Reflections on the past and present state of Russian psychiatry.

This paper is an analysis of three periods of Russian psychiatry: before 1917, during the Soviet period, and after the fall of the Soviet Empire. The section on Russian psychiatry before 1917 considers the biomedical model in psychiatry which was transferred from somatic medicine without recognising the difference in the character of signs and symptoms. Mechanisms of mental disorders were analysed predominately from the position of the "physiology of superior nervous activity". At the same time, the role of the social and psychological factors in psychiatric problems was not totally ignored. The psychoanalytical approach was accepted and adopted. The second section considers ideological concepts which influenced the development of Soviet psychiatry. Psychological approaches to diagnosis, treatment and explanation of the mechanisms of development of the disorders were prohibited and excluded from the practice of psychiatrists. The clinical orientation of Soviet psychiatry was directed towards the disclosure of the symptoms, syndromes and nosologies according to oversimplified interpretation of psychiatric terminology. As a result psychiatrists developed a specific mentality and skills in detecting symptoms of psychopathology in every consulted person. Psychiatric statistics were published in a wholly misleading manner. The last section reviews current situation in contemporary Russian psychiatry. Its development continues to be influenced by "negative" aspects inherited from the Soviet era. It is expressed, particularly, in the continued hyper diagnosis of schizophrenia and extremal postponement of the official use of the adapted version of ICD-10 containing several deformations as compared to the original one. However, psychological approaches are revived and many Russian psychiatrists are taking an active interest in recent developments in the field of psychodynamic and transcultural approaches, and to deploy them in their clinical practice.