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565-
Edited by
A. W. BEVERIDGE
566
567
Another of
Schipkovenskys important
This
on
was an
Schipkovensky) .
In the
was
subjected
to
the
568
malign influence of the Soviet biologist Lissenko who tried to reject genetic
theory. In these circumstances, which are probably difficult for foreign
scientists to appreciate, many lecturers did not dare to express important
facts concerning heritability in mental illness. It is thus fitting to mention
Milev who tried to demonstrate the endogenous basis of many exogenous
psychoses. For many years Milev studied the genetics of schizophrenia and
he made several important contributions; in particular his ideas about the
genetic heterogeneity of the different types of course of schizophrenia, the
rarity of the disorder among gypsies (quite numerous in Bulgaria) and the
differences in the illness between men and women.
Zaimov, who briefly held the chair in the Department of Sofia, discussed
the similarities between the disorganized thinking in schizophrenia and in the
aphasias. His ideas can be summarized thus: (1) In comparing the
disintegration of the associative process in semantic jargon and in
schizophrenia, it is possible to find phenomenologically similar, even familiar
elements. Such elements include the associative deviations based on meaning
and phonetic relationships, as first described by Kraepelin. To these may be
added associative deviations with intrusions of dominant personality
attitudes, deviations of perseveration, deviations of loss of control or passive
attention, etc. These are called disintegrative deviations of the associative
process. (2) The slips of the tongue of healthy people can be used as a model
for studying these phenomena. (3) In a pathophysiological framework,
deviations in the associative flow in schizophrenia and in semantic jargon can
be interpreted on the basis of Jacksons concept of dissolution, Vvedenskys
doctrine of parabiosis, Pavlovs doctrine of phase states, and Uchtomskys
8
concept of dominance.8
Like his mentors Usunov and Schipkovensky, Zaimov was an excellent
teacher and physician who showed a deep clinical understanding of the
psychoses. Among the works of Zaimov and his colleagues, mention should
also be made of the eminent Bulgarian painter, Bojadzhiev.9 He suffered a
stroke which caused a right hemiplegia and a mixed, mainly motor, aphasia.
The painter subsequently learned to draw with his left hand, but more
importantly there were changes in his style. He now preferred light colours
with an abundance of fantastic elements, and he had a frenetic desire to
paint. These new features could be interpreted either as a complicated
personality reaction, or as the influence of aphasia on artistic style. Together
with Uzunov, Zaimov described one extraordinary paraphrenic patient who
developed a whole writing system by using signs similar to pictograms,
ideograms, syllables and letters.&dquo; It corresponded to the four main phases in
the development of human writing. His alphabet was also enriched by the
spatial orientation of the signs.
Temkov rapidly assimiliated psychopharmacology and together with Kirov
1
published a comprehensive volume&dquo; on the subject. Its value was
demonstrated by its almost simultaneous translation into Russian and it
569
became the main reference book for Russian psychiatrists for some time
before they published their own work.
A special place in Bulgarian psychiatry is occupied by Dimitrov, whose
work was accomplished during a period when negative and critical attitudes
towards in-depth psychology and dynamic psychiatry prevailed. At that time
any analytical work was considered a serious ideological mistake and
submitting to Western influence. Although Dimitrov lost his sight at the
onset of his medical career, he managed to publish four monographs in
which he concisely presented the teachings of Freud, Adler, Jung, NeoFreudianism and the philosophical basis of psychoanalysis. His studies on the
forerunners of psychoanalysis such as Schopenhauer, Oswald, Wagner and
Feuerbach are particularly valuable and were published in Germany.2, 3
These works were only allowed to be published during the totalitarian era
after the inclusion of critical remarks in the Marxist style.
It is only in the last three decades that creative developments in Bulgarian
child psychiatry have taken place. In 1984 Achkova published a monograph
on childhood schizophrenia, 14 in which she described 70 children followed
up for between 1 and 20 years. She described three symptoms: (a) fading
intention, (b) regressive questions (asking a series of questions and neither
expecting, nor demanding, nor listening to an answer, and (c) impulsive
running away, claimed to be caused by the release of the drive to migrate
which had lost its biological purpose. She maintained that in childhood there
were only the rudiments of symptoms and that delusional mood did not
crystallize into delusions. By following up patients with early childhood
autism Achkova demonstrated that many either developed schizophrenia or
had evidence of an organic cause. She stressed the frequency of catatonic
features, which brought childhood schizophrenia nearer to secondary or
defect catatonia. Together with Christozov she studied affective illnesses in
childhood and pointed out their atypical presentation and their potential for
chronicity. Christozov, who also worked in the field of child psychiatry,
contributed mainly to the area of neuroses.
In the field of diagnosis there are two opposing views in Bulgaria. In some
hospitals the diagnosis of schizophrenia is used quite widely. In others, such
as the University Clinic of Psychiatry in Sofia, there is an unconcealed
attempt to restrict the boundaries of schizophrenia while expanding those of
affective and schizoaffective psychoses.
Schizoaffective psychoses were studied thoroughly by Kirov who used
Leonhards term, cycloid psychoses. By following up the long-term course
of several hundred schizophrenic patients he tried to show that a large
number of acute and recurrent cases were more closely associated with the
affective psychoses and that Leonhard was right to group them as cycloid
psychoses.&dquo; Kirov stated that a number of these cases would not benefit
from depot treatment which only produced side effects without greatly
influencing the course of the disease. Kirov maintained that schizophasia
570
represented
course.6 In
Therapeutic practices
ECT
was
University Clinic
571
used
widely. Unlike many countries where its use has been restricted (e.g.,
Germany and the USSR), it is considered to be irreplaceable. Its results are
superior to psychopharmacological treatment in many depressions and
especially beneficial in malignant catatonia. In psychogeriatrics ECT is more
effective than antidepressants with the possible exception of Clomipramine.
The views of the University Clinic in Sofia with regard to ECT concurred
with those of The Royal College of Psychiatrists, as outlined in their
Memorandum of 1977.
As might be expected, most patients are treated with psychopharmacological drugs. The most widely used neuroleptics are Chlorpromazine,
Transcultural issues
572
573
amentive
Politics and
psychiatry
It is well known that for four and a half decades Bulgaria was ruled by a
totalitarian regime in which one party identified itself with the state and
anybody who did not think and act in accordance with the leaders of the
party were considered to be real or potential enemies. Furthermore, their
opinions could not be discussed in public. A person who has spent his life in
a democratic society cannot imagine the degree to which the state party
interfered with all aspects of life and with an individuals free will. Only in
this light can one understand the rejection and prohibition of reactionarybourgeois theories in science, such as the genetic theory. In the field of
psychiatry the regime tried to impose Pavlovian theory and to stress the
superiority of Soviet science. This explains the incident at the Congress in
Honolulu 1983 in which the Soviet Union was expelled from the World
Psychiatric Association. Immediately afterwards, the leaders of the
Psychiatric Associations of Bulgaria and the other socialist countries except
the former GDR left the WPA in protest. Predictably, the majority of its
members were not even asked for their views, which were far from
concurring with those of the communist-ruled leaderships. We were glad to
be readmitted to the WPA at the Congress in Athens 1989. The recent
political changes in Eastern Europe led to a halt in the politicizing of science
and facilitated contacts with the West.
Finally, there is a highly creditable aspect to Bulgarian psychiatry. It has
not been used as a way of dealing with political dissidents by labelling them
as mentally ill and admitting them to psychiatric hospitals for compulsory
treatment, such as happened in the Soviet Union.
574
1.
von
575
pathogenen affectiven Erlebnissen, Archiv für Psychiatne und Nervenkrankheiten, lxxxviii (1929),
370-410.
3. Nicola Schipkovensky, Schizophrenie und Mord (Berlin: Springer, 1938). [Ger]
4. Nicola Schipkovensky, Schwachsinn und Verbrechen (Jena: Fischer, 1962). [Ger]
5. Nicola Schipkovensky, Psychotherapy versus Iatrogeny (Detroit: Wayne State University Press,
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
1977).
Georgi Usunov, Atebrin - Psychoses, Yearbook of the University of Sofia, Medical Faculty, xv
(1946), 467-709. [Bulg]
Todor Tashev, Manic-Depressive Illness (Sofia, 1979) [Bulg] .
K. Zaimov, Associative process in semantic jargon and in schizophrenic language. In J.W.
Brown, Jargonaphasia (New York: Academic Press, 1981), 151-168.
K. Zaimov, D. Kitov, N. Kolev et al., Aphasie chez un peintre, LEncéphale, lvii (1969),
377-417. [Fr]
G. Usunov, K. Zaimov, Les Ecrits dun paraphrène, Annales Médico-Psychologiques, cxxx
(1972), 327-356. [Fr]
I. Temkov, K. Kirov, Clinical Psychopharmacology, 2nd Edn (Sofia: Medicina i Fiscultura,
1976). [Bul]
C. Dimitrov, Richard Wagner und Sigmund Freud, Zeitschnft für Psychosomatische Medizin
und Psychoanalyse, xviii (1972), 286-296.
C. Dimitrov, I. Gerdjikov, Ludvig Feuerbach und Sigmund Freud, Zeitschnft für
Psychosomatische Medizin und Psychoanalyse, xx (1974), 87-98. [Ger]
M. Atchkova, La Schizophrénie chez lenfant, Psychiatrie de lenfant, xxvii (1984), 69-106.
[Fr]
K. Kirov, Studies of the course of cycloid psychoses, Psychiatrie, Neurologie und Medizinische
Psychologie, xxiv (12) (1972), 726-32. [Ger]
K. Kirov, Studies on the course of schizophasia, Psychopathology, xxiii (1990),339-41 .
G. Popov, Experience of the Time by patients with paranoid schizophrenia, Dissertation
(Varna, 1983). [Bulg]
A. Marinov, Verlauf, Ausgang und Prognose der Schizophrenien, In G. Huber, Schizophrenie
(Stuttgart: Schattauer, 1981), 85-95. [Ger]
C. Todorov, Structure, varieties and diagnosis of the anancastic personality, Dissertation
(Sofia, 1983). [Bulg]
A. Atanassov, Abreaction (Sofia: Medicina i Fiscultura, 1991). [Bulg]
E. Scharankov, Feuergehen (Stuttgart: Hippokrates, 1980). [Ger]
W. Milev, K. Kirov, On the occurrence and peculiarities of cyclothymic melancholia in
Bulgaria, Bibliotheca Psychiatrica et Neurologica (1967), 133 (Beiträge zur Vergleichenden
Psychiatrie, N. Petrilovitsch (ed.), Basel/New York), 22-37. [Ger]
K. Milenkov, Epidemiological studies on affective psychoses, Dissertation (Sofia, 1982) [Bulg;
Engl. summary]