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      Power in psychiatry. Soviet peer and lay hierarchies in the context of political abuse of psychiatry

      History of Psychiatry
      SAGE Publications
      Dissidents, expert community, hierarchies, power, Soviet psychiatry

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          Soviet political abuse of psychiatry in the Brezhnevite era offers a rich case study of entanglement between various layers, impact spaces, and actors of power. This article discusses two types of discursive power in Soviet psychiatry. One sprang from the madness-affirmative cultural canon, in which dissidents sought their self-legitimation. More prominently, there was the power of psychiatrists within their own hierarchic system. I analyse how the action scopes for psychiatric power varied, depending on whether the recipient was a patient or fellow professional. Here, the inherent hierarchy structured and regulated the peer community and secured the stability of medical practices – and of the political entanglement of these practices and actors with the state-owned places of power.

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          Red tape and corruption

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            The ethics of Soviet medical practice: behaviours and attitudes of physicians in Soviet Estonia.

            To study and report the attitudes and practices of physicians in a former Soviet republic regarding issues pertaining to patients' rights, physician negligence and the acceptance of gratuities from patients. Survey questionnaire administered to physicians in 1991 at the time of the Soviet breakup. Estonia, formerly a Soviet republic, now an independent state. A stratified, random sample of 1,000 physicians, representing approximately 20 per cent of practicing physicians under the age of 65. Most physicians shared information with patients about treatment risks and alternatives, with the exception of cancer patients: only a third of physicians tell the patient when cancer is suspected. Current practice at the time of the survey left patients few options when physician negligence occurred; most physicians feel that under a reformed system physician negligence should be handled within the local facility rather than by the government. It was common practice for physicians to receive gifts, tips, or preferential access to scarce consumer goods from their patients. Responses varied somewhat by facility and physician nationality. The ethics of Soviet medical practice were different in a number of ways from generally accepted norms in Western countries. Physicians' attitudes about the need for ethical reform suggest that there will be movement in Estonia towards a system of medical ethics that more closely approximates those in the West.
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              Psychiatry in the Soviet Union.

              J. Wing (1974)
              The services for chronically handicapped people with psychiatric disorders in the Soviet Union are described. The system is based upon a network of community units, each of which includes a day centre, a follow-up clinic, and a sheltered workshop. British services could profitably learn from the experience of these units. The diagnostic system used by many Soviet psychiatrists is different from that incorporated in the International Classification of Diseases. In particular, the term "schizophrenia" is used to describe conditions which British psychiatrists would label in other ways.This clinical difference partly explains the different concept of "criminal responsibility," but another large component of the difference is political rather than medical. There are also variations from British practice in certain juridical procedures. These differences together make Soviet psychiatric practice in the case of political dissenters unacceptable to most British psychiatrists. It is too soon to say that frank discussions of these matters could not lead to improvement. British and Soviet psychiatrists still have something to learn from each other.

                Author and article information

                Hist Psychiatry
                Hist Psychiatry
                History of Psychiatry
                SAGE Publications (Sage UK: London, England )
                1 October 2021
                March 2022
                : 33
                : 1
                : 21-33
                [1-0957154X211047805]University of Vienna, Austria
                Author notes
                [*]Anastassiya Schacht, Department of History, University of Vienna, Kolingasse 14-16, 14.18, Vienna, A-1090, Austria. Email: anastassiya.schacht@ 123456univie.ac.at
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funded by: universität wien, FundRef https://doi.org/10.13039/501100003065;
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                dissidents,expert community,hierarchies,power,soviet psychiatry


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