (I. M. Balinskii), Moscow University (S. S. Korsakov), and the University of Kazan (A. U. Freze). At these clinics the main schools of Russian psychiatry took shape. (I. P. Merzheevskii, V. M. Bekhterev, V. P. Serbskii, P. B. Gannushkin, and N. N. Bazhenov were among the most distinguished members of these schools.) Zemstvo medicine (care funded by district and provincial assemblies in prerevolutionary Russia) played a major role in the development of psychiatric treatment. (Among the doctors associated with zemstvo medicine were V. I. Iakovenko, P. P. Kashchenko, and L. A. Prozorov.) The first society of physicians for the insane was organized in St. Petersburg in 1861. Congresses of Russian psychiatrists were held periodically from 1887. Problems in psychiatry were also discussed at the Pirogov congresses.
In psychiatry the end of the 19th century was marked by the development of a nosologic classification of psychoses by the German psychiatrist E. Kraepelin, whose work was anticipated by that of K. Kahlbaum in Germany and V. Kh. Kandinskii and S. S. Korsakov in Russia. The late 19th century also saw the development of the psychiatry of minor or borderline disorders and the elaboration of a theory of neuroses and psychopathies (the French physician J.-M. Charcot). Psychiatry abandoned the “theory of madness” and became a scientific discipline concerned with morbid changes in the human psyche.
In the 20th century two approaches developed in psychiatry: the materialist and idealist approaches. The materialist approach, which is responsible for advances in the field, concentrates on the character of psychoses, relying on progress made in biology, neurophysiology, and morphology. The idealist approach, which consists of many trends, including Freudianism, phenomenology, and personalism, is characterized by K. Jaspers’ view that there is an “impassable desert” between the physical and the mental. Antipsychiatry, a peculiar variety of the idealist approach, is based on the thinking of the 20th-century French philosopher M. Foucault.
Progress in psychiatry was promoted by increased knowledge of the clinical manifestations of schizophrenia (E. Bleuler and many others) and other mental disorders and by genetic analysis. In addition, there were advances associated with new methods of treatment, including the biological method of treating general paresis (proposed by the Austrian psychiatrist J. Wagner von Jauregg in 1917 and anticipated by studies by the Russian physician A. S. Rozenblium in 1876), as well as insulin shock therapy and electroshock therapy for schizophrenia. Most of the progress in psychiatry in the second half of the 20th century is attributable to the development and use of psychotropic agents.
An important feature of the development of psychiatry in the USSR was the establishment of psychiatric dispensaries—a new type of service that provided outpatient treatment for most mental patients, arranged jobs for them, and helped prevent the exacerbation of mental illness. In the middle of the 20th century, outpatient care became widely available in other socialist countries and later in the USA, Great Britain, the Netherlands, France, and elsewhere.
The emphasis on prevention broadened the opportunities for the study of incipient and borderline forms of mental illness, for genetic research, and for the treatment and rehabilitation of patients. This emphasis, along with the nosologic approach and a theoretical foundation (the doctrine of higher nervous activity), are characteristic of Soviet psychiatry. There are many psychiatric research centers in the Soviet Union, including the institutes of psychiatry of the Academy of Medical Sciences of the USSR and the Ministry of Public Health of the RSFSR, the V. P. Serbskii Institute of Forensic Psychiatry in Moscow, the V. M. Bekhterev Institute of Psychoneurology in Leningrad, the Institute of Psychoneurology in Kharkov, the M. M. Asatiani Institute of Psychiatry in Tbilisi, psychiatry divisions in a number of institutes, and about 100 psychiatry subdepartments at medical institutes and at institutes for advanced medical studies. Among the major foreign research centers are the national Mental Health Association in Washington, D.C., and institutes of psychiatry in New York and London. Research at the principal Soviet and foreign centers is multidisciplinary, covering the clinical, social, epidemiological, psychological, neurophysiological, pathophysiological, and pathomorphological aspects of various problems. There are institutes for psychiatric research in many countries, including Poland, Czechoslovakia, Hungary, Bulgaria, the FRG, France, Japan, and India.
In 1973, approximately 15,000 Soviet psychiatrists were members of the All-Union Society of Neuropathologists and Psychiatrists (founded in 1927). Since 1968 the society has been a member of the World Psychiatric Association (founded in 1961), which includes 74 national societies. International congresses of psychiatrists have been held since 1950. The Mental Health Unit of the World Health Organization plays an important role in organizing international psychiatric research.
The problems of psychiatry are discussed in the Soviet journal Zhurnal nevropatologii i psikhiatrii im. S. S. Korsakova (S. S. Korsakov Journal of Neuropathology and Psychiatry, since 1901) and in foreign journals such as Archiv für Psychiatrie und Nervenkrankheiten (Berlin, since 1868), Fortschritte der Neurologie, Psychiatrie und ihrer Grenzgebiete (Stuttgart, since 1929), Les Annates Medico-Psychologiques (Paris, since 1843), L’Evolution Psychiatrique (Paris, since 1925), the American Journal of Psychiatry (Washington, D.C., since 1844), and the British Journal of Psychiatry (London, since 1855).
A. V. SNEZHNEVSKII