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Excavating the Psyche: A Social History of Soviet Psychiatry in Bulgaria

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Abstract

This article investigates how an imported Soviet psychiatric model affected Bulgarians who experienced psychological crisis by examining therapeutic possibilities that were available and foreclosed in the People’s Republic of Bulgaria. Bulgarians struggling with psychological disorders in the present day experience polar forms of marginalization: non-recognition on one extreme, and chronic medicalization on the other. Both tendencies can be traced to the Communist-period remodeling of mental healthcare, which outlawed private practice and individual-centered therapy, which reified empirically observable, physiological underpinnings of pathology while suppressing therapies that engaged with the existential context of mental illness. I argue that the reproduction of a Soviet psychiatric model instigated a modernization process but failed to anticipate the idiosyncrasy of economic and social conditions within the country. Furthermore, that this model rejected a therapeutic focus on the individual but developed no effective alternative for identifying and treating subjective characteristics of mental illness. Bulgaria’s history of psychiatry has received little scholarly attention beyond Bulgarian psychiatrists who documented the development of their field. This article presents archival, literary and oral history footholds towards the development of a social history of Bulgarian psychiatry—a perspective that is especially and problematically missing.

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  1. Bloch, Sidney. Psychiatry as Ideology in the USSR. Journal of Medical Ethics. (3, 1978, c. 126–131). Adler, Nanci; Mueller, Gerard O.W.; Ayat, Mohammed. Psychiatry under tyranny: a report on the political abuse of Romanian psychiatry during the Ceausescu years. Current Psychology. (1, 1993, c. 3–17), Baudis, P. "Key moments in the history of Czech psychiatry." Psychiatr Danub. (1–2, 2003, c. 49–55). Kozulin, Alex. 1984. Psychology in Utopia. Cambridge, MA: MIT Press. McLeish, John. 1975. Soviet Psychology: History, Theory, Content. London: Methuen.

  2. Marks, Sarah, and Mat Savelli. 2015. Psychiatry in Communist Europe (Mental Health in Historical Perspective). Palgrave Macmillan. Raikhel, Eugene. 2016. "Special Issue: Psychiatry in Eastern Europe." Transcultural Psychiatry 53 (2). Zajicek, Benjamin. Scientific psychiatry in Stalin's Soviet Union: the politics of modern medicine and the struggle to define 'Pavlovian' psychiatry, 1939–1953. Chicago, IL: University of Chicago, 2009.

  3. Amnesty International and the Bulgarian Helsinki Committee reported on dismal conditions and outdated practices in Bulgarian facilities for mentally ill. See: Far From The Eyes Of Society. 2002. Amnesty International. https://www.amnesty.org/en/documents/eur15/005/2002/bg/, Sanadinovo: This is Truly A Ghastly Place. 2002. Amnesty International. https://www.amnesty.org/en/documents/document/?indexNumber=eur15/002/2002language=en, Human Rights Committee on the List of Issues, Bulgaria Review. 2011, and Mental Disability Advocacy Center and Bulgarian Helsinki Committee. bit.ly/1LB0Vy9.

  4. Dr. Zahari Zarkov (psychiatrist), interviewed by T. Ivanov on Bulgarian National Radio, 9/23/2015.

  5. Topouzova, Lilia. Lovech: Bulgaria’s Last Gulag Camp (1959–1962). Physical Violence and State Legitimacy in Late Socialism, ed. Thomas Lindenberger, Jan Behrends and Pavel Kolar (New York: Central European University Press. Forthcoming, 2018.

  6. See: Шехирян, Джулиан. "Сведени до Тела: Съветската Психиатрия в Народна Република България." Тялото при Социализма. Sofia, Bulgaria: Center for Advanced Study Sofia, 2016. 111–34. Print. Поредица Иследователски Форум. Also: Chehirian, Julian. "Psychiatry and Its Social History in Communist Bulgaria." Interview by Svetla Baloutzova. Center for Advanced Study Sofia: Newsletter 2015–2016 n.d.: 38–40. Print. http://cas.bg/en/newsletters.html.

  7. Elrod, Norman. Review of “Russian Psychology.” Studies in Soviet Thought, Vol. 42, No. 2, Lev Vygotsky and Contemporary Social Thought (Sep., 1991), pp. 159–189.

  8. Schipkowensky, Nikola. “Principles of Psychiatric Rehabilitation and Their Realisation in Bulgaria.” International Journal of Social Psychiatry. 1973 Autumn; 19(3): 240–5. Milenkov, Kiril and Christo Christozov. Mental Health Care in Bulgaria Since World War II. International Journal Of Mental Health. 1991, 20 (4): 11–20. Kirov, Kiril. Bulgarian Psychiatry: Development, Ideas, Achievements. History Of Psychiatry. 1993, 4(16). 565–575. Dontschev, Petko and Harvey Gordon. Forensic Psychiatry in Bulgaria. Criminal Behavior and Mental Health. 1997 7(2). 141–151. Koychev, Georgi. History of Bulgarian Psychiatry. Psychiatria Danubina. 2003 15 (1–2). 61–63. Milenkov, Stefan and Heiner Fangerau. Bulgarian Psychiatry In The Period Around World War II (1930–1950). International Journal Of Mental Health. 2006, 35(4). 47–53. Boyadjiev, Boris and Georgi Onchev. Legal and cultural aspects of involuntary psychiatric treatment regulation in post-totalitarian milieu: the Bulgarian perspective. The European Journal of Psychiatry. 2007 21(3), 179–188. Nyagolova, Mariana. Сontribution To the History of Psychology in Bulgaria (from the Liberation To 1912). Psychological Thought. 2012 5(1). 2–21.

  9. See Sarah Marks and Mat Savelli’s volume “Psychiatry in Communist Europe” (2015).

  10. Wortis, Joseph. Soviet psychiatry. Baltimore: Williams & Wilkins, 1950. Joravsky, David. Russian psychology, a critical history. Oxford, UK: Blackwell, 1988. Zajicek, Benjamin. Scientific psychiatry in Stalin's Soviet Union: the politics of modern medicine and the struggle to define 'Pavlovian' psychiatry, 1939–1953. Chicago, IL: University of Chicago, 2009. Marks, Sarah, and Mat Savelli. 2015. Psychiatry In Communist Europe (Mental Health In Historical Perspective). Palgrave Macmillan.

  11. See section on “Transnational connections and psychiatry in Communist Europe” for an analysis of professional exchanges, the cross-proliferation of literatures, and participation of psychiatrists from Bulgaria and other Eastern European nations in Western conferences on psychiatry.

  12. See: Martin Malia, Richard Pipes, Zbigniew Brzezinski, and Richard Conquest.

  13. See: Sheila Fitzpatrick, J. Arch Getty, Graeme Gill, Roberta Thompson Manning.

  14. Concerning the evolution of Bulgaria’s forced labor camps, Lilia Topouzova writes that the escalation of violence at the Lovech camps much after a De-Stalinization process is at odds with a popularized narrative of diminishing political repressions in the latter years of the Communist regime. See: Topouzova, Lilia. “Lovech: Bulgaria’s Last Gulag Camp (1959–1962)”.

  15. Georgiev, Mincho. Mitev, Vanyo. History of Medical Sciences in Bulgaria. Sofia: Publishing House Prof. Marin Drinov, 2013.

  16. This is in contrast to literature on psychiatry in the U.S.S.R, for which David Joravsky, Benjamin Zajicek and Joseph Wortis have independently chronicled the politics of the Pavlovianism.

  17. For the importance of the continuing ideological training of hospital staff, see: Book 1955–1958, Archival Unit 16, Folder 7, page 3. Fund 160 of the Ministry of Health, National Archives, Sofia.

  18. For more on “materialism” as it relates to Russian and Soviet psychology and psychiatry, see Joravsky, David. Soviet Marxism and Natural Science, 1917–1932. New York: Columbia University, 1961. Print. Also: Joravsky, David. Russian psychology, a critical history. Oxford, UK: Blackwell, 1988. Also: Vasilyeva, Anna. "The Development of Russian Psychotherapy as an Independent Medical Discipline in the Second Half of the Twentieth Century." International Journal of Mental Health 34.4 (2006): 31–38. Web.

  19. Kirov, Kiril. Bulgarian psychiatry: development, ideas, achievements. History of Psychiatry. (4, 1993, c. 565).

  20. Koychev, Georgi. History of Bulgarian Psychiatry. Psychiatria Danubina. 2003 15 (1–2). 61.

  21. "Александровска болница." Web. 15 Jan. 2017. http://alexandrovska.com/display.php?bg/история-клиника-по-психиатрия.

  22. Atanassov, Nikola. "Psychotherapy In Bulgaria." Bulgarian Association of Psychotherapy. 2005. Web.

  23. Bulgarian Psychiatry in the Period Around World War II (1930—1950). International Journal of Mental Health, (4, 2006, c. 48).

  24. Ibid. Also, documentation of hospital histories can be found in “Dossiers of Hospitals; City of Nikolaevo, Plovdivsko, Sevlievo, Tserova Korea, Shipka, and the City of Kotel” (1945). Book 1941–1954, Archival Unit 2, Folder 139. Fund 160 of the Ministry of Health, National Archives, Sofia. One memorandum notes that regional psychoneurological dispensaries formed into a hub for the care of mentally and neurologically ill individuals. However, “the connection with villages is upheld directly by the work of doctors. This network is not fortified enough, however, and clinics are not well supported.”

  25. Windholz, G. J. The 1950 Joint Scientific Session. J Hist of the Behavioral Sciences. (33, 1997, c. 61–81).

  26. The archives of the Ministry of Health contain references to the work of the Pavlovian Committee—the local propagation of Soviet medical discourse and ideology, as well as documentation of theses and academic courses on the Pavlovian Teaching. See “Report on the work of the Pavlovian Committee” and “Course on the Pavlovian Teaching - Theses,” Book 1941–1954, Archival Unit 14, Folders 48 and 99.

  27. Book 1955–1958, Archival Unit 16, Folder 7, page 7. Fund 160 of the Ministry of Health, National Archives, Sofia.

  28. Milenkov, Kiril. Predov, Nikolay. Gaidarov, Tsvetan. “Bulgarian doctors and students of medicine—victims of the Communist terror of 1944–1989. Sofia: 2003.

  29. Stoev, Stoyu. Freudianism and its counteraction in Bulgaria. Sofia, Bulgarian Academy of Science, 1969.

  30. Milenkov, Stefan. Fangerau, Heiner. Ibid.

  31. Book 1955–1958, Archival Unit 17, Folder 14. Fund 160 of the Ministry of Health, National Archives, Sofia.

  32. One memorandum reports statistics for “patients with neuroses and alcoholism, imbeciles, the developmentally challenged, epileptics, those with fainting spells, schizophrenia and true madness.” It beckons us to keep in mind that many cases are an “inheritance from the past,” pointing to continuing efforts to understand the conditions under which these illness develop. Book 1955–1958, Archival Unit 16, Folder 7, page 7. Fund 160 of the Ministry of Health, National Archives, Sofia.

  33. Giliarovski, Vasil Alekseevich. Psychiatry. Moscow, 1954; published in Bulgaria two years later. Sofia: Science and Art, 1956, pp. 3–4.

  34. “…Insulin shock therapy, sulfozin, blood transfusion, glucose, subcutaneous oxygen insufflation, calcium chloride infusions, barbamil and sleep therapy (using Pavlov's theory about the therapeutic role of conditioned suppression).” Ibid, p. 408.

  35. “Our psychiatrists developed a special system—work therapy, which has a significant role in the fortification of mental (nerve-psychological) health. It plays a big role in the treatment of neurotic states… The goal of work therapy is to organize the working-life of the patient, to return them to socially beneficial work in the community.” Ibid, p. 502.

  36. Practices of selfhood in a socialist context are treated by Momchil Hristov in "Interpellation and/or Subjectification: the Socialist Subject between Foucault and Althusser." Divinatio. (2010).

  37. Bozhinov, Sasho. Koinov, Raycho. Nerve Illnesses. Sofia: Medicine and Physical Culture, 1968.

  38. One such publication examines the ability of language to influence the primary and secondary nerve systems towards betterment; Authors Collective. Language as a therapeutic or illness-inducing factor. Collected papers on the Pavlovian doctrine. Sofia: Bulgarian Academy of Science, 2nd edition, 1954, pp. 249–257.

  39. “Nerve Illnesses,” p. 438.

  40. Ibid.

  41. Temkov, Ivan. Ivanov, Vladimir. Tashev, Tasho. Psychiatry. Sofia: Medicine and Physical Culture, 1973, p. 303.

  42. Ibid., p. 319.

  43. This ideological rejection of the possibility for phenomena to be undetectable, unknowable or unreachable through material investigation is familiar for the period. This attitude is documented by Kiril Milenkov. Milenkov, Kiril. Predov, Nikolay. Gaidarov, Tsvetan. “Bulgarian doctors and students of medicine—victims of the Communist terror of 1944–1989. Sofia: 2003, p. 21.

  44. Vladimir Ivanov continued to develop these ideas in a later publication: “Social Psychiatry.” Sofia, Medicine and Physical Culture, 1989. According to practitioners whom I consulted in 2015, still too few practitioners apply the principles of a social approach to psychiatry in Bulgaria today (Dr. Aleksi Aleksiev. Personal interview. March 2015. Dr. Emil Markov. Personal interview. May 2015).

  45. Initiatives and research concerning alcoholism and tobacco use were featured prominently in psychology and psychiatry discourses during the Communist period.

  46. K Milenkov, interview by Veronika Bikova, "БКП злоупотреби с психиатрията," Про и Aнти, 2003. Bulgarian Communist Party’s Abuse of Psychiatry. http://www.decommunization.org/Articles/Milenkov.htm.

  47. Milenkov, Kiril. Predov, Nikolay. Gaidarov, Tsvetan et al., “Bulgarian doctors and students of medicine—victims of the communist terror of 1944–1989. Sofia: 2003.

  48. Milenkov, Kiril. Predov, Nikolay. Gaidarov, Tsvetan et al., “Bulgarian doctors and students of medicine—victims of the communist terror of 1944–1989. Sofia: 2003, p. 21.

  49. Ibid.

  50. Ibid.

  51. Ibid.

  52. Ibid.

  53. Book 1955–1958, Archival Unit 17, Folder 14 Pg 8. Fund 160 of the Ministry of Health, National Archives, Sofia.

  54. Schipkowensky, Nikola. Psychiatry versus Iatrogeny: a confrontation for physicians. Detroit, 1977.

  55. Psychotherapy—Methods and Tendencies. Ed. Hristo Hristozov. Sofia: Medicine and Physical Culture, 2002, p. 134.

  56. Ibid.

  57. For an example of criticisms against Freudian psychoanalysis in Bulgaria, see “Стоев, Стою Гочев. Фройдизмът и преодоляването му в България. София : Изд. на БАН, 1969. Stoev, Stoyu. Freudianism and its counteraction in Bulgaria. Sofia, Bulgarian Academy of Science, 1969.

  58. Hristozov, Hristo, Ed. Practical Psychotherapy. Sofia: Medicine and Physical Culture, 1988.

  59. Dr. Georgi Koychev. Personal interview. February 2015.

  60. Stankushev, Todor. Etudes of the Psychiatrist. Sofia: Medicine and Physical Culture, 1985.

  61. The sculpture depicted (“Weeping”) is one of Nikola’s earliest. Materials: wood from plum tree.

  62. Personal interview with his representative and caretaker, Georgi Todorov. December 2014.

  63. Georgi Todorov. Personal interview. December 2014.

  64. Lyuba Tsaneva. Personal interview. May 2015. Tsvetan Kolev. Personal Interview. November 2014.

  65. This was done on ideological grounds. An unacceptable paradox was seen in a practitioner benefiting monetarily from the illness and misfortune of their patients. It was argued that the clinician has an interest in its prolongment.

  66. Smaller asylums with even less resources and inadequate facilities struggled to reproduce even the problematic therapeutic environment of larger institutions. Today such smaller institutions, such as “social homes” are at the heart of an inherited problem and a process of re-conceiving of our national approach to mental health care.

  67. "Bulgaria: Not enough progress made on social rights of people with disabilities." MDAC. February 2, 2016. http://mdac.info/en/news/bulgaria-not-enough-progress-made-social-rights-people-disabilities.

  68. Шербанова, Вероника. "България последна в Европа по грижа за психично болните | Здраве." Offnews.bg. October 17, 2014. https://offnews.bg/zdrave/balgaria-posledna-v-evropa-po-grizha-za-psihichno-bolnite-404895.html.

  69. "Топ психиатър: Психиатричната диагноза е доживотна присъда." June 13, 2017. http://dnes.dir.bg/news/psihiatria-tzveteslava-galabova-25905388.

  70. Цеков, Николай. "Имат ли права българите с психични проблеми". August 26, 2017. http://p.dw.com/p/2ish3.

  71. National Center for Social Health and Analysis: “More than 151 thousand Bulgarians are registered for supervision in psychiatric facilities in our country,” 2012.

  72. Dr. Zahari Zarkov (psychiatrist) and Julian Chehirian (researcher), interviewed by Theodore Ivanov on Bulgarian National Radio, 9/23/2015.

  73. Dr. Zahari Zarkov (psychiatrist) and Julian Chehirian (researcher), interviewed by Theodore Ivanov on Bulgarian National Radio, 9/23/2015.

  74. Exhibited at the Red House Center for Education and Debate, Sofia, Bulgaria, from Sept. 24 to Oct 9, 2015. For film documentation of the exhibition, see: http://vimeo.com/232385548.

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Acknowledgements

This study was supported by Fulbright - Bulgarian American Commission under Grant No. 34143771.

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    Julian Chehirian

  2. American Research Center in Sofia, Sofia, Bulgaria

    Julian Chehirian

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Chehirian, J. Excavating the Psyche: A Social History of Soviet Psychiatry in Bulgaria. Cult Med Psychiatry 42, 449–480 (2018). https://doi.org/10.1007/s11013-017-9559-2

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