PSYCHIATRY

PSYCHIATRY, the science of mental diseases, History of P. As a scientific discipline, P. was formed only in the 19th century, although the diseases it deals with began to attract interest and attention at the earliest stages of human society. The Soviet researcher of the history of psychiatry, Yu. V. Kannabikh, divides its development into six periods. 1. Pre-scientific period - from ancient times to the appearance of Greek medicine. Its characteristic feature is the primitive-theological view of mental diseases, which seem to be caused by witchcraft and evil spirits and which yield to incantations rather than treatment. At the same time, however, unsystematic accumulation of disparate facts and observations was taking place, which received vivid expression in mythology and folk poetry. 2. The second era encompasses ancient Greco-Roman medicine. Its beginning can be conventionally placed in the 7th or 6th century B.C., when the first attempts at a medical approach to the mentally ill appeared. Along with metaphysical speculations in this era, a scientifically realistic trend increasingly asserted itself. Hippocrates, Celsus, Archigenes, Areteus, Soranus and Galen described the clinical pictures of a number of diseases, laid the foundation for scientific terminology in the field of P., and gave several valuable and often far-ahead-of-their-time indications for the care of patients and their treatment. This brilliant era ends at the end of the 3rd century of our era. 3. In the third period, which largely coincides with the era of feudalism, the beginnings of P. developed within the framework of monastic medicine, where for a whole series of centuries a peculiar mixture of mysticism and primitive folk healing flourished. Monastic care for the mentally ill can be seen as the first hint at the organization of stationary psychiatric care. In the 10th, 11th, 12th and 13th centuries, as urban economies developed in Italy, France and Germany, the view of mental diseases as phenomena subject to natural-scientific study became increasingly established. This trend spread widely during the Renaissance. In the 15th and 16th centuries, the construction of special 'madhouses' (in Spain, Germany) had already begun, mostly simplified and insignificant in size. At the same time, this period was marked by the famous 'witch trials', in which the mentally ill undoubtedly became victims of the Inquisition. From this era, the work of two individuals deserves special mention: the famous physician of the early 16th century Paracelsus, who was actually one of the founders of hypnotherapy, and - somewhat later - the German physician J. Weyer, who devoted his activities to protecting the mentally ill, who fell under accusation of witchcraft and sorcery, from the Inquisition. In the 16th, 17th and even partly in the 18th centuries, the view of the mentally ill contained abundant elements of mysticism. Only at the end of the 17th and beginning of the 18th centuries did the number of psychiatric hospitals increase, and at the same time the first studies of insanity appeared, seeking to rely on the data of natural science. 4. A truly new era in the history of P. - the fourth period of its development (Kannabikh) - should be considered the second half of the 18th century, especially its last decade. Psychiatry in this period and later was particularly fertilized by the ideas of French materialist philosophy (La Mettrie, Cabanis). This shift was first manifested in the change in attitude toward the mentally ill. The Parisian surgeon Tenon and the Englishman Tuke were the first propagandists for humane treatment of the 'insane', but the glory of the revolutionary reorganizer of the care of the mentally ill rightfully belonged to the director of the Parisian asylum Bicêtre-Pinel, who, already during the time of the Convention, achieved the cessation of chaining patients in this institution. Pinel's successor, Esquirol, with his work 'On Mental Diseases,' in which he gave an elementary classification of psychoses and descriptions of their main clinical pictures, laid a solid foundation for all further development of scientific P. He already clearly represented to himself the existence of an indissoluble connection between somatic and mental symptoms. P. is also indebted to him for many valuable practical measures for patient care, in particular the introduction of the stomach tube for feeding those who refuse food. A contemporary of Esquirol, Baillarger, in 1822 gave the first clinical and pathoanatomical description of progressive paralysis (Baillarger's disease) as a separate entity. Esquirol's students, Falret and Baillarger, significantly deepened the development of the doctrine of progressive paralysis and first described the regularity of the alternation of phases of excitement and inhibition within one disease - circular psychosis. A number of other French psychiatrists - Calmeil, Lôre, Parcieux, Brière de Boismont, Trélat, Moreau de Tours, as well as the greatest Belgian psychiatrist Griesinger, complete this brilliant era, which marked the beginning of the development of modern scientific and practical P. and is inextricably linked with the name of Pinel. 5. The next period in the development of Western European psychiatry, Kannabikh named after Conolly, the English psychiatrist who, continuing the work of Pinel, spoke for the complete abolition of mechanical methods of restraining the mentally ill (tying, straitjackets). The principle of this era in P. is expressed in non-restraint - 'no restraint.' Conolly's ideas, which received recognition in England in the 1830s and 1840s, required several more decades for their spread to the continent - and especially to the countries of Central Europe - time that was needed to eliminate the socio-economic backwardness of these countries compared to industrial England. In Germany, for example, the era of reaction, along with the flourishing of idealistic natural philosophy and mysticism, gave rise in P. to the reactionary school of 'psychics' (Gehrhardt, Jöhler, Beneke), in whose worldview medieval concepts of the role of the demonic principle, 'evil,' 'sin,' etc. in the origin of diseases revived. Gehrhardt thought that not only psychoses, but also somatic diseases arise due to the destructive effect of vice: 'in the history of a finally shaken digestion,' he writes, 'of a liver or spleen affected in its tissues, in the history of disease of the portal vein or a diseased uterus with its ovaries - we could find evidence of a long vicious life, which has carved all its crimes as if with indelible letters into the structure of the most important organs necessary for man.' Convinced of the need to correct the mentally ill, the 'psychics' contributed to the spread of a peculiar mechanized psychotherapy, which was the complete opposite of the prevailing tendency in France and England at that time toward non-restraint of the mentally ill: with the help of straitjackets, special bindings and belts, patients were immobilized for long periods in a lying, sitting or standing position, placed in rotating cages or subjected to rotation in the beds on which they lay, suddenly plunged into ice water or cold water was slowly poured on their heads, etc., i.e., they were essentially subjected to torture. The polar opposite of the school of psychics was the school of 'somatists' (Nasse, Jacobi, Friedreich, etc.), which existed almost at the same time and proceeded from the position that mental diseases are based on material changes in the body. The feature of the most influential of the somatists, Jacobi, was the denial of the exclusive role of the brain in the origin of psychoses, to which he attributed equal importance to the sympathetic nervous system, blood vessels, and all other internal organs. After several years of fierce polemics, the somatic direction by the beginning of the fifties achieved a complete victory over the psychics. The work of the somatists was completed by the life and work of the brilliant psychiatrist Griesinger, who won for German psychiatry a leading position in the further development of this science and in his textbook (1845), which gave the first scientific and systematic exposition of the doctrine of mental diseases. The psychiatric worldview of Griesinger followed from his philosophical views, which were mainly nourished by French materialism, and was determined by the following provisions: 1) every psychosis is based on a certain patho-anatomical process in the brain; 2) mental activity is built according to the reflex scheme, and 3) the psychotic pictures themselves are not diseases, but only variable symptoms of a single brain process with a certain course; they can be distributed according to the stages of this process, starting from curable primary anomalies and ending with incurable secondary phenomena of madness and feeble-mindedness. The latter position became the slogan of the 'symptomatic school' in psychiatry, which prevailed in Germany until Kraepelin. With Griesinger, whose importance in the history of P. was equal to that of Pinel and later Kraepelin, German P. began to adopt the practical achievements of English and French psychiatrists. Griesinger himself was an energetic fighter for the principles of Conolly.

After him followed a brilliant cohort of researchers (Meynert, Westphal, Wernicke, and others), who in their work proceeded from the same fundamental principles as him and applied these principles to the detailed scientific development of individual questions of clinical psychiatry. A particular feature of this direction, especially sharply expressed in Meynert, was the exceptional interest in questions of brain anatomy, the solution of which, according to the views of this school, had to determine the success of psychiatry as a clinical and therapeutic discipline: mental processes were subject to localization in specific centers and the pathways connecting these centers, some of which had already been named 'associative,' and psychopathological phenomena in the ideal had to be expressed in terms of the 'brain mythology' (ironic expression of Nissl) that was growing on the basis of the extreme lack of factual knowledge. Clinic, although it had of necessity to give it preferential attention, in concept receded to the role of a secondary discipline, which was only supposed to register symptoms corresponding to the sequential lesion of one or another parts or systems of the brain. Despite the noted one-sidedness and simplification in understanding the tasks of psychiatry, the scientific achievements of this school are enormous, and every modern researcher turns to them as sources when developing any question of scientific and clinical psychiatry. In France, a new current in psychiatric research was introduced by a contemporary of Griesinger and Darwin, Morel, author of the 'Treatise on Degenerations,' which laid the foundation for the hereditary-biological study of mental diseases. According to Morel, the basis of the majority of psychopathological phenomena lies in degeneration (see). Morel also compiled a classification of psychoses, based on the principle of degeneration. A more profound development of questions of clinical psychiatry from the point of view of this doctrine was given by the greatest French psychiatrist of the second half of the 19th century, Magnan, who divided all psychoses into accidental, i.e., diseases that can strike any normal person, and degenerative, closely connected with the abnormal psycho-physiological organization of the degenerate. In German science, Morel's ideas influenced Griesinger, and they permeated the most widespread classifications of psychoses of Schüle and Krafft-Ebing in the last quarter of the 19th century. 6. The last, sixth, period in the development of psychiatry, directly merging with the present, is closely connected with the activity of the genius reformer of psychiatric science—Kraepelin. In practical psychiatry, this period, beginning with the last decade of the 19th century, is characterized by the colossal expansion and improvement of psychiatric care, the organization of hospitals, colonies, and patronages. In the care for the mentally ill, a new era begins, which to a large extent erases the boundary between psychiatric and somatic diseases—the era of the bed regime, with the advent of which the last remnants of the system of 'restraint'—locking excited patients in 'isolation cells'—are also destroyed. In theoretical psychiatry, this epoch is filled with Kraepelin's struggle for the principle of clinical nosology, put forward earlier by Kalbaum, which was supposed to destroy in theory the fundamental difference between somatic and mental diseases. In opposition to the symptomatic direction that had prevailed before him, Kraepelin came to understand mental diseases by analogy with diseases studied by internal medicine as special, fundamentally different from each other processes with their own etiology, symptomatology, course, and outcome for each. Kraepelin also broke with another view of his predecessors, namely, that mental diseases are diseases of the brain, and, returning to the views of somaticists, put forward the position that psychoses are diseases of the entire organism, and psychopathological phenomena represent only the most vivid manifestations of the disease, to which a number of general somatic symptoms should correspond, and in the basis of which one should most often seek one or another disorder of metabolism, caused in some cases by a change in the activity of the endocrine glands, in others by poisoning or an infectious process. The greatest achievement of Kraepelin is the union of numerous symptomatic pictures of psychoses with different names into a few large nosological groups, among which the groups of early dementia (now schizophrenia) and manic-depressive psychosis took a dominant position and have held it to this day. Kraepelin's doctrine became the foundation of all modern psychiatric science. However, the symptomatic direction, at the head of which from the beginning of the 20th century stood the Freiburg professor Hoche, did not surrender its positions. The nosological principle, in Hoche's opinion, is untenable because the etiological factors that Kraepelin had in mind represent only impulses that lead to the manifestation of predispositions to certain pathological forms of reactions, already laid in the psyche of probably every person. These forms of reactions are what we observe in the form of one or another symptom-complexes. Psychopathological symptom-complexes represent various variants, the boundaries between which are difficult to draw and are indistinct; to try to strictly delimit them and to seek in the basis of each a strictly defined pathological process with the same etiology, course, and outcome means to chase phantoms. Hoche received significant support from Bonhoeffer's doctrine of exogenous types of reactions, i.e., about the fact that all mental disorders arising as a result of infections, intoxications, and injuries, regardless of the cause that caused them, proceed in the form of a few typical symptom-complexes. The psychogenic disorders of the psyche, so-called reactive states, which attracted the attention of psychiatrists, especially during the war of 1914-1918, also did not fit into the framework of Kraepelinian nosology. The disputes between the supporters of these two directions continued until the beginning of the 1920s, when they lost their acuteness to a large extent due to a number of concessions from Kraepelin himself, who agreed to the probability of the existence of pre-formed mental mechanisms leading to the development of relatively few symptom-complexes that recur in different diseases, which as it were represent different registers of the organism and are characteristic not so much of the pathological process that set them in motion as of the areas of personality affected by the disease. The softening of contradictions was also facilitated by the influence of the ideas of constitutional pathology, which began to develop from the first decade of the 20th century, as well as the structural understanding of psychoses with its striving for multi-layered diagnostic layering. Psychiatry in prerevolutionary Russia. On the condition of the mentally ill and the construction of institutions for them—see. Mentally ill. Scientific psychiatric work in Russia was almost not carried out until the beginning of the 1860s. A pioneer of this work was the first Russian professor of psychiatry, I. M. Balinsky (at the St. Petersburg Medico-Surgical Academy, the department was established in 1857). Balinsky did not leave major printed works, but his lectures were distinguished by the subtlety of clinical analysis, brilliance, and originality and attracted to the study of psychiatry a number of talented young people, many of whom (Merezhovsky, Sikorsky, and others) later became prominent psychiatrists. Balinsky also took an active part in public work in the field of psychiatry: he founded (in 1862) the 'Society of St. Petersburg Physicians for the Insane,' developed plans for the construction of a number of hospitals, worked a lot as a forensic expert, etc. His successor, scientifically much more significant, was I. P. Merezhovsky, whose clinic in the 1870s-1880s was the main nursery of Russian scientific and practical psychiatry. Merezhovsky also made the first attempts, albeit very naive and often reactionary (e.g., thoughts on religious education), to outline the circle of measures necessary for the protection of mental health and thus actually to lay the foundation of mental hygiene. The second in time of the establishment of an independent department of psychiatry in Russia was Kazan (founded in 1866), the third was Kharkov (1877). In Moscow in 1863, from the course of private pathology and therapy, a separate course in neuropathology was separated, with which the teaching of psychiatry remained connected until 1887. In this year a separate psychiatric clinic was opened in Moscow and at the same time an independent department of psychiatry was established. S. S. Korsakov, who took it over, was at the same time the greatest scientist with a world reputation, which is now associated with the name of the disease he described (see Korsakov psychosis), and the reformer of Russian psychiatry on the principles of non-restraint and bed regime for mental patients. The 1880s and 1890s, the years of Korsakov's professorship, were the era of the most intensive construction of new psychiatric hospitals and the reorganization of old ones. This work was carried out by a cohort of talented psychiatrists (Litvinov, Yavenko, Kashchenko, Andriolli, Bazhenov, Butske, German, Govseev, Yevgrafov, Maksimov, Steenberg, Yakobi, and others) with the most active assistance of Korsakov.

By the beginning of the 20th century, Russian psychiatry was already on an equal footing with Western European psychiatry both in terms of the organization of care for the mentally ill and in the scientific development of its questions. In the latter respect, its ranks produced such major scientists as Bernstein, Bekhterev, Kandinsky, Kovalsky, Krainsky, Rybakov, Serbsky, Sikorsky, Sukhanov, Tokarsky, Chizh, and others, who published numerous works in scientific societies and congresses as well as in the specialized international press. Soviet psychiatry. The imperialist war and the subsequent years of civil war and intervention heavily affected the condition of psychiatric hospitals, bringing many of them into a state of severe devastation. However, as early as the summer of 1918, the neuropsychiatric section (P.P. Kashchenko, Zakharov, Prozorov, Rakhmanov, with the participation of Gannushkin), initially founded under the Council of Medical Colleges and later incorporated into the People's Commissariat of Health of the RSFSR, established connections with provincial psychiatric hospitals, assisting them with guidance and material resources. By 1925, the recovery period of Soviet psychiatry ended and its reconstruction began on the principles of prevention and dispensarization: attention grew to those groups of mentally ill patients who usually do not enter psychiatric hospitals, and accordingly, extramural psychiatry developed widely (institutes of district psychiatrists in Moscow and Leningrad, neuropsychiatric dispensaries, etc.). In recent years, Soviet psychiatry has taken an increasingly active part in socialist construction itself: hospital affairs are being restructured to provide preferential assistance to the socially most valuable groups of the working population, with special attention given to acute and curable conditions; active labor therapy, covering 80-90% of all patients in many hospitals, is systematically organized, extending to the establishment on hospital grounds of entire factories built on an industrial model (the Kashchenko Hospital in Moscow, the clinical department of the Psychoneurological Academy of the Ukrainian SSR, etc.). Extramural psychiatry concentrates its attention mainly on workers in leading industries, helping to rationally organize their labor and striving to improve their living conditions. Together with the organs of labor expertise and social insurance, psychiatrists care for the speedy return of discharged patients to work and for the involvement of those under their supervision in production. Scientific work in psychiatry, striving to master the principles of Marxist-Leninian worldview, has developed especially widely in the post-revolutionary years. Particularly intensive work is being done on the study of psychopathies, reactive states, and exogenous diseases, i.e., forms that do not require long-term hospitalization and are mainly part of what is called 'minor psychiatry.' Here a number of researchers have the opportunity to most fully develop their abilities (Gannushkin, Gilyarovsky, Osipov, and others).

-.P. Zinoviev. Directions in psychiatry. Anatomophysiological direction. The successes of anatomy and physiology of the nervous system, which contributed to the powerful development of neuropathology in the second half of the 19th century, for a long time could not be sufficiently used by psychiatry due to the extraordinary complexity of the phenomena it studied. Nevertheless, already Griesinger, and after him Meynert, Wernicke, taught that at the basis of every psychosis there is a patho-anatomical process in the brain and that all human mental activity is built according to the reflex scheme. The works of Nissl and Alzheimer at the beginning of the 20th century provided the most valuable material for studying the basis of a significant part of mental diseases. At the same time, it became possible to patho-anatomically delineate progressive paralysis, syphilitic psychoses, arteriosclerosis, senile psychoses, etc.; on the basis of anatomical data, new forms of mental diseases (Alzheimer's disease, Pick's disease) were identified, and it was established that psychoses previously considered functional (epilepsy, presenile psychoses, schizophrenia, etc.) belong to organic diseases of the nervous system. Around the same time, Brodmann, on the basis of architectonic data, established the presence of isolated fields in the cerebral cortex, which gave the premise for the possibility of localizing simpler mental functions and their disorders. On the other hand, the achievements of physiology (especially the English and Dutch schools - Sherrington, Magnus), as well as biochemistry and serology, also began to find application in psychiatry. Thus, psychiatry developed largely along the same path as the related field of neuropathology. The most prominent representatives of the neurological school of psychiatrists include Pick, Petz, and Kleist. In Russia, by the beginning of the 20th century, on the basis of the achievements of physiology (Pavlov's doctrine of reflexes, etc.), the reflexological school in psychiatry was founded (Bekhterev and others). - The anatomophysiological direction (to which the neurological and reflexological schools also belong) undoubtedly contributed to strengthening the connection between psychiatry and other medical disciplines, facilitated the rapid growth of psychiatric knowledge, had a great influence on the general course of development of psychiatry (in particular, it strongly reflected on Krepelin's nosological concept), and at the same time, at this stage, it had enormous principled significance, strengthening the positions of materialism in this field of knowledge. Undoubtedly, however, a number of representatives of this direction fell into the error of simplification, for example, reducing all the qualitative specificity of mental phenomena to reflexes and thus taking a mechanistic position or explaining a number of psychopathological phenomena in a narrowly localizing manner. Nevertheless, the anatomophysiological research method in psychiatry, along with other methods, and especially with the clinical one, should and will continue to give valuable results in our science.

^m- Gurevich. Biochemical direction. The first works on biochemistry of psychoses date back to the end of the 19th century (Krainsky and others), however, the continuous development of related questions begins only with the appearance of Kaufman's two-volume monograph (1908-1910). After him, an increasing number of workers began to devote themselves to biochemical researches in the mentally ill. In this direction, in Germany, the work of the contemporary Munich researcher Wuth is of interest, and in the USSR - Prof. Yushchenko, Jewish, etc. Despite the large number of painstaking researches, the results remain modest. This is explained by the extreme complexity and diversity of the subject of research. From this also grows a number of fundamental errors usually made by researchers in this difficult field. The main one is the tendency to establish a causal connection only with the disease itself for the deviations found in the area of metabolism in this or that mental illness, forgetting about the presence of side interdependencies, such as: the influence of concomitant diseases (tuberculosis, syphilis, etc.), differences depending on sex, age, duration of the disease, the picture of the latter (for example, excitement, stupor), etc. The detachment from the clinic, the loss of connection with the living, concrete person living in specific conditions of environment, nutrition, etc., which was present in many researchers, also had a harmful effect. Earlier researchers, based on observations of the influence of alcohol, opium, etc., on the nervous system, built their conclusions on the assumption that psychoses are a reflection of disorders in the area of metabolism. In recent years, based on the concept of the decisive importance of the intermediate brain for metabolic processes, the opposite opinion is more often expressed, namely, that the disorder of metabolism in mental disorders is a secondary phenomenon, and the primary one should be considered the lesion of the brain. It is possible that in many cases both the metabolic disorder and the brain disease are themselves subject to a third common cause. Only research conducted in close connection with clinical observations and according to the principle already accepted in clinical practice of establishing layered, multidimensional connections and relationships can finally solve all these complex questions.

Jewish. Experimental-psychological direction. The complication of tasks in clinical observation and the need to create a methodology for psychiatric research that in its precision would not yield to the methods of somatic medicine created by the end of the 19th century a very favorable soil for attempts to use in psychiatry the psychological experiment. The circumstance that Kraepelin was a student of Wundt and before the beginning of his psychiatric career worked in his Leipzig laboratory could not but contribute to the close rapprochement of experimental psychology with psychiatry. Kraepelin continued his psychological works even when he was already the head of the Heidelberg clinic. The topics of these works, naturally, the further they went, the more they were determined by his psychiatric interests. Thus arose the classical studies that laid the foundation of experimental psychopathology on mental fatigue and on the influence of small doses of various narcotic substances on mental activity. Students of Kraepelin carried out a number of works on the study of individual mental functions in various psychoses. Soon experimental-psychological laboratories began to be established in other psychiatric clinics (in our country for the first time in Moscow by Tokarsky). Subsequently, the attention of psychiatrists interested in experimental psychology was focused on developing methods that could be easily applied at the patient's bedside. Psychological tests were used here (see Tests). A great deal of work was done by Heilbronner, Ziehen, Ranschburg, Moller, Gregor, Bernstein, Rossolimo and others in their development and practical application. Sommer stood somewhat apart, applying not tests but precise laboratory experiment in combination with a uniform scheme of questions proposed to the patient. The overwhelming majority of tests were aimed at studying the intellect. Of the tests proposed for the study of the emotional sphere, only a few found practical application (Jung's associative experiment, Rorschach's psychodiagnosis, etc.). Following the development of individual tests, entire systems of schemes for experimental-psychological research were compiled, aimed at covering as much as possible all the most important aspects of the mental activity of the sick. One of the first successful test schemes was proposed by the Russian psychiatrist A. N. Bernstein. He strove not only to replace the subjective description of the mental state of the patient with an accurately recorded status based on test research, but also to establish a differential diagnosis based on the qualitative characteristics of the tasks performed by patients. Rossolimo proposed a scheme of "psychological profiles" which retains its relative significance to this day. In Germany, Ziehen's scheme was popular for a time, but the French scheme of Binet and Simon achieved worldwide distribution, having as its task the establishment of the degree of mental development of children and adolescents. The development of psychotechnology in the last two decades, although it brought great possibilities in terms of the choice of tests, did not however give psychiatry anything fundamentally new. On the other hand, characterology, which began to develop rapidly in the last decade, gave an impetus to a special application of tests not for testing the state of individual mental functions, but to a certain extent in accordance with the thoughts of Bernstein-for determining the qualitative characteristics of different types of human personalities. Psychoanalytic direction. Freud was very interested in mental diseases in the narrow sense of this word, and he sharply criticized the professional-psychiatric approach to understanding psychopathological phenomena and gave a special solution to a number of questions of psychiatric theory. His explanation of the persecution delusion by homosexual tendencies of patients and other, sometimes witty, but most often based on little acquaintance with the clinic, excursions into the field of psychiatry are known. His students Bleuler and Jung were themselves professional psychiatrists and both devoted a significant part of their attention to the psychoanalytic interpretation of early dementia (schizophrenia). While their orthodox psychoanalytic constructions mostly did not hold, their interest in the intimate basis of the experiences of patients and their desire to penetrate into their essence proved extremely fruitful for the development of psychiatry. In this regard, psychiatry owes much to Bleuler, whose large monograph on early dementia, renamed by him schizophrenia, to this day remains a classical and unsurpassed example of a subtle psychopathological analysis that completely newly illuminated the spiritual world of patients. Bleuler owed much of his success to the fact that, having early parted ways with Freud, he did not tie himself to his orthodoxy. Later he almost completely abandoned psychoanalytic interpretations. When, starting from the end of the war, Freudianism became a fashionable trend, it drew into the orbit of its influence a number of not only German but also French, English and American psychiatrists. In America, a significant part of psychiatrists are still under the influence of the orthodox psychoanalyst Jelliffe and White, who combined simplified psychoanalysis with a special biological dynamism. P. Schilder, author of valuable works on general psychopathology, unsuccessfully tried to rebuild the entire clinical psychiatry "on a psychoanalytic basis." The influence of psychoanalysis was not avoided by many major non-Freudian psychiatrists. In particular, Kretschmer readily uses in his constructions the idea of the sexual basis of some psychopathological phenomena, as well as the concepts of repression and symbol formation based on displacement and condensation, however avoiding speaking about the Oedipal, castration complex, etc. Adler's direction (see Adler's teaching) had little influence on psychiatric thought. In general, psychoanalysis, stimulating interest in the study of the content of patients' experiences, played a significant role in the development of psychiatric thinking in recent decades, although its attempts at a positive solution to psychiatric problems (e.g., psychoanalytic explanation of the pathogenesis of schizophrenia, epileptic seizures, organic symptom complexes, etc.) have obviously suffered a complete failure. The phenomenological direction in psychiatry arose to a large extent as a reaction to the tendency of the school of Kraepelin to exhaust the data necessary for psychopathological research exclusively by external, objective description of the behavior and utterances of the mentally ill. The founder of this direction, the Heidelberg psychiatrist and philosopher Jaspers (K. Jaspers), in his course of general psychopathology, in the chapter on objective symptoms-objective psychopathology-opposed the chapter on subjective phenomena of the sick psyche-"phenomenology." He borrowed this term from the idealist philosopher Husserl, however somewhat changing its meaning. Jaspers strove for as precise and free from any prejudgments as possible depiction of the subjective side of the experiences of patients. The data for phenomenological analysis, according to Jaspers, should serve primarily the self-descriptions of patients, verified with the help of empathy and inner contemplation of the researcher. Experiences should not only be described statically, but dynamic relations should also be established between them, again not by the method of externally objective finding of causes and effects, but by means of internal "understanding" of their subjective connections. Jaspers believes that not all experiences of the mentally ill are accessible to empathy and understanding. In particular, in his opinion, the schizophrenic psyche is incomprehensible, accordingly its phenomena should be interpreted only as a result of extrapsychic causes. However, hypothetical constructions about the material basis of psychopathological phenomena, in particular the anatomical-localization hypotheses of Wernicke and Meynert on the essence of associative processes, Jaspers considers only as masking the absence of real knowledge and therefore harmful ("brain mythology"). Ideologically, Jaspers is closely connected with the reactionary turn to idealistic metaphysics that emerged at the beginning of the 20th century in Western European science, but the revision of psychopathological concepts carried out by him on the basis of enormous and masterful analytical work, accompanied by a new formulation of a whole series of problems, also had a great positive influence on German psychiatry, deepening its problematic and preparing the ground for its further progress. A number of prominent psychiatrists (Gruhle, Mayer-Gross, Kurt and Karl Schneider, E. Strauss, etc.) became ardent adherents of his ideas; many others turned out to be under the influence of the latter without noticing it themselves; however, as a school, the phenomenologists quite quickly exhausted themselves in fruitless attempts at speculative descriptions and schemes. With Jaspers, a fashion for philosophizing began in German psychiatry, up to attempts (Kronfeld) to construct a philosophically substantiated method of psychiatric knowledge different from the natural-scientific one. All this idealistically philosophizing psychiatry is in essence a backward movement to ideas similar to those that inspired the "psychics". Structural analysis and medical characterology.

The phenomenological direction led to a more critical study of the psyche of the mentally ill than was done by Kraepelin and the psychoanalysts. Only on this cleared ground did it become possible to pose the problem of the structure of psychosis. Birnbaum and almost simultaneously Kretschmer, starting from the position of the complexity of psychotic pictures, pointed to the necessity not only to differentiate diagnoses but also to study the form of structure of each individual case depending on the various ratios of the factors acting in it. They demanded the distinction between pathogenesis and pathoplasticity and the identification of constitutional bases of personality, phenomena caused in it by exogenous physical factors, age-related changes, layers conditioned by the influence of experiences, etc. The psychiatric diagnosis came to require a whole series of complex analytical constructions that would make it possible not only to dissect the picture of the disease but also to give a holistic definition of the sick personality itself. In other words, it became necessary to create a special psychiatric characterology. The foundations of the latter were laid by Kretschmer. His constructions are in many ways controversial and even directly incorrect, however his merit remains that he managed to give psychiatric problems such a broad, relevant and vital significance that they never had before. The constitutional direction. Even before the war, a number of researchers devoted themselves to the study of the problem of 'borderline states' and psychopathic constitutions (see Psychopathies). In Russia, this problem was particularly studied by P. B. Gannushkin in a number of articles on psychopathic constitutions and by Yu. V. Kannabikh in his work on Cyclothymia. The basis of Kretschmer's constructions, as well as all works of the constitutional direction, lies in the idea of the hereditary determination not only of endogenous psychoses but also of psychopathies and in general of somato-psychic constitutions. This aspect of Kretschmer's doctrine closely aligns with the work of a number of predominantly German psychiatrists studying the problems of heredity in P. (Rüdin, Kohn, Hoffmann, Lange, Luxenburger, etc., in the USSR-Yudin). The incorrect understanding by some authors of this direction of hereditary properties as not subject to any change led them even to the revival of Lombroso's idea of the born criminal ('crime as fate' by Lange). The current state of psychiatry. In addition to deepening its problems over the last 20 years, a major internal shift has also occurred in P. towards a much closer connection with life than before. Before the war, psychiatric science was developed almost exclusively within the walls of psychiatric hospitals, and naturally all the attention of psychiatrists was focused on the study of grossly expressed psychotic pictures ('major psychoses'). Modern P., on the contrary, particularly devotes itself to initial, weakly expressed borderline cases that do not get into psychiatric hospitals (in this respect Soviet psychiatry also stands not in the last place here-see the works of Rosenstein and others). They have to be studied on outpatient material, in the course of examinations (forensic, labor), in sanatoriums and medical institutions of not narrowly psychiatric type. Correspondingly, the outlook of psychiatrists has significantly expanded. In their practical activity, the distinctions from representatives of other areas of medicine are increasingly erased and areas of work connecting them with somatic disciplines of medicine are increasingly coming to the fore. The somatic condition of mental patients began to attract the attention of psychiatrists back in the time of Kraepelin and Magnan. At present, numerous works are devoted to its study, and not only metabolism but also the functional state of organs and tissues (in particular the reticulo-endothelial system), processes in the digestive tract, the blood picture, etc. are being studied. The important role which syphilis plays in the etiology of mental diseases has long been known. The research of a number of authors (Gilyarovsky, Toporkov, etc.) makes it probable that it does not remain without influence on the occurrence of the so-called 'neurotic' pictures and certain diseases that follow the schizophrenic type. Many works have recently been devoted to the study of the relationships between tuberculosis and mental diseases, especially schizophrenia. - Part of the psychiatrists turned to direct work on the study of the mental state of patients with various somatic diseases, as a result of which the structure of 'exogenous reactions' is increasingly being clarified, in particular the mental syndromes accompanying such diseases as encephalitis, multiple sclerosis, brain tumors and other nervous diseases, typhus, malaria, other infections, neoplasms, malignant anemia, heart diseases, postoperative complications. - Under the influence of P., a number of problems of somatic medicine itself are being reconsidered, in particular the question of the colossal role of the mental factor in the picture and course, for example, of internal diseases. The problem of psychotherapeutic influence on them has been posed (e.g. in bronchial asthma, stomach ulcer, nervous dyspepsias, colitis, etc.). In psychiatry itself, therapeutic nihilism is gradually being overcome and energetic searches for methods of treating psychoses are beginning. A pioneer in this field was the Vienna psychiatrist Wagner-Jauregg, the author of the method of treating progressive paralysis by vaccinating patients with malaria, which is now firmly established. More and more attempts are being made at somatic treatment of other mental diseases, in particular attempts are being made in the direction of finding therapeutic effects on schizophrenia. Soviet scientists have proposed a whole series of biological methods for treating psychoses, and recently in a number of scientific institutions systematic work has begun on the study of the effects of these methods (Gilyarovsky, Lifshits, Sereysky, Khoroshko, etc.). In another area of their research-the doctrine of psychopathies and psychogenic reactions-P. comes into close contact with the field of social sciences and is increasingly drawn into the study of the circle of problems [here a number of Soviet psychiatrists have tried to pose these problems anew (Vnukov, Yudin)] standing at the junction between the biological and social series. Such a broad scope of work and the attempt to resolve a number of the most important problems in the field of P. are possible only under the conditions of socialist construction. Soviet psychiatrists (Ravkin, Rosenstein, Gilyarovsky, etc.) have also made their contribution to the study of the question of the influence of professional hazards on the psyche (mainly occupational injuries). Here it was possible to isolate a number of unique symptom complexes (in lead poisoning, poisoning by carbon monoxide, carbon disulfide, etc.).

P. Zinoviev. Forensic psychiatry occupies a special position among other practical branches of psychiatry. Having as its object mentally ill individuals who violate existing laws, it deals with the assessment of various psychotic forms and conditions from the perspective of the possibility of applying certain measures of influence to their carriers. Such an assessment goes beyond purely medical judgment and forces the psychiatrist to intrude into the sphere of criminal law. Therefore, the range of problems addressed by forensic psychiatry is significantly expanded. This special feature of forensic psychiatry is also reflected in its historical development, which is determined mainly by the development of psychiatry and the expansion of its sphere of interests. Already in the views of Italian jurists of the 16th century, the importance of medical observations in cases of mental disorders began to be recognized. The principles of Italian jurists show their thorough familiarity with the subjective conditions of imputability and with the essence of mental illnesses. Small children were considered non-punishable. Mental illness excluded imputability, and affect was recognized as a mitigating circumstance. The founder of forensic psychiatry is Paolo Zacchia, a member of the Rotae Romanae, author of the treatise "Questiones medicolegales". In this treatise, he presents a rich symptomatology of mental disorders. He teaches to pay attention not only to the speech of the mentally ill, but also to their behavior, he advises studying the facial expression of the mentally ill and their physique. At the end of the 18th century, along with the growth of clinical psychiatry, the former forensic psychology turned into forensic psychiatry. By this time, in the field of criminal law, a transition is observed from objective imputation of crime to imputation based on the subjective element, i.e., the concept of imputability, resp. non-imputability, is formed. In the 19th century, such fundamental guides to forensic psychiatry as those by Serbsky in Russia and Krafft-Ebing in Germany already appear. Forensic psychiatry, throughout its development reflecting the basic principles of criminal law, could not but be class-directed. This orientation is masked by various kinds of "scientific" theories. Flourishing in the West, the sister of forensic psychiatry—criminal psychopathology—is the theoretical soil that feeds forensic psychiatric practice (see Criminology). The views of one of the leading representatives of criminal psychopathology, Karl Birnbaum, deserve special attention. In his lectures on psychopathic criminals ("Die psychopathischen Verbrecher"), he speaks of the existence of a special "degenerative-criminal constitution". Explaining a number of forms of social behavior (e.g., regicide) by psychopathic predisposition, he essentially revives the theory of the "born criminal." If one now recalls that bourgeois psychiatrists (Wilmans, Birnbaum) attribute almost 50% of offenders to psychopaths, and that they consider revolutionaries to be psychopaths, it becomes understandable what a sharp weapon of class struggle criminal psychopathology places in the hands of bourgeois justice. Soviet criminal law exposed the bourgeois doctrine of the universal character of law and clearly declared its class nature. The basis of the Soviet criminal code is the task of protecting the proletarian state. In connection with this, the concept of imputability, resp. non-imputability, has lost its metaphysical meaning. The task of the psychiatrist in a Soviet court is to give a scientifically-based conclusion on the advisability of applying one or another measure of social protection to a person who has caused doubt in the court about his mental health, with mandatory consideration of the interests of protecting the proletarian state. Under conditions of intensifying class struggle, forensic psychiatric assessments acquire special responsibility, since mental illness can sometimes serve as a screen for a class enemy. This requires the psychiatrist to be extremely vigilant and forces him to thoroughly review his scientific baggage, largely borrowed from bourgeois psychiatry. This explains the development of Soviet forensic psychiatry along the path of reevaluation of values. In the first place, the neolombrosian ideas of bourgeois criminal psychopathology, transferred to Soviet soil by the work of the Moscow Cabinet for the Study of the Criminal Personality (headed by E. K. Krasnushkin), were subjected to criticism. In the process of the struggle against neolombrosianism, the urgent need to revise the doctrine of so-called borderline states became apparent. The problem of psychopathies deserves special attention here, since it is precisely the incorrect formulation of this problem that serves as the soil for the development of neolombrosian and other biologizing theories. The question of reactive states, which often mask the class orientation of the behavior of one or another offender, also receives no less urgency. Furthermore, the latest achievements in clinical psychiatry and the experience of psychhygienic work have highlighted the problem of mild and defective forms. The material accumulated in this area requires a review of forensic psychiatric evaluations within mental illnesses for the purpose of developing clearer indications for the application of medical measures and the restructuring of the system of compulsory treatment. Finally, the reorganization of places of deprivation of liberty and their transformation into factory-plant and agricultural colonies has posed before forensic psychiatry the urgent task of scientifically developing the problems of psychhygiene and psychoprophylaxis in corrective-labor institutions (the psychiatrist's participation in labor selection, in the organization of labor and living conditions, etc.). Such are the main problems that Soviet forensic psychiatry develops in relation to the tasks of criminal legal and corrective-labor policy.

A. Vuneev. Child psychiatry includes the doctrine of the peculiarities of mental deviations of infancy, preschool, school, and adolescent periods (age from 0 to 17 years). Being a part of general psychiatry and reflecting various directions of the latter, child psychiatry has so much that is specific that it was deemed necessary to single it out as a separate department. The main peculiarity of child psychiatry is that its object is the growing organism with a specific dynamics and an accelerated rate of development. Each age phase of childhood and adolescence is characterized not only by a certain complex of psycho-physical properties but also by a specific nervous-mental morbidity, in the sense of the predominant significance of certain etiological factors, the predominance of certain forms and the specificity of the clinical picture. The peculiarities of child psychiatry also include its closer connection with related disciplines: neurology, pediatrics, and pedagogy. With neurology, it, like 'adult' psychiatry, is connected by the commonality of a whole group of diseases (epilepsy, encephalitis, syphilis, etc.); in the direction of connection with pediatrics, questions related to the group of endocrine glands and various forms of metabolic disorders come to the forefront. The connection with pedagogy is carried out mainly in the area of therapeutic measures—it is characteristic of child psychiatry that the therapeutic work proceeds in parallel with the pedagogical, and the teacher participates in the therapeutic-psychiatric work. The significance of child psychiatry for solving general psychiatric problems is determined by the following two points: 1) dealing with initial forms of diseases and simpler etiological relationships, child psychiatry can give much for elucidating the etiology and pathogenesis of various diseases; 2) even greater significance is attached to child psychiatry in the questions of prevention of mental morbidity. The plasticity of the child makes him the best object for preventive measures, and it can be said that all psychoprophylactic work will be rationally constructed only when it begins in childhood. The history of child psychiatry dates back to the middle of the 19th century. For several decades, the study of mental anomalies of childhood was limited to a group of severe forms of feeble-mindedness (idiots and epileptics). For these children, special institutions were organized, which were built on the basis of private and public charity. One of the first workers in this field, the Swiss physician Guggenbühl, who in 1836 founded an institution for cretins, was far from the scientific substantiation of his work. The French psychiatrist Itard (1801), in the study of mental underdevelopment, also went along the line of charity. In Germany, in the questions of the mentally ill child, the philanthropic direction also predominated initially. Only at the beginning of the current century did major psychiatrists (Siemens, Strohmayer, Scholz, Homburger, Gregor, Stir, Claparède, Decroly, Wallon, Lévy, Williams, Thomas, and others) begin to deal with child psychiatry, who gave a scientific basis to this discipline. In recent years, separate trends have begun to crystallize in child psychiatry, such as psychoanalytic, which has particularly spread in England and America, and individual-psychological (the school of A. Adler in Vienna). In America, the psychoghygienic direction has received wide dissemination. At present, there is a large network of children's preventive institutions there, but all of them have the character of private or public charity. And here, as in Western Europe, many excellently equipped children's institutions are accessible only to rich children. In Russia, interest in child psychiatry clearly appears only at the beginning of the 20th century, when these questions begin to be developed by individual psychiatrists in large cities: in St. Petersburg—Griboyedov, Lazursky, Vladimirsky; in Kyiv—Sikorsky; in Moscow—Rossolimo and his students (Rabinovich, Prisman, Surov, Zabugin), V. P. Kashchenko, Feldman, Postovsky, and others; in Kazan—Troshchin. As for institutions for mentally ill children, they, as in Western Europe, were built mainly for severe forms of feeble-mindedness (idiots and epileptics) and had a philanthropic character, which is evident from some of the names—'shelter of St. Mary,' 'asylum of the Queen of Heaven.' For borderline conditions in the prerevolutionary period, there were only a few private institutions and several auxiliary schools. The development of child psychiatry went at a more accelerated pace only after the October Revolution, when the questions of children's health protection were raised to the proper level, and the organization of assistance to mentally ill children became a state affair. During 15 years, by the organs of Narodny Komissariat Prosveshcheniya (Narkompros) and the People's Commissariat of Health, a whole network of institutions was built for children deviating in a mental respect (see Defectiveness, organization of assistance to defective children). In parallel with the organizational work, scientific research work was carried out, which at present is conducted in almost all large or medium-sized centers of the Union. In its development, child psychiatry has gone through a number of stages. In the initial stages, there is a tendency to separate from general psychiatry and to single out into a special discipline—'defectology,' studying defective children. This period gave much of value to child psychiatry in terms of organizing joint work with teachers, developing a typology of institutions and methods of examination (the school of Rossolimo in Moscow, Griboyedov, Vel'sky, Grabarov in Leningrad, in Ukraine—Vladimirsky, Tarasevich, Kvint). But this separation from general psychiatry also had a negative side; the very term 'defective' was unfortunate, because it spoke of some irreparable damage, the defectological nomenclature and classification of diseases were not sufficiently scientifically substantiated. In the following stages, child psychiatry goes along the line of rapprochement with general psychiatric disciplines. In this respect, Moscow has given the most: here a children's department was organized at the psychiatric clinic (Gilyarovsky, Vinokurova), a special children's psychoneurological clinic of the People's Commissariat of Health (Gurevich, Ozeretsky, Sukhareva, Osipova), a psychoneurological clinic for infancy (Simeon), a psychiatric hospital for adolescents (Azbukin), a large children's psychiatric department (with 200 beds) at the Kashchenko Hospital and a number of others. During the revolutionary period, child psychiatry produced a number of works in the Russian and foreign press concerning various groups of childhood diseases, the development of children's character and motor skills. In recent times, a significant shift has been noted in the direction of the great development of the psychoghygienic direction: the organization of dispensary work, psychoghygienic work in the mass school and in the FZU (Factory Apprentice Schools), psychoneurological work in vocational consultation, etc. This is still not enough, but these first steps will be fruitful if so-called child psychiatry, in step with general psychiatry, goes along the line of methodological reorganization of all work in the service of socialist construction.

G. Sukhareva. Military psychiatry—an applied branch of P., having as its main task the development of forms of organization of psychiatric assistance in the army in peacetime and wartime. Along with this main task, military P. faces the task of psychiatric examination, which is part of the usual clinical development of issues in P. It should be said that war does not cause any special forms of psychiatric diseases (this was particularly emphasized by the imperialist war). This is why military P. studies the usual nosological forms mainly from the perspective of military-psychiatric examination (see War-military psychoses). The organization of psychiatric assistance in the army is entirely subordinate to the general tasks of the military-sanitary service—assistance in strengthening the combat capability of the army. Materials on the history of military P. are extremely scarce. In Russia, this issue first arose during the Russo-Japanese War. There are no data on the state of affairs in providing assistance to the mentally ill in earlier wars (wars of the 19th century—Crimean, Russo-Turkish). As for foreign armies, the first data relate to the Franco-Prussian and Anglo-Boer wars. These data are mainly of the nature of statistical summaries of psychiatric morbidity and descriptions of observed diseases, with comparatively little attention paid to the organization of assistance. During the imperialist war, when the exceptional scale of military operations presented enormous demands on the military-sanitary service of all warring armies, it turned out that most of these armies were not prepared for the development of psychiatric assistance. The greatest interest is presented by the experience of the French and American armies. In France in 1922, neuropsychiatric centers were created, attached to large military units, providing first psychiatric aid at the front, serving as collectors for the mentally ill, and being staging points for evacuation to rear psychiatric hospitals. Thanks to the treatment of acute psychotic outbreaks (often of a reactive nature) in these centers, it was possible to avoid evacuation to the rear of many patients. In the American army, a large neuropsychiatric organization was created in 1917 with the participation of the National Committee on Mental Hygiene, both for the USA and for the expeditionary corps in France. Of exceptional interest is the preventive examination to which the entire American army of over 2 million people was subjected, of whom about 72,000 were screened. The result of this was a sharp decrease in the number of neuropsychiatric diseases in the expeditionary corps, particularly demonstrable compared to the neighboring British army. In the tsarist army, where the military-sanitary service was completely unprepared for the wave of mental diseases and had no psychiatric organization, the latter was taken over by the Red Cross, which over 3 years deployed over 6,000 psychiatric beds, organized the evacuation system, creating special psychiatric cars that played the role of mobile collectors. During the years of the war (1914-1917), a number of conferences were held on issues of psychiatric assistance to the army. The main task of military P. is to prevent mentally ill persons from entering the army. This task is resolved by the corresponding articles of the schedule of diseases (Order of the Revolutionary Military Council of the USSR No. 111, 1931). According to Art. 2, 'persons suffering from all forms of mental diseases are discharged from the ranks of the Red Army.' Similarly, Art. 1 resolves the question of military service for persons suffering from oligophrenia. The question is significantly more complex in the case of psychopaths. The last schedule provides for the possibility of their discharge from military service in accordance with Art. 4, however, not all cases of psychopathy can be covered by this article, and the diagnosis itself is considerably more difficult here. In general, the question of fitness for military service for persons suffering from various neuropsychiatric diseases is decided on the basis of an individual approach, provided that expert questions are solved carefully and cautiously. For appropriate selection and ensuring real possibilities of screening, the proper organization of accounting for mentally ill persons among the civilian population (in this case, of conscription age) is of decisive importance. The participation of physicians armed with psychiatric knowledge in conscription commissions is extremely important. No less important an element in the system of military-psychiatric service in the RKKA is psychogenic work in units, first of all in military educational institutions. This work should cover issues of rationalization of training, work and rest regimes, hygiene of mental labor, etc. Naturally, psychogenic work in the RKKA is subordinate to the general tasks of combat training and political education. Organization of psychiatric assistance in the RKKA. At present, in most military districts there are district psychiatrists—members of district medical commissions, on whom both the tasks of examination and the organization of psychogenic work in military units are placed. There are no psychiatric inpatient facilities in the RKKA (with the exception of the psychiatric clinic of the VMA and the psychiatric department of the 1st Moscow Communal Hospital). Examination and treatment of servicemen are carried out in general civilian psychiatric hospitals. A. Edelstein. Journals and societies. From Russian periodical publications, one was devoted to psychiatry—the journal 'Modern Psychiatry,' published in Moscow from 1907 to 1917, founded by Bernstein and Lahtin, and later edited by Gannushkin. All other journals that published psychiatric literature combined psychiatry with neuropathology (see). The same is true of congresses, which were always common to both specialties, with the exception of Leningrad, which for a long time had a separate society of psychiatrists. In the post-revolutionary period, in addition to the all-union congress of psychiatrists and neuropathologists, the People's Commissariat of Health of the RSFSR convened three conferences mainly devoted to organizational issues on questions of psychiatry and neuropathology (in 1920, 1924, and 1926—the last conference was all-union).