Making medicine political: outpatient ssychiatry in the soviet Union in the 1920s and 1930s

This article aims to understand how a marginal approach to a mental illness became for a short time the status of a public health policy. In Russia, as in Europe, psychiatry has been established around the institution of an asylum. Since the end of the nineteenth-century, some psychiatrists had required that hospital care be complemented with institutions better integrated in the social milieu, aimed at preventive care. After the October revolution, the Commissariat for Health (Narkomzdrav) made certain decisions to promote psychiatric care outside hospitals. They remained of limited importance during the period of the New Economic Policy, but came to prominence with a decree in 1929. However, the significance of the decree was limited because, within two years, it was displaced by another policy returning to the hospital-centered approach Narkomzdrav embraced in the 1920s. The primacy of the extra-hospital psychiatric services was thus a parenthesis that speaks to the larger question of the role of psychiatrists within the soviet project. It also raises the issue of the protection granted by a state to an individual supposed to participate in the building of the new society.