Soviet Psychiatry

American physicians who believe that U.S. medicine is the world's best in all departments got a jolting report this week from a research psychiatrist who spent five weeks in Russia last summer, concluded: "The care of mental patients in the Soviet Union is superior to our own in a number of important respects."

Dr. Nathan S. Kline, 43, research director at New York's Rockland State Hospital, told the New York Academy of Sciences that whereas the U.S. is woefully short of doctors for the mentally ill, the Soviet Union comes close to meeting ideal U.S. standards. In proportion to population, it has 50% more physicians for mental illness than the U.S.

Equally significant is the ratio of psychiatrists to hospitalized patients. Against one for 200 patients in the U.S., it is one for every 25 in Russia. And whereas many U.S. psychiatrists are engaged in intensive therapy, often of the analytic type, so that they have time for only a small number of patients, intensive and prolonged treatment is rare in Russia, where there is no waiting for psychiatric care.

Paid to Stay Home. Most striking, to Dr. Kline, was the basic difference in handling psychotic patients. In the U.S. most are promptly admitted to big (usually state) hospitals, and many spend the rest of their lives there, slowly deteriorating. Outpatient treatment at clinics or in day hospitals is still rare. In Russia the reverse is true. "Hospitalization is for extremely brief periods by our standards, with very early discharge and follow-up in the dispensaries," said Dr. Kline. The relatively few psychiatric hospitals are almost entirely for acute cases. The many dispensaries (eleven in Leningrad alone) care for the vast majority of cases.

Some long-term (socalled chronic) psychotic patients are kept in work villages (kolonii) out in the country. "This," reported Dr. Kline, "was the one type of facility which I could not obtain permission to visit." But a great majority of long-term patients are kept at home, treated by their families under hospital supervision. A mentally ill worker draws a disability pension for as long as he is unable to work. His family can get up to 400 rubles ($40) a month to care for him. But it still costs the state only about half as much as keeping him in a hospital, said Dr. Kline--and, more important, it helps the average patient get better faster.

Work to Get Well. The Soviets reject Freud and his analytic principles. In his place they have elevated Ivan P. Pavlov, apostle of conditioned reflex psychology. One result is that neurotics are hospitalized far more often than in the U.S., since environment is blamed for neurotic disturbances. But these patients rarely stay longer than two months.

Prominent at both inpatient and out-treatment units is the emphasis on work as one of the most important and constructive factors in treatment. (In U.S. hospitals, occupational therapy is usually make-work and little better than leaf raking.) Workshops, Dr. Kline found, constitute complete industrial production units, e.g., one in Leningrad has six full-size looms and manufactures snowsuits. Patients not only get training, but receive full industry-scale pay for their work. Not only do they get better faster, but often they emerge from the hospital better able to support themselves and their families than when they entered.

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