Psychogiene

760 Organization of neuropsychiatric assistance...

760 IV. Organization of the psychogiene movement...

760 Psychogiene, the science of strengthening mental health, and the prevention and treatment of mental illnesses. Soviet P. is defined as the theory and practice of health measures concerning mental health, undertaken with the aim of actively contributing to socialist construction in the USSR. P. should not be artificially opposed and separated from psycho-prophylaxis, which it encompasses and includes as a part of its work. P. deals with both the healthy from the standpoint of strengthening their mental health, increasing its strength and stability, and resistance to various harmful factors that impair its full integrity, as well as with the sick, aiming to prevent the development of these diseases. Both tasks—strengthening mental health and preventing the occurrence and development of mental illnesses—are inextricably linked. From this point of view, the assertion found in Soviet literature that separates P. from psycho-prophylaxis, recognizing for psychogiene the field of activity among the healthy, and under psycho-prophylaxis measures relating to a person who is already deficient in mental health, is incorrect. I. Subject and tasks of psychogiene. P. has existed for barely 25 years (see below) and is still in the process of its formation. P. grew directly out of psychiatry and first covered its organizational and preventive problems. At the same time, P. is closely linked with general and social hygiene. The broad development of P. in capitalist countries in the post-war years is primarily due to the enormous growth of mental illness, especially increasing as the crisis of the capitalist system deepens, the material and living conditions of the broad working masses worsen, the intensification of exploitation, impoverishment, unemployment, fascist terror, etc. The inevitable companions of capitalism—tuberculosis, syphilis, alcoholism—also contribute to this growth. P. in bourgeois countries is above all a palliative response to the growing mental illness and a means of combating the revolutionary activity of the broad proletarian masses by involving them in bourgeois-philanthropic movements. By obscuring the fundamental social sources of mental illness, which lie in the conditions of capitalist society, bourgeois P. replaces the radical measures that are unrealizable under capitalism with scattered philanthropic initiatives. In the USSR, the powerful development of P. has reasons that are completely opposite in their class nature. As a result of the victorious socialist construction, which has led and continues to lead to a fundamental improvement in working and living conditions in the USSR, we have a growing decrease in mental illness year by year. The development of P. in the USSR reflects the general health policy of the Soviet power and the broad social measures aimed, in particular, at eliminating mental illness. The social order is the expansion of psychogiene work in factories, plants, collective farms, educational institutions, etc., the psychogiene education of the broad masses, the improvement of work and living conditions aimed at strengthening and developing mental health as a powerful factor in increasing labor productivity and the growth of socialist culture. The class opposition in the origin, nature, and development of bourgeois and Soviet P. is also expressed in the definitions of its subject and tasks given by bourgeois psychogienists. Thus, the American psychogienist Williams (E. Williams) distinguishes P. as an organized social movement and as a scientifically based striving to preserve human mental health, including here the behavior and social relations of the subject. P. seeks to raise interest in mental health, reveal its importance, and the damage caused to society by mental abnormality, and the relationship between the latter and social problems (such as crime, complications of family life, instability of industry, and social disorders). P. is also concerned with the organization of assistance to the mentally ill, legislation concerning the mentally ill. The ultimate goal of P.—the prevention of mental and nervous diseases and their harmful effects on social life.—A. Meyer defines P. as the hygiene of the human personality. P. should take upon itself the organization of mental health and also deal with questions of school, industry, home life, court, marriage permits, consultations. In this work, P. should receive the support of the state and the public. Potet, author of the manual 'L'hygiene mentale,' believes that 'the task of P. consists in the protection and improvement of the human psyche; it is an attempt to establish rational and scientific data for mental activity, to develop guidelines for the prevention of psychopathies... P. strives to a large extent to contribute to the long-term well-being of the individual in society and thereby it constitutes one part of social hygiene.' Stransky (E. Stransky) defines P. 'as a scientifically based striving to preserve mental health both in relation to the mentally healthy person and to prevent illness in those threatened by it.' Sommer, head of the German Psychogiene Union, says: 'psychogiene represents expanded psychiatry, which has gradually emerged from the psychiatric field into social life to ensure the mental health of individuals, entire peoples, and all humanity.' Finally, the charter of the German Psychogiene Union defines P. as follows: 'the term "psychogiene" primarily encompasses the striving for the appropriate organization of open and closed assistance to the mentally ill and psychopaths on psychogiene bases (work therapy, patronage, out-patient assistance, institutions for the nervous, etc.) and further mental hygiene and prevention in the proper sense and finally the dissemination of psychogiene knowledge among different sections of the population. P. in its practical application should not only operate within the framework of psychiatry but in all areas of social life.' In all the definitions given, on the one hand, there is a tendency to hide the class nature of bourgeois P. under the concepts of 'above-class,' 'ahistorical' content of its subject (see above the definition of Sommer and others), on the other hand, the improper expansion of the subject of P., including here the study of the laws of development of social life (see above the definition of Williams), as a result of which P. replaces politics, becoming in fact the policy of the ruling class, carried out for the purpose of strengthening the exploitation of the working masses. The latter—so-called psychogiene universalism—was transferred to Soviet P. by Mendeleson. Quoting Müller-Lier's words that 'doctors and especially psychoneurologists should strive to expand the boundaries of medicine, to create a new science that would encompass all human suffering and all misery and teach how to fight them,' Mendeleson believes that 'such a new science will be psychosociology as a synthesis of P. and sociology.' Rosenstein in his early statements also revealed a tendency to replace P. with all the influences of social life and health care (for example: 'psychogiene influence on the personality of a new society raises questions of organizing interpersonal relations, perhaps psychogiene ones'). The tasks of Soviet P. can be basically formulated as follows. 1) Scientific development of specific measures to strengthen mental health, and forms and methods of practical work in this area as applied to the current areas of socialist construction (industrial P., educational P., military P., etc.). 2) Study of mental illness and its roots (social pathology and etiology) and development of forms and methods of its accounting and proper organization (sanitary statistics). ^Development of the principles of organization of psychiatric assistance. 4) Psychogiene propaganda. II. History of the psychogiene movement. The emergence and development of P. in capitalist countries reflected the profound shifts that occurred in bourgeois medicine, in particular psychiatry, towards moving beyond the framework of individual healing to social reformism within the framework of the capitalist system, to social measures concerning the fight against mental illnesses and their sources. These progressive tendencies found expression among most outstanding progressive psychiatrists of the bourgeois era in their development of various problems of social etiology and social pathology of mental illnesses, a turn towards studying borderline states, 'nervousness,' mild and initial forms of mental illnesses, in increased interest in the problems of characterology, giftedness, mental labor, and organizational-psychiatric issues. The organized psychogiene movement dates back to 1908-1909, when the 'National Psychogiene Committee' was established in the USA.

It arose at the initiative of Clifford Beers and Adolf Meyer, the leading American psychiatrist. After a three-year stay in a psychiatric hospital, associated with a psychotic episode, Beers became an advocate for the reorganization of psychiatric care, dedicating to it his famous book 'A Mind that Found Itself'. In general, the work developed after the imperialist war (during the last, a large and interesting experiment in psychogienic work was carried out in the American army, as a result of which the neuropsychiatric morbidity in the troops sharply decreased). The main directions of work went along the lines of childhood psychogiene, psychogiene of mental labor (organization of psychogieneic offices in universities, colleges), and penitentiary psychogiene. In Europe, the psychogieneic movement was first organized in France, and initially the 'National Committee of Psychogiene' (1918) was created, and in 1920 it was replaced by the 'French League of Psychogiene', whose leaders are Toulouse and Genil-Perrin. The 'German Union of Psychogiene' developed quite extensive activity, despite the fact that Germany later than others became involved in psychogieneic work. Organized in 1927 by Sommer, Re-mer and others, this Union held two meetings in a few years, at which a number of issues of the organization of P. were worked out. The main content of the work is concentrated on the issues of organization of psychiatric assistance. Similar committees have been organized in all countries of Europe, America, Australia and others in the past years (in 24 countries in total). In 1922, the first international conference on P. was held in Paris. The next conference took place there in 1927. In May 1930, the first international congress on P. was held in Washington, which was a review of the achievements of the world psychogieneic movement. 48 countries participated in the congress, and up to 300 reports were heard. Representatives of the USSR also participated in the congress. The 2nd international congress is scheduled for Paris in 1935. The great growth of the psychogieneic movement in the USA in the post-war years was directly related to the colossal growth in the number of psychiatric diseases, which increases every year. However, the economic crisis, which engulfed the capitalist world and which of course further contributed to the growth of psychiatric morbidity, strongly affected the psychogieneic movement, depriving most organizations of funds for work. In Russia, the first mention of P. is found in the works of the I Congress of domestic psychiatrists (1887), where the issues were addressed in the reports of Mergyevsky and Sikorsky. However, both reports had a reactionary character, the issues of psychoprophylaxis were closely related to religion. Subsequently, Serbsky, Bekhterev and others, in the years after the first Russian revolution, already linked the tasks of neuropsychic improvement with the tasks of liberating the country from autocracy. Psychogieneic work received its real form only after the October Revolution. However, among other preventive branches of Soviet healthcare, the restructuring of psychiatry on new principles was markedly delayed. While the fight against tbc and ven. b-ny received wide development from the very first days of the existence of NKZdr., the issues of preventive struggle with neuropsychic diseases and the organization of psychogieneic work first arose in 1923 at the II All-Russian Conference of neuropathologists and psychiatrists [the I All-Russian Conference (in 1918) was held under the flag of preserving the old zemstvo forms of organization of psychiatric assistance], where the main problems of P. were worked out [reports--on the basic principles of P. (Rozenstein), on neuropsychiatric dispensaries (Zinovyev), on the fight against alcoholism (Strashun), on drug addiction (Sholomovich), on eugenics (Yudin) and a number of others]. At the next conference (already all-Union) in 1925, these principles received further development, and some preliminary results of psychogieneic work were summarized. The center of psychogieneic work became the State neuropsychiatric dispensary of NKZdr. in Moscow. In the following years, the issues of P. were invariably on all neuropsychiatric conferences and congresses (All-Union Congress of Neuropathologists and Psychiatrists-1927, Congress on human behavior-1930, All-Ukrainian Conference of Psychoneurologists-1930). In the past years, the Soviet psychogieneic movement, although it did not take on the character of a mass movement and did not go beyond the limits of healthcare agencies, extremely insufficiently covering our children's contingents, nevertheless in the field of organization of psychiatric assistance achieved wide development of out-hospital care, first of all covering large masses of so-called 'borderline cases', and in addition developing its excellent forms of psychogieneic work both in terms of principles and methods. True, at the first steps of development, a number of errors were made, arising both from the uncritical transfer of Western European theories to our conditions without taking into account the qualitative difference of our conditions, and from insufficient orientation to the needs of socialist construction (criticism of these errors--see below when considering the corresponding sections of the work). III. Methods and content of psychogieneic work. Industrial psychogiene has as its task the development and implementation of measures to reduce neuropsychiatric diseases in production, strengthening the neuropsychic health of workers in order to increase labor productivity. Although in this field we have not yet gone beyond the scope of experimental and demonstrative work and P. in production has not taken on a mass character, however, the USSR is the only country where problems of industrial P. are being posed and developed. Nowhere in the world, even in the USA with their super-industrialization, are these issues addressed. The unique experience described by Anderson in his book 'Psychiatry in Industry' is called industrial P. by mistake, since it is about the experience of work not in production, but in a department store in New York. The work in essence aims first of all at the selection of any politically dangerous employees--people who know how to respect 'authorities' should be selected first, and an 'army of radical agitators' should not be admitted to enterprises. Of course, this is by no means accidental, but fully stems from the class nature of bourgeois P., which by its very nature (especially in the conditions of the crisis of capitalism with a colossal army of unemployed) cannot set the task of neuropsychic improvement of the working masses, since this task is unachievable in the conditions of capitalist exploitation, where the increase in labor productivity goes at the expense of increased exploitation of workers. That is why the experience of Soviet P. is of special interest as the only real attempt to develop industrial P. However, it must be said directly that only in the last 2-3 years Soviet P. has been restructured in accordance with the needs of socialist construction. The entire initial period (approximately 1923-30) the work was built on erroneous methodological premises that characterized all occupational pathology in those years (Obuk, Kaplun, in psychogiene Rozenstein, Ravkin and others). These errors consisted in the uncritical transfer of the provisions of bourgeois scientists to our conditions without taking into account the fundamental difference in labor in the country of building socialism. These errors were also expressed in the fact that all work went along the line of bare description, neutral statement of facts, which did not equip for effective overcoming of shortcomings, but on the contrary, creating exaggerated ideas about the supposedly huge 'pathological involvement' of nervous and psych, b-ny, led only to intimidation and involuntary demobilization. A large number of surveys conducted during these years (mainly in Moscow by the State neuropsych. dispensary and the Institute named after Obuk) covered the main professions, such as: various specialties of textile workers (spinners, weavers), metalworkers (nail-making, lamp production, etc.), chemists (galoshes, aniline production) and a number of others (works of Ravkin, Berger, Goldovskaya, Chernukha and others). By critically overcoming methodological errors on the basis of positive experience, Soviet industrial P. has now developed a certain system of work in production. Basically, this work is concentrated at health posts. With the wide development of psychogieneic work, the creation of an organizational center in the form of offices of industrial P. is envisioned. This can for now be recognized only as a task of the near future, when psychogieneic work in production acquires a mass character. The content of this work can basically be outlined in the following directions: work on any new production should begin first of all with the study of production on the basis of compiling a psycho-sanitary characteristic of the corresponding shop. Using the data of general san. characteristics, the psychogieneic specialist in production pays special attention to those production factors that affect the central nervous system (e.g. vapors of benzene, mercury, lead, etc.), on the nature of labor processes (using partly the data of time and motion study).

Parallel to this, psychogienic study of workers is conducted. At the same time, on the basis of studying the signaling records of the health post, nervous and mental morbidity among the workers of this shop or production is identified. Further work proceeds in two directions: a) work among the healthy, b) work among the sick. The first of these is of the greatest importance, although more attention has been paid to the second until now. Work among the healthy begins first of all with participation in the allocation of labor force. For this purpose, the psychogienist participates in the medical selection of new workers arriving at the plant, gives instructions about their distribution among shops and within a shop, taking those in need under subsequent dispensary observation. On the basis of studying labor processes, he participates in their rationalization from the point of view of psychogienic measures, in the development of the work regime, etc. Here P. is closely intertwined with psychotechnology. However, while psychotechnology is essentially unable to study individual individuality, P. builds its conclusions on the basis of detailed study of the personality, thereby introducing a substantial correction to the data of psychotechnical research. At the same time, laggards, shoddy workers, those repeatedly injured, and truants are identified and taken under individual study in order to identify the causes of these phenomena and develop measures to eliminate these causes and include these workers in the general production regime. On the basis of data from the signaling records, those with long-term and frequent nervous and mental diseases are taken under dispensary observation, they are studied in order to develop specific measures to reduce morbidity. It is also necessary to mention the neurogienic work for the prevention of organic nervous diseases, in particular lesions of the peripheral nervous system. For example, in the foundry shop of the 'Dynamo' plant, as a result of rationalization of the molder's workplace carried out according to the instructions of the neurologist, it was possible to reduce the incidence of neuritis. All this work is consolidated by mass work, which has as its task the familiarization of all workers in the shop (production) with the tasks, content, and methods of psychogienic work. For this purpose, conversations, lectures are conducted, circles, exhibitions, corners are organized, articles are placed in the factory press, a psychogienic consultation is organized. The work in the fight against alcoholism should also be included here. The work outlined here is based on the experience of psychogienic work in the 'Dynamo', 'Kaucuk' plants and a number of others (Moscow), 'Khems', 'Bolshevik' (Ukraine). Psychogiene of mental labor. The significance and tasks of this work are determined by the hundreds of thousands and even millions of workers and collective farm members who are involved in study. Taking up a book for the first time, often combining study with work in production, these new contingents, refuting in practice any 'theories of acquired disability', especially need to be instilled with skills of mental labor, its organization, and mastery of its technique. However, to the present time, this branch of psychogienic work has not yet acquired a mass character and is currently mainly carried out in individual higher educational institutions and is aimed at raising the academic performance of students through neuropsychological health improvement. This psychogienic work is conducted in various types of schools in the form of creating special psychogienic offices, organizationally connected less with the health department, where such exists, than with the academic department. The psychogienic office includes a psychiatrist-psychogienist, a psychologist-psychotechnician, and a specialist in the methodology and technique of mental labor. Basically, the work consists of the following stages: 1) Selection upon admission through psychogienic examination, revealing the state of health and features of the nervous and mental organization of the personality from the point of view of their significance for the learning process (compilation of 'psychogienic journals'). 2) Compilation of a psychogienic characteristic (state of nervous and mental health, general level of development, features of intellect, features of character, state of mental performance). Materials for the characteristic are obtained from both general medical examination and special psychogienic and psychotechnical examination. 3) Dynamic observation of selected groups and individuals, taking into account the effect of the educational process on them. 4) Mass psychogienic work on the technique of mental labor, on the organization of rest. This work should be coordinated with mass sanitary and cultural work. Here, as in industrial P., there is the problem of developing and implementing a 'psychogienic minimum'. 5) Participation in the organization of the pedagogical process for both groups and individuals. Psychogienic work is intertwined with special outpatient psychiatric care. Basically, with the presence of special medical and psychogienic selection, we are mainly dealing with healthy individuals. In the absence of strict selection and in educational P., the problem of adaptation to the educational process of those with long-term and frequent illnesses, of resolving questions of mental performance in various nervous and mental and somatic diseases that do not interfere with study, arises. Psychogienic offices should have a special fund of therapeutic and preventive assistance, such as places in rest homes, sanatoriums, hospitals, physiotherapy institutions, etc., to prevent the development of more persistent disorders from primary states of fatigue, exhaustion, etc. Experimental demonstration points of this work exist at the Communist University of the Toilers of the East named after Stalin in Moscow, at Marxism courses in Kharkov, etc. The work of these points has revealed the special value of psychogienic data periodically collected and of guidance for planning and rationalization of mental work with the help of a system of records, notes, graphical method, special technical and auxiliary equipment, etc. The organizational status of these offices has not yet been fully determined: in some educational institutions they are part of the health department (health post), in some - of the academic and methodological department, in some they are in the position of an independent department. It is quite obvious that this work is differentiated depending on the characteristics of one or another educational institution (technical, socio-economic, medical, agricultural, etc.). Besides the USSR, similar work has long been conducted in the USA. Its beginning was laid by psychologist Stanley Hall together with psychiatrists; this work spread to many colleges and universities. In some places it is connected with the department of preventive medicine of the medical faculty. In 28 colleges in the USA there are point-clinics consisting of psychiatrists, psychologists, and social workers. From individual statements by American psychogienists, it is evident that they do not have unanimity in deciding the question of the essence of this work. Some consider it more medical, basing it on treatment, but besides treatment they are especially interested in familiarization with the entire environment of students in order to find the source of difficulties in adaptation, others relate it to the educational and upbringing part. Individual familiarization with maladapted persons goes mainly along the line of finding emotional conflicts, among which a special role is played by those that lie between the 'ideals' of parents and the influence of the environment. All attention is directed towards those in need of treatment, the number of whom reaches 10-18% (according to different authors). Next come cases of difficulties in adaptation, and the need for psychogienic guidance is determined in some cases up to 85%. In difficulties of adaptation, various 'problems' troubling youth play a huge role. Americans attach great importance to a course of lectures, seminars on psychogiene for both new students and teachers. Individual psychogienists demand that teachers be familiarized with the characteristics of each student. Psychogiene of rest. As an object here, daily rest after work, the day off, the use of the annual vacation can be designated. To this day, rest proceeds chaotically and is not subordinated to the main task - the restoration of labor resources and thereby the increase in labor productivity. Meanwhile, organized influence on the nervous and mental sphere is the most important moment in fulfilling the said task. The rest regime should constitute the main content of P. of rest. In particular, such questions as the influence on the nervous and mental sphere of switching from one type of labor to another (physical labor for a mental worker and vice versa), the influence of one or another entertainment (cinema, chess, etc.) can be designated here. Practically, here will be the participation of psychogienists in the work of culture and rest parks, in the work of rest homes, sanatoriums, participation in the development of their regime. The question of physical culture and psychogiene should be especially raised.

The positive effect of physical culture on the nervous and psychic sphere is clear a priori, however no one has yet engaged in the theoretical substantiation of this problem, or in the development of special indications depending on one or another individual characteristics. Similarly, the task of studying tourism as a psychogienic factor stands in full. The struggle against alcoholism and other drug addictions. Although alcoholism is losing its significance for us year by year, it is still not possible to exclude this problem from P. The influence of alcohol and other narcotics on the nervous and psychic sphere has been known for a long time. One can boldly say that alcoholism is the 'oldest' psychogienic problem. Indeed, for a long time the struggle against alcoholism proceeded not so much along the path of therapeutic measures, which are of course palliative, but along the line of preventive measures. Of course, alcoholism is above all a social problem, and therefore it is resolved by social measures, as we see when comparing the state of the question in the USA, where prohibition turned into a national disaster, causing unprecedented crime, and in the USSR, where as a result of the victorious completion of the construction of the foundation of socialism and the unprecedented growth in the cultural level of the masses, alcoholism has lost its particular acuteness. During the years of the NEP, an extensive narcological organization was created in a number of places, which was attempted to be built separately from the general psychiatric organization. The network of narcological dispensaries (at present merged into the system of unified dispensaries), significant numbers of medical personnel, the mobilization of the working public in the form of societies for the 'struggle against alcoholism', 'for a healthy way of life' - all this corresponded to those years when this problem had not yet lost its acuteness. At present, a sharp decrease in the number of alcoholics being treated in neuropsychiatric departments is noted everywhere. In any case, the few who remain do not need a special network and can be fully served by the existing extramural psychiatric organization. As part of psychogienic work in production, health centers should be involved in the struggle against alcoholism. Other narcotics (cocaine, morphine, opium, etc.) do not have any serious significance for us. Psychogiene of sexual life. One or another phenomena of sexual pathology are most closely connected with disorders in the nervous and psychic sphere. But not only clearly expressed pathological phenomena, but also a number of moments connected with the physiology of sexual life (excesses in the sense of intensity of sexual life, abortions, coitus interruptus, impotence, etc.), all this directly affects nervous and psychic health and therefore must become an object of P. Here one can outline such questions as regulation of sexual life (its intensity), elimination of sexual conflicts, etc. (see Sexual question). Special importance must be given to sexual education (see), which should eliminate the above-mentioned moments. Mention should be made of consultations on the sexual question. In Germany they are quite widespread and to some extent have a eugenic character. Psychogiene and eugenics. Questions of eugenics (see) in bourgeois P occupy a central place. Entire psychogienic conferences are devoted to them. This is a direct consequence of the emasculation of P in the West and its lack of any other content. Relying on bourgeois eugenics, which has particularly clearly revealed its class nature at present in the 'eugenic' measures of the Hitler government, Western psychogiene thus determines its own class face. In particular this finds its expression in the unscientific theories of sterilization, which are so popular among bourgeois eugenicists and psychogienists. The task of Soviet P is the critical assimilation of that positive which eugenics offers in the struggle against individual nervous and psychic diseases, and the use of these data for the creation of 'healthy builders of socialism' (Stalin).

Psychogiene of childhood age. The greatest American psychogienist White called childhood the 'golden time for P.' Indeed, it is precisely during these years that personality is formed, inclinations are developed, habits are created, and a worldview begins to take shape. In individual cases, again during this same period, various deviations from the norm arise, which subsequently develop into complex psychopathological pictures. Hence the tasks of P. of childhood age are clear. This primarily includes the development of measures that ensure the strengthening of the neuropsychic health of the child and adolescent, the maximum identification of the positive qualities inherent in them, for which we have all the conditions that do not exist anywhere in the capitalist world. The organized children's communist movement plays a primary role in this formation of personality. Along the line of participation in the pioneer movement, as well as in school, P. faces enormous tasks. Here P. merges with pedology and the work of physicians. Undoubtedly, in that part where pedologists deal with the issues of neuropsychic health of children, they are essentially doing purely psychogienic work. When establishing the daily routine and organizing the educational process, psychogienic aspects must be taken into account. Great importance is attached to the help of psychogienists to teachers in creating discipline in children's collectives, based on taking into account the individual characteristics of children. Involving teachers in psychogienic work, it is necessary to cultivate skills of mental labor in schoolchildren. Great importance is attached to familiarizing both children themselves, as well as teachers and parents, with the issues of P. On the basis of the latter, questions of P. of the child in the home environment can be raised. Along the line of extracurricular work, psychogienic work will be carried out in pioneer detachments, for which advisory assistance to pioneer leaders is necessary. The second direction of work goes along the path of prevention of nervous and psych. diseases in childhood. Careful observation, identification of initial phenomena based on the study of microsymptomatology should ensure the possibility of taking necessary measures. For these purposes, systematic observation of the neuropsychic sphere of children is necessary, first of all, of the so-called 'nervous' children, difficult to educate, and lagging behind. - A number of problems of P. remain unilluminated, which have not yet received their theoretical formulation. Among them, one should mention P. of living conditions, P. of the individual, age-related psychogiene, etc. All these issues are current problems of P., requiring development and specification. Psychogiene in the Red Army. The experience of the American army, conducted on such a broad scale (covering 2 million people with the rejection of 72,000 people), shows very clearly what a large field of work opens up here before P. The main task of P. in the RKKA is to contribute to the strengthening of the combat capability of the army on the basis of strengthening neuropsychic forces and reducing morbidity. The system of psychogienic work in the RKKA covers all stages in sequence, starting from the preparation of conscription (when it is necessary, relying on the civilian psychiatric organization, to identify all those who are inadequate in terms of neuropsychic health), participation in medical selection (for the timely rejection), participation in the assignment (based on psychogienic characteristics) and then through participation in the rationalization of training and living conditions, consultations regarding difficult to discipline, poorly performing, etc. Special importance is attached to psychogienic work in military schools and military academies, where it proceeds on the same principles as civilian higher educational institutions with adjustments for the special conditions of military service. P. in the Red Army should be closely linked with political work. Particular importance is attached to the development of issues of psychogiene of war. Psychogienic propaganda. All the work mentioned above should find its support in widely organized psychogienic propaganda. The content of this mass work should be the following issues: the fight against 'nervousness', prevention of neuropsychic diseases, P. of mental labor and rest, hygiene of mental labor, P. of sexual life, the fight against alcoholism, upbringing of children, etc. It is extremely important to link this work with anti-religious work. The methods of this work are the same as those of sanitary education: methods of living and printed word and the visual method - lectures, conversations, exhibitions, posters, slogans, brochures, cinema, radio, etc. As objects of this work, teachers, pedologists, psychotechnicians, rationalization technicians, penitentiary workers, etc. should be named first. Organization of neuropsychiatric assistance. As already mentioned, P. was born primarily from the tasks of reorganization of psychiatric assistance, and to this day, this task constitutes the main content of psychogienic work in a number of countries (primarily in the USA, Germany and several others). In our country, the matter of psychiatric assistance over the past years is characterized primarily by the broad development of outpatient assistance, the broad coverage of 'borderline cases', and the creation of a network of children's neuropsychiatric institutions. This entire network has been finalized by the adoption of the principle of 'graduality' (resolution of the collegium of the People's Commissariat of Health of April 28, 1932 (see in detail Mental patients). A psychiatric network built on this principle provides support points for psychogienic work, thereby implementing one of the main slogans of Soviet healthcare about preventive principles in medical care (Z.P. Solovyov). This network is built on the basis of accounting for neuropsychic morbidity. Issues of accounting are one of the most important tasks of psychogiene. IV. Organization of the psychogienic movement. The international psychogienic movement is united by the International Committee on P., located in New York. It also includes representatives from the USSR. In most countries, there are national committees or leagues of P. Among the institutions, one should primarily name in the USA: Institute for Child Guidance in New York (along the line of P. of school age), Institute of Human Relations at Yale University in New Haven with departments of psychology, psychiatry and P. and a special psychoclinic for the earliest childhood, Institute for Juvenile Research in Chicago (for difficult to educate adolescents), Clinic for guidance of childhood and youth in Boston, State Psychiatric Institute in New York. Statistics of psych. diseases are developed by a special department of statistics of the National Committee on P. and a similar department of the psychiatric organization of the state of Massachusetts. In Europe, the only psychogienic institution to some extent can be called the one established by Toulouse Centre de psychiatrie et de prophylaxie mentale. In a number of countries (USA, France, Germany, etc.), special journals on P. are published (see the list below in the literature). In the USSR, the scientific centers are: for the RSFSR - the Scientific Research Institute of Neuropsychiatric Prevention, transformed in 1928 from the above-mentioned Neuropsychiatric Dispensary of the People's Commissariat of Health. For the Ukrainian SSR, such a center is the Institute of Social Psychoneurology and Psychogiene of the All-Ukrainian Psychoneurological Academy. There are institutes of psychoprophylaxis in Rostov, Gorky, Perm and the Regional Office of Social Psychiatry and P. in Moscow. P. is taught in medical institutes in close connection with psychiatry or in the form of separate elective courses (in the 1st Moscow Medical Institute, in the Leningrad Institute for the Advancement of Physicians). In the Central Institute for the Advancement of Physicians in Moscow, there is a department of psychiatry and P. with mandatory teaching on industrial, educational and military P. In Kharkov, in the Psychoneurological Institute of Personnel, there is a special independent department.