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Psychiatry, Clinical Psychology, and Psychotherapy: The Question of Politics

Psychiatry, Clinical Psychology, and Psychotherapy: The Question of Politics

If historians have demonstrated anything, it is that psychiatry, clinical psychology, and psychotherapy cannot be neatly associated with any one particular kind of political ideology or movement. In 2002, I published an article in the Harvard Review of Psychiatry in which I posed the question, “Was there a communist psychiatry?”1 Admittedly, my intention was to be a bit provocative. The question pushes in two directions at once. On the one hand, it raises the general possibility of psychiatry being defined by the political environment in which it operates; on the other hand, it suggests that perhaps psychiatry as such did not historically exist in post-1945 communist countries.

At a talk I gave on the subject, a psychiatrist who had practiced in Cold War Eastern Europe assured me (somewhat annoyedly) that psychiatric services were offered there at the time and that clinicians had been medically trained, not simply politically indoctrinated.

I actually agree with this psychiatrist, as I think my article makes clear. The provocation of the original question was and is intended less for practitioners in the former Eastern Bloc, than for audiences in the West, where an abiding image had emerged of a Soviet-era psychiatry inevitably corrupted by political ideology. My point was to push us to reconsider this image historically and to question whether communism was the prime—or even a significant—mover in the development of psychiatry in the East.

All of this raises broader questions. Is there invariably a political—and here I mean “politics” to refer to the ideas and efforts of organized parties, movements, and states—dimension to psychiatry, clinical psychology, and psychotherapy? If so, what effects do political ideologies and systems have on them? As fields of inquiry and intervention, do psychiatry and psychotherapy have inherent political affinities and tendencies?

Historians of mental health have actually shown a great deal of interest in these issues. The Enlightenment pedigree and revolutionary leanings of Philippe Pinel (1745-1826), chief physician at the hospitals of Bicêtre and Salpêtrière, have been well documented, for instance. His so-called moral treatment—ostensibly replacing shackles, purging, and blistering treatments with a nascent form of talk therapy—was, it has been shown, directly informed by his general attitudes about government and human dignity.2 In fact, post-revolutionary France was the site of a general rethinking of human psychology that purposely and directly threatened established elites.3


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