The Theoretical Bases of Soviet Psychotherapy

B. M . S E G A L , M.D., PH.D.*f | Cambridge, Mass.

Beginning in the 1930's all Western psychologic theories, especially psy-

choanalysis, were labeled reactionary. Pavlov's theory remained as the
sole "truly materialistic" basis for Soviet psychotherapy. Only in recent
years has theoretical research shown signs of life. Certain concepts from
cybernetics, information theory, and even social psychology are now used
widely.

Before the revolution and i n the years immediately following it, psycho-
therapy in Russia developed i n close contact with Western psychotherapy.
This situation changed abruptly in the 1930's after Stalin's rise to power
and the beginning of a period of repression and the isolation of Soviet sci-
ence and medicine. Any research i n the field of personality psychology be-
came dangerous i n the state where only one personality existed, "the great
and wise leader of the people" and where everyone was seen as a cog i n the
state machine.
Throughout the Soviet era, psychotherapy has been subjected to strict
Party pressure and control since the authorities believed that psychotherapy
was influenced by "bourgeois antimaterialist theories" and "reactionary
Freudianism." As a result, the theoretical development of psychotherapy
was inhibited even more than that of other fields of psychiatry. For many
years psychotherapy was the "Cinderella" of Soviet psychiatry due to the
suspicious attitude on the part of the authorities, the neglect of so-called
"minor psychiatry" (the psychiatry of neuroses, nonpsychotic, and sexual
disorders) and the popularity of a clinical (descriptive) and physiologic ap-
proach. Psychotherapy was only mentioned wth disdain and i t enjoyed
little prestige in the eyes of psychiatric authorities (for example, i n the only
Soviet psychiatric journal articles on psychotherapy are seldom to be found).
Research on this subject has been almost nonexistent and young psychi-
atrists have stayed away, preferring to study more popular and less danger-
ous fields such as the course of the various forms of schizophrenia, physiol-
ogy, and psychopharmacology.
I t should also be considered that the state system of psychiatric care has

* Harvard University, Russian Research Center, Archibald Coolidge Hall, 1737

Cambridge St., Cambridge, Mass. 02138.
f The author of this paper was the head of the Department of Clinical Psychol-
ogy and Psychotherapy of the Moscow Institute of Psychiatry from 1967 to 1970.

503
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given rise to the "depersonalization" of the patient. The subject is viewed

as a defective machine. Soviet psychiatrists, like any other Soviet officials,
have had neither the opportunity nor the time to conduct prolonged psycho-
therapeutic discussions. Treatment procedures in Soviet psychiatric institu-
tions have been limited, as a rule, to the prescription of medication. Short-
term psychotherapy (mostly superficial "rational" therapy or hypnosis) has
been legally practiced by only a few enthusiasts (or by illegal private prac-
titioners), although the numbers of patients with neuroses, functional com-
plaints, and alcoholism cases have increased in the country.
Interest i n psychotherapy has grown recently i n conjunction with some
slackening of ideological control and a rebirth of research i n personality
psychology. However, as will be shown below, this research still reflects
some negative features of Soviet psychiatry—its subordination to the official
state ideology, its conservatism, its doctrinaire attitude, and its isolation from
Western science. There is a striking contradiction between the theoretical
pronouncements about the role of social experience and personality i n the
development of disease on the one hand and a formal, impersonal approach
to the patient and his social environment on the other. (Soviet psychiatry,
in fact, presents a bias toward organic etiology). Some of these facts have
been already noted by American authors, particularly i n the publications
concerning psychotherapy (1-10).

PSYCHOTHERAPY A N D I D E O L O G Y
Some Western experts studying different aspects of Soviet psychiatry try
to analyze these problems separately from ideological, political, and social
conditions of Soviet society. However, psychiatry like other institutions in
that country serves not only medical aims, but it protects the social and
political interests of the establishment. O n the other hand, ideology still
continues to play a great role in Russia, in spite of the beginning of prag-
matization of society. Myasishchev, a well-known Soviet psychotherapist
and leader of the so-called Leningrad school, has stated thajt "the rebirth of
Soviet science after the October revolution, particularly of human physiol-
ogy and psychology, based on Marxism-Leninism, is a prerequisite for a
genuine scientific system of psychotherapy" (11). His articles praised "the
wise Party." For instance, one of them quotes in full "the moral code of
communism" from the official "Program of the Communist Party of the
USSR."
Another eminent Soviet psychotherapist, M . S. Lebedinsky (Moscow)
supports h i m : "The problem of psychotherapeutic theory should be decided
in accordance . . . with the ideology of society. . . . I n the Soviet Union
psychotherapy developed and is developing on the basis of Marxist-Leninist
philosophy" (11). The head of the third psychotherapeutic "school," I . Z.
T H E THEORETICAL BASES 6tf S O V I E T PSYCHOTHERAPY 505
Velvovsky (Kharkov) pledged "socialistic obligation" in the collection of
papers on psychotherapy, devoted to his jubilee; he emphasizes that he is
happy to serve the Motherland, following the directions of "the Great
Communist Party."
I t is necessary to note that these ultra-orthodox statements are character-
istic of representatives of the old generation who grew up during the time
when such statements were the means of survival. Contemporary works are
more moderate although they too are based on the same ideological pre-
mises.J
Thus Soviet psychotherapists, like all Soviet scholars, must solve one of
the riddles of present-day Communist ideology, which on the one hand
declares the primacy of matter (brain) over mind (consciousness) and on
the other hand states that an individual's psychology and behavior are the
product of social experience (Lenin's theory of reflection).
That is the first important contradiction. However, there is another
serious problem here. I f , according to Marx, any manifestations of indi-
vidual life are "a manifestation and affirmation of social life" (13) then
the psychologic disorders such as neouroses, alcoholism, and crime which
afflict Soviet society are the result of its social structure; but official ideology
and propaganda can in no way tolerate such a conclusion. Therefore, offi-
cials insist that these social problems are a survival from capitalism in the
human consciousness. I n recent years, Soviet theorists also have combed
the writings of classical Marxism for clues to the role of biologic factors in
the development of personality. They are probing Marx for some words
about "natural connections" in man (14). A. A. Zvorykin writes that
"attempts to find a comprehensive approach in the unity of biologic, psycho-
physiologic, and social factors are a sign of the times" (15).
Genetic research is no longer prohibited in the Soviet Union particularly
since it has become clear to the authorities that it is more useful to explain
the growth of neuroses, alcoholism, and crime by genetic factors and not by
the distinctive features of the Soviet social system.

THE CONCEPT OF P E R S O N A L I T Y

The Soviet conception of personality is closely related to the philosoph-

ical ambiguities of the interrelation of psychic, social, and physiologic fac-
tors. I n recent times it has become fashionable to write about personality
and to admit the importance of studying the features and structures of
personality. P. V . Kopnin, director of the Soviet Academy of Sciences l u -
ll: I t is difficult to separate sincere convictions from compulsory ritual declara-
tions. In many cases it is a question of a psychologic defense, such as, for example,
"cognitive dissonance" (Festinger). But the problem of the psychology of the to-
talitarian society is not the subject of this paper.
506 AMERICAN JOURNAL OF PSYCHOTHERAPY

stitute of Philosophy explains that "our ideological opponents criticize

Marxism for omitting man from its field of vision." This criticism is justi-
fied since Marxist theory operates only with class concepts and economic
categories and since Soviet practice ignores personality, its rights, and values
in the name of state interests.
According to this leading Soviet philosopher this is slander against
Marxism which is "real humanism . . . opening the path to the liberation
of human personality" (16). For many years Soviet psychologists have
repeated Marx's words that man is the sum total of social relationships
(L. S. Vygotskii, S. L . Rubinstein, A. N . Leontyev, A. G. Kovalev, V . N .
Myasishchev, V . S. Merlin, and others). They consider personality to be
a system of relationships surrounding reality which is reflected in conscious-
ness and behavior. V . N . Myasishchev and others have described this "sys-
tem of relationships." They include in this concept elementary reflexes
and needs as well as "the most complicated manifestations of high nervous
activity": convictions, judgments, ideology (17). According to K . K .
Platonov "personality is man as a bearer of consciousness" (18). I n recent
years social psychologists like I . S. K o n (19) have begun to emphasize
social roles and the importance of interaction in the development of per-
sonality, which is simultaneously the subject of activity ("concrete individ-
ual").
Most authors today point to the danger of an "anthropological, bour-
geois biologization of personality" (that is, a biologic approach to person-
ality) as well as to the error of seeing personality as a purely social phenom-
enon; both views ignore the fact that man is both "a part of nature and its
product." The structures of personality have been described by K . K .
Platonov and others although there is presently no generally accepted def-
inition of the term "personality" in Soviet psychology. Leading Russian
psychotherapists emphasize now the fact that psychotherapy exerts a healing
influence on personality.
The attempt of the Pavlov school (A. G. Ivanov-Smolensky) to reduce
psychotherapy to speech therapy has been criticized and it has been noted
that psychotherapy influences the entire personality, "man as a whole and
the conscious, social individual" (20). But all these assertions had a spec-
ulative character. I t is only in recent times that attempts are being made
to move away from general statements on the role of the personality types
(see pp. 15-18).
N . Rollins (9) points out that "the outcome for the West is the pro-
liferation of psychotherapeutic techniques which improve the patient's ad-
justment by sensitizing him to his human environment, and his human en-
vironment to him. I n contrast, the Soviet trend had fostered a group of
suggestive therapies which desensitize the patient to his human and physical
THE THEORETICAL BASES OF SOVIET P S Y C H O T H E R A P Y 507

environment, promoting peace, tranquility, and relaxation, in spite of en-

vironmental stress."
This remark is only partially true. I t would be more correct to say that
in any society there are groups of patients with a high sensitivity to social
stress as well as those with weakening of relationships to the environment.
However, due to the structure of Soviet society there are more widespread
frustrations and different forms of conflicts, reactions of anxiety, hostility,
escapism (alcoholism, for instance) than in the West.
Therefore, the important goal of Soviet psychotherapy is on the one
hand an intensification of the patient's tolerance to stresses; but on the
other hand, it has to direct many a patient's activity from personal prob-
lems toward social problems useful for society, that is, "sensitizing" him to
his environment. As a result of the decline of a sincere belief i n ideologic
and political dogmas, the significance of the second approach has decreased.

THE PRINCIPLE OF A C T I V A T I O N
I n the 1920's and 1930's a number of Soviet psychiatrists began to work
out the "principle of activation" in psychotherapy. I n doing so they fre-
quently alluded to Lenin's statement that "human consciousness not only
reflects the objective world, but creates it as well."
Yu. V . Kannabikh, one of the proponents of the principle of activation
wrote that its goal was to call forth in the patient's mind definite impres-
sions, emotions, values, tendencies, reactions, and habits (21). This can be
accomplished only by impelling the patient to activity in the widest sense of
the term. Through activity, principally work, he gains new and useful ex-
perience. New conditions and creative work make it possible to compensate
for disorders; Kannabikh and others point out the patient's capacity for
growth and make clear his current of light from life and society. V . A.
Gilyarovsky's principle of "psycho-orthopedics" resembled this concept (22).
S. I . Konstorum states that " I n the final account activation psychotherapy
leads to the reconstruction of the psyche not by a verbal appeal to the in-
tellect or to the emotional sphere but by changes i n the patient's attitudes
and relationships to his milieu" (23). Konstorum considered this to be the
watershed separating activation therapy from Dubois' rational therapy and
from psychoanalysis.
M . S. Lebedinsky writes that neurosis, pathologic reactions, and mental
illness are always related to the impairment of conscious, willfull, rationally
directed activity. Therefore one of the psychotherapist's most important
tasks is to make the patient more active. The psychotherapist himself must
consider his own activity.
We oppose passivity in the therapist. The principle of activating the patient
opposes the principle of taking him away from real life to the distant past and
508 AMERICAN JOURNAL OF P S Y C H O T H E R A P Y

dreams. We favor a situation where the doctor's influence and basic attention
will be directed to the patient's present and future. The psychotherapist
should help the patient correctly evaluate his responsibilities to his family and
society, his service duty, his potentials, his expectations, his personal worth, his
shortcomings, and his interrelationships with his surroundings. In his interac-
tions with the patient, the doctor should exert an influence which is defined by
the medical task, the principles of our medicine, the ideology of our society, its
morals and science (12, p. 26-27).
As can be seen from these quotations, the important task of social activating
therapy is essentially psychagogica (A. Kronfeld), that is, the education and
reconstruction of personality based on the demands of society, ideology, and
the state.
This theoretical approach underlies several methodological procedures
being used in Soviet psychotherapy, particularly its didactic tendency (re-
gardless of all talk about the activity of the patient himself), its moralism,
its attempt to instill in the patient feelings of responsibility, duty, and social
obligation (superego, as psychoanalysts would say).
As Kolb said, "Soviet psychiatrists have relied and continue to rely upon
the strengthening, development, or reconstruction of the ego function" ( 4 ) .
The principle of activating therapy especially emphasizes the important role
of work. I t is so-called work therapy which roughly corresponds to occupa-
tional therapy. Soviet psychiatrists have also recommended "culture ther-
apy" (music, art, physical exercises). But, in reality, only work therapy has
been used more or less widely in the practice of psychiatric dispensaries and
hospitals and discussed i n the several works from a clinical or methodolog-
ical point of view (24-26).
At the present time, Soviet authors prefer to talk about "social and work
readaptation and rehabilitation." However, the articles dealing with this
subject continue to describe this only as a process modifying various psycho-
pathologic syndromes (27, 28).

PSYCHOANALYSIS A N D OTHER " I D E A L I S T I C WESTERN THEORIES"

Immediately after the revolution attempts were made to unite Freudian-

ism with Marxism and to prove the materialist nature of psychoanalysis. I t
was noted that Freud, like Marx, reduced human motivation to basic needs
and interpreted human behavior in a deterministic way. But in the 1930's
psychoanalytic works were condemned along with all remaining theoretical
foreign studies. Freudianism was labeled a bourgeois pseudo science, a re-
actionary mythology calculated to deceive the workers. Freud's name could
only be uttered with disdain. The practice of psychoanalysis was prohibited.
Since translation of foreign literature ceased, the younger generation of psy-
chiatrists was completely unfamiliar with psychodynamics and knew only
THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 509

that i n the corrupt West, particularly i n the United States, some naive fools
and swindlers were asserting that "something sexual" lay at the root of
mental disorders. The "critique" of Freudianism was reduced to ridiculing
incidental, isolated quotations taken out of context from the works of for-
eign authors whom the critics themselves rarely read (quotations were sim-
ply copied from one article to the next).
This situation began to change very slowly and with difficulty i n the
post-Stalin years. Although Western psychologic and psychiatric literature
remained inaccessible to a wide circle of psychiatrists and psychologists, the
tone of some contemporary works of criticism became more serious. Cau-
tious attempts are now being made to separate the "rational element of psy-
choanalysis" from the "idealistic philosophy" which Soviet science should
reject (29-33). A . G. Spirkin, a philosopher, writes i n Consciousness and
Self-Consciousness that "the method of psychoanalysis permitted Freud to
comprehend an extremely confused tangle of unhealthy conditions and to
reveal the sources of certain neurotic experiences" (32). However, he has-
tens to add, Freud then incorrectly used this method to study human psy-
chology i n general and historical processes in the development of society and
culture. He concludes by saying that this makes psychoanalysis not only
scientifically unsound, but also fallacious. I . S. K o n , the well-known sociol-
ogist, uses many Freudian concepts, particularly defense mechanisms, al-
though from a Marxist viewpoint (19).

THE PROBLEM OF THE U N C O N S C I O U S

Long ago, the Georgian psychologic school of Uznadze addressed the is-
sue of the unconscious, but its research was limited to the problem set, vis-
ual, and other illusions (34). More recently i t has begun to deal with cer-
tain problems of cybernetics, psychiatry (35-37), and social attitudes. But
in Russia this problem has only begun to be investigated recently. I n the
first contemporary monograph directly devoted to the issue of the uncon-
scious (33) F. V . Bassin gives a detailed account of this subject which has
been taboo for Soviet psychologists and psychiatrists for a long time. Like
all Soviet authors, he calls for a struggle with Freudianism; but at the same
time he considers i t useful to study unconscious processes from a scientific
standpoint. By "scientific standpoint" he means the concept of "set," post-
Pavlovian neurophysiology and cybernetics. According to Bassin "uncon-
scious forms of higher nervous activity" should be studied experimentally,
"scientifically" (however, Bassin does not use his proper experimental data).
The 'relationship between conscious and unconscious psychic activity under
norrrkal conditions is one of synergism, not antagonism, as Freud suggested
with his concept of repression. Conscious activity provides an intermittent
and unconscious continuous regulation of adaptive behavior. The effect of
510 AMERICAN JOURNAL OF P S Y C H O T H E R A P Y

psychotherapy comes from changing an existing set and creating a new set,
thanks to modifying the patient's relationship with the environment.
Why were the attacks on psychoanalysis directed not only at Freudian
"pansexualism" but at his concept of the unconscious as well? This is en-
tirely understandable. Soviet Party leaders were reluctant to recognize
that irrational forces and egoistical aspirations motivate man, since from the
official point of view behavior is determined by social factors which have
been comprehensively analyzed by Marx and Lenin and have been "real-
ized" by the "working masses." For a totalitarian society, the uncontrolled
and irrational unconscious is extremely dangerous.
Soviet psychotherapists have attached central importance in the etiology
of neuroses to actual experiences and have defined neurosis as an illness of
personality characterized by disturbed relationships to the environment (11,
12, 17, 20, 38). I t is not necessary to search for any "deep mechanisms" in
the process of psychotherapy. They affirm that psychotherapeutic work
should help to bring out the physiologic mechanism behind a particular
symptom. O f course, psychotherapists should not completely ignore the
study of the genesis of emotional disorders, the anamnesis of disease. But
it is emphasized that Soviet psychiatrists understand the analytic method to
be the careful analysis of the concrete influences of the external environ-
ment "containing both social factors directly acting on the conscious and
factors changing the somatic condition" (39). They deduce a process of
realization as a reconstruction of associative connections with the center of
the pathologic dominant (17). Most psychotherapists, afraid of reprisals,
shunned the term "analysis" in general and preferred to avoid studying
traumatic experiences from the patient's childhood. They denied repres-
sion, sublimation, projection, and other protective mechanisms of the ego.
The works of the Leningrad psychologist V . N . Myasishchev, who deals
with structures of personality, are an exception. Myasishchev and his
"school" recognize the need for an analysis of the sources giving rise to
neuroses, although from a Marxist and anti-Freudian position (11, 17, 20,
38). A recent article by R. A. Zachepitsky was devoted to the importance
of childhood psychotraumas in the genesis of hysteria (40). However, My-
asishchev emphasizes that sexual trauma is usually an "external aspect" and
covers other experiences of the mature personality (17, 18).
N . V . Ivanov writes that "works by Soviet psychiatrists do not give at-
tention to the unconscious because of an ignorance of the social conditions
which form the personality and a dogmatic deciphering of different sym-
bols" (39, p. 420).
Soviet authors write that psychotherapists should study the patient as a
holistic conscious personality. " I n opposition to the views which see psycho-
therapy as only a stimulus for the transition from the realm of the uncon-
 THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 511

scious to the realm of the conscious, they see the basis of the psychother-
apeutic process in the reconstruction of consciousness as knowledge and
attitudes which not only reflect but safeguard the directed activity of the pa-
tient's role" (12, p. 20). "The conscious person can act under the influence
of his instincts, but these instincts have already been reconstructed and they
possess new, human qualities" (10). With the doctor's asistance the patient
should "realize" a good deal, but by this word, Soviet psychotherapists have
in mind "understand correctly." The essence of the matter is not repression
but simply the failure to understand. Thus the patient should come to un-
derstand his responsibility for his incorrect behavior; he should recognize
his mistakes, understand how his incorrect life position influenced the de-
velopment of his neuroses, how he should change his relationship and atti-
tudes to his surroundings. I n other words, realization does not mean an
emotional conviction of the need for change, but only an intellectual process.
I t is true, as mentioned above, that in recent times some authors, fre-
quently not psychiatrists, but rather psychologists and philosophers (19, 30¬
33), are beginning to recognize, albeit with reservations, that the uncon-
scious exists and that its suppression is a possibility (and Pavlov himself is
said to have recognized this).
The ideas of Jung, Adler, and the so-called neopsychoanalysts (Horney
Sullivan, and others) have received a similarly critical evaluation i n the So-
viet Union. The only difference is the fact that the more recent psycho-
dynamic work is even less well known to Soviet authors. Therefore crit-
icism of that work is even more superficial and groundless.
To some extent the psychosomatic trend in psychology is an exception to
this rule since in some respects it is similar to a branch of Pavlovian doc-
trine developed by K . Bykov—"corticovisceral pathology" (41). However,
in speaking about psychosomatic relationships, Soviet psychotherapists point
to the ideological incorrectness of this theory based on its similarity to psy-
choanalysis. Soviet authors write that although we should welcome the idea
that the somatic and psychic are related, one cannot agree with the attempt
to interpret functional disorders in a particular organ as a symbolic expres-
sion of psychic processes. And the trend toward a psychosomatic interpre-
tation is seen as a means for masking the true causes of disease, ignoring
the basic social causes behind the high rate of mental illness in the United
States. The thesis that there is a high rate of disease in capitalist countries,
particularly in the United States, is obligatory in the Soviet press. How-
ever, Soviet statistics conceal the true figures on the spread of socially based
disease in the Soviet Union.
Other foreign psychotherapeutic methods based on new philosophical
and psychologic conceptions are also unacceptable to Soviet psychotherapists.
For instance, it has been said that existentialism only evolved from a ten-
512 AMERICAN JOURNAL OF PSYCHOTHERAPY

dency to isolate the internal world from objective reality in foggy formula-
tions which are passed off as preordained necessities.

DEPTH P S Y C H O L O G Y A N D G R O U P PSYCHOTHERAPY

Speaking of contemporary depth psychology, The Great Medical En-

cyclopedia points out that "Aspects of Freudianism remain. . . . The isola-
tion of the psychic from the somatic, the turning to the patient's past which
is viewed only from a position of studying the 'intrapsychic' dynamic and
completely ignoring the social nature of personality (39, p. 418). . . .
Contemporary trends, based on the philosophies of existentialism and prag-
matism, although they represent a departure from the turning to the past
which is characteristic of psychoanalysis, nevertheless remain truly idealistic
conceptions of the psyche" (p. 419). Theories such as psychobiology and
existentialism stand for agnosticism and are therefore completely worth-
less, according to The Great Medical Encyclopedia.
Different theories of group psychotherapy (Moreno's psychodrama, and
others) are relatively unknown i n the Soviet Union and the attitude toward
them is guarded. According to V . E. Rozhnov, director of the Psycho-
therapy Department of the Central Institute for Doctors' Training, foreign
psychotherapists view the group as individuals with no connection among
themselves. "This reflects the individualistic, predatory nature of bourgeois
society and the moral and ethical norms which hold sway there. Each pa-
tient is taugh to think only of himself . . . to strive for health and fortune,
often even i f i t means harming another person, equally unfortunate i n the
eyes of fate" (42).
Group psychotherapy is widespread i n the West since, according to
Rozhnov, the doctor considers it advantageous to himself; the many differ-
ent foreign psychotherapeutic methods objectively fulfill the social require-
ments of the ruling classes—the distortion of the true causes for social dis-
eases and accommodating the patient to "the cannibalistic laws of the cap-
italist world." N . V . Ivanov (43) and especially S. S. Libikh (44) are more
restrained and moderate i n their attitudes toward this issue. However, they
also emphasize that "foreign group psychotherapy" is alien to "collective"
Soviet psychotherapy, because "collectivism is the principle of the world out-
look of the Soviet people" (38). But Soviet authors usually limit them-
selves to stating that the "native, collective psychotherapy" secures a con-
scious re-evaluation of experience, readaptation, and activation of the pa-
tient. There is no serious and objective evidence of this statement and
there are a very few theoretical investigations on this subject.
I t is not surprising that after warnings and assaults from psychiatric and
ideological authorities, therapists are rather afraid to make use of contem-
porary foreign experience and Western theories of psychotherapy. They ac-
THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 513

tually limit themselves to two old methods: suggestion and persuasion (ra-
tional therapy). Autogenic training is the only exception. This method
has become more widespread because it is free of psychoanalytic explora-
tion and is closely connected with hypnosis which is popular in the Soviet
Union, especially among patients. Autogenic training does not demand
much time; it is widely used in state medical care as well. The effect of
autogenic training, as well as the effect of hypnosis, is discussed in Soviet
works from a physiologic viewpoint (45-47) but very rarely from a psycho-
logic one (48).

P A V L O V ' S T E A C H I N G S A N D PSYCHOTHERAPY
"When I think of Freud and myself, I imagine two teams of miners who
have begun to dig a railroad tunnel through the foot of a great mountain,
the human psyche. The difference is that Freud started somewhat below
and buried himself in the depths of the unconscious, while we have already
reached the light" (49). These words are Pavlov's.
M y task is not to review Pavlovian theory. I will briefly touch only on
its importance for psychotherapy today. Believing psychology to be unsci-
entific, Pavlov based his views of the psyche on his teachings on conditioned-
reflex activity. Psychic processes and disorders were the result of the inter-
action of processes of excitation and inhibition in the cortex.
Most important for psychotherapists was Pavlov's conception of the ac-
tion of the second-signal system. Pavlov's students studied the influence of
"verbal signals" on the brain's functioning and on the flow of physiologic
processes. According to Pavlov, a hypnotic condition is a partial sleep.
Rapport with the hypnotist or "contact" comes about through the inhibition
of the cerebral cortex, while a "center of alertness" is preserved.
The role of Pavlovian theory in Soviet psychotherapy and psychiatry has
changed during the last 50 years. Immediately following the revolution it
was popular but not dominant. After the sadly celebrated sessions of the
Soviet Academy of Sciences and Academy of Medicine in the 1950's, Pav-
lovian doctrine was declared to be the brilliant discovery of Russian science.
I n accordance with Stalin's dictates, it was to become the leading doctrine
in psychiatry and medicine. A n orgy of reprisals against the "enemies" of
this doctrine and "cosmopolitans" (mainly Jews) was begun. This move
was accompanied by organized purges and persecution of scientists and doc-
tors, by dismissals and arrests.
A group of ignorant Party careerists who endlessly quoted Stalin, Ly-
senko, and Pavlov emerged as the "heads" of Soviet psychiatry. Psychiatric
and psychotherapeutic terminology was altered and made to conform to
Pavlovian terminology. A doctrinaire, dogmatic mood reigned which Pav-
lov himself had tried to avoid. As mentioned above, not only psychoanal-
 514 AMERICAN JOURNAL OF PSYCHOTHERAPY

ysis, but all Western theories (emphasizing constitutional and hereditary

factors, psychobiology, and so forth) were called "reactionary," "anti-Rus-
sian," and were forbidden. Psychologic institutions were subjected to total
ruin. Instead of scientific works, studies on the priorities of "native" Rus-
sian science were published. Research was confined to the study of theories
of higher nervous activity. But the mountain gave birth to a mouse.
Guided by Pavlovian hypotheses about the defensive role of protective in-
hibition, psychiatric leaders solemnly proclaimed the creation of a "protec-
tive regime" i n psychiatric hospitals. This simply signified the importance
of peace and quiet in the wards. Medical personnel had to whisper. A n
individual approach to the patients was to be preserved and conditions con-
ducive to rest and prolonged sleep were to be created.
Nothing came of these beginnings and nothing could come of them since
conditions in Soviet "mad houses" many of which remained from prerev-
olutionary times, were deplorable. The wards were overcrowded with ex-
cited and aggressive patients who were tied down and subjected to other
classical measures of restraint. Psychopharmacologic methods were not yet
known. There was a shortage of doctors and medical personnel. I n such
conditions any talk of a "protective regime" or even psychotherapy was pure
hypocrisy. I n most cases, treatment by sleep was ineffective. Only condi-
tioned-reflex therapy for alcoholism (with the help of apomorphine and
other emetics) produced any positive results. (Incidentally, this method
began to be used in the thirties).
After Stalin's death the Pavlovians' dominance i n psychiatry began to
wane along with some liberalization in political and scientific life in gen-
eral. The struggle against "traitors" and "worshippers of the West" ceased.
New theoretical works appeared on the role of the deep structures of the
brain which regulate psychic functions, sleep, and the waking state. A num-
ber of physiologic works began to criticize the obsolete Pavlovian hypothesis
of the "reflex arc." New theories of the "feedback" "ring reflex" and other
cybernetic and psychologic concepts appeared (50, 51).
At the present time almost nothing remains from the "classic" Pavlovian
era. Only a few diehards systematically cite Pavlov to explain the mech-
anisms of neurotic disorders, alcoholism, and hypnosis. Some psychother-
apeutic groups, mostly in cases of alcoholism, occasionally use learning and
behaviorist methods. Thus in some alcoholic wards patients are treated by
a system of penalties (denial of discharge, for example). However, the doc-
tors using these methods are not familiar with the theories and only refer to
"conditioned reflex."
As I already mentioned, there is a tendency to save and to modernize
Pavlov's theory. But most psychiatrists and research scientists have moved
away from Pavlovian physiology and have turned to contemporary biochem-
THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 515

ical, and neurophysiologic methods of research. Neurocybernetics is par-

ticularly widespread.

ATTEMPTS TO CONSTRUCT N E W THEORETICAL N O R M S

From the above account it is clear that Soviet psychotherapy lacks a
theoretical basis. First of all Soviet psychology has not developed a theory
of personality. Existing schemata are either a summary of Marx's philo-
sophic views on human nature in psychologic terms or eclectic attempts to
base the structure of the personality on a simple description of various levels
or spheres. Such speculative hypotheses as the principle of activation, the
concept of the unity of the physiologic and the psychologic, are not based on
research since psychologic tests were banned i n the Soviet Union for many
years. Now projective tests (Rorschach, T A T ) and the M M P I are used
only in certain laboratories, in particular i n the Bekhterev Institute in Len-
ingrad and in the Department of Clinical Psychology and Psychotherapy of
the Moscow Institute of Psychiatry. The use of these tests met sharp op-
position from orthodox psychiatrists and psychologists. Neurophysiologic and
cybernetic (essentially neobehavioristic) approaches to behavior have also
been worked out.
A few Soviet theoretical works devoted to psychotherapy now attempt
to use psychologic as well as philosophical conceptions. These include the
theory of activity (S. L . Rubinshtein, A. N . Leontiev, B. G. Ananiev, A. V .
Zaporozhets) ; the hypothesis of orientation to situations (A. V . Zaporozhets,
P. Ya. Galperin) ; the conception of needs (A. N . Leontiev) ; the concep-
tion of relationships (V. N . Myasishchev) ; set theory (the school of D . N .
Uznadze) ; a modified theory of higher nervous activity, and information
theory.
I will conclude with a review of some contemporary attempts to explain
the nature of the psychotherapeutic process. While it is still considered
necessary to refer to Pavlovian theory in official literature, it is pointed out
that the theory should be evaluated in the light of up-to-date achievements
in neurophysiology. Some psychologic ideas are more widely used today,
particularly theories of relationships (attitudes) and goals with the aim of
interpreting the effect of psychotherapy on the patient. However, all au-
thors continue to emphasize the materialistic (Marxist-Leninist) approach
to the understanding of the psyche (although a sincere belief in Marxist-
Leninist dogmas has declined now).
N . V . Ivanov's presentation at the National Conference on Psycho-
therapy (Moscow, June, 1966) is typical in this respect. He summed up
"generally acknowledged achievements of the theory of Soviet psycho-
therapy" and as usual underlined that its merits are a "materialistic ex-
planation of the essence of psychotherapeutic effects on the basis of the
516 AMERICAN JOURNAL OF PSYCHOTHERAPY

activity of the second-signal system" and the development of Marxist teach-

ing on personality as a system of relationships. However, he pointed out
that these achievements do not exclude the necessity of studying many other
"unsolved" theoretical problems. First of all, Ivanov asked whether it is
possible to regard psychotherapy as re-education of personality. Another
unsolved problem—he continued—is the role of personality in the manage-
ment of the body. He complained that there are few studies concerning
the causes of resistance of patients to therapy; moreover, while in the past
Soviet authors examined the influence of therapy on different clinical
variants of neuroses, they did not take into consideration the individual
pecularities of personality and "the emotional charge" of inner experience.
Ivanov noted also that the classification of emotional stress factors has
not been studied sufficiently and that there are no clear-cut criteria for "sed-
ative" and "activating" psychotherapy. Once again polemicizing against
psychodynamics and denying protective mechanisms of the ego, he acknowl-
edged, however, the necessity of discussing the dynamics of the therapeutic
process, although by dynamics he understands "the dynamics of relation-
ships of personality" as well as the changes in clinical symptoms and atti-
tudes of the patient (11).
The recent works of Lebedinsky have the same purely descriptive and
declarative character which I have already mentioned. The author is now
freer i n his psychologic approach to personality but he again criticizes "for-
eign idealistic theories" in his recent article " O n Certain Principles of Psy-
chotherapy and its Place in the Clinic (52)." He emphasizes the fact that
the theoretical bases for Soviet psychotherapy are the following: a ma-
terialistic approach to the patient, rational influence on personality, primar-
ily the conscious sphere, reconstruction of attitudes toward the micro- and
macro-environment. The psychotherapist's task is to alter incorrect atti-
tudes. A t the same time he now recognizes that psychotherapy should be
based on an understanding of the present in connection with "essential"
moments of the past (and future).
I have already referred to the works of V . N . Myasishchev, one of the
older researchers. A t the Fifth Soviet Congress of Psychiatrists and Neuro-
pathologists in 1969 he summarized his medical and psychologic ideas about
psychotherapeutic theory (52). As usual he paid homage to the method-
ological bases of Marxism-Leninism. Psychotherapy is a process by which
the doctor influences the patient. The therapeutic result depends on the
positive interrelationship between the doctor and the patient. The doctor
should be compassionate, kind, attentive, and critically demanding; the pa-
tient—respectful, trusting, and attached to the doctor. The essential fea-
ture of psychotherapy is its emotional nature. Knowledge of the history of
the origin of the disease, personality peculiarities, and past attitudes are
THE THEORETICAL BASES OF SOVIET PSYCHOTHERAPY 517

important conditions for understanding the patient's present condition.

These define the structure of therapy, its scope, and duration. I n some
cases the patient acts as a consciously thinking and independently acting
subject; i n others he acts as an object subordinated to outside influence.
The first case calls for persuasion, the second for suggesion. The basic
combination of both methods is autosuggestion. I t is characteristic that i n
these works by two leading Soviet psychotherapists the Pavlovian viewpoint
is mentioned with restraint but still not rejected outright.
A typical example of the eclectic approach is seen i n the work of A . N .
Shagam entitled "Materials Toward a Theory of Psychotherapy" (54).
Shagam states that a theory of psychotherapy should start with Pavlov's
teaching on hypnosis on the one hand and the personality teachings of
Myasishchev, N . V . Ivanov, and I . Z . Velvovsky on the other (although
none of these authors formulated such a doctrine). He outlines a schema
which views illnesses as the object of psychotherapy and which treats the
following factors: (1) the psychophysiologic mechanisms of personality;
(2) the complex of "pathodynamic structures" which reveal the major syn-
dromes of the illness; (3) the "pathologic watch point" (in Pavlovian ter-
minology this is the "center" of pathologic exaltation) as an apparatus
built on "disaster signals" this expresses the psychologic structure of the re-
lationship of personality to illness; (4) an apparatus for the energetic ac-
tivation (of, for example, the reticular formation). I t is not difficult to
see that this plan is an attempt to set out certain psychologic concepts (at-
titudes and goals) i n the language of modernized "higher nervous activity."
As mentioned above, a number of Soviet psychiatrists and therapists
(Konstorum, Lebedinsky, Rokhlin, and others) emphasize the need for an
integral, clinical approach to psychotherapy. A n example of such an
attempt is an article by B. S. Bamdas which eclectically combines a tra-
ditional clinical approach with the elements of Pavlovian physiology (55).
At the beginning the author sharply criticizes psychoanalysis (an act which
bears the character of a religious ritual i n traditional Soviet works) ; he
then proposes a theory based on an evaluation of clinical syndromes and on
personality features (purely descriptive). He then suggests a treatment
method for these syndromes i n Pavlovian terms.
Some works, finally, are completely free of traditional directives for a
Marxist interpretation of psychic processes and for Pavlovian theory as an
all-encompassing doctrine. These works can be divided into two groups:
those analyzing the problem from a clearly psychologic position and those
viewing i t through information theory.
According to the psychologist P. Ya. Galperin, psychotherapists should
start from the notion that the mind's basic function is to "orient" man and
to regulate behavior on the basis of formed orientations (56). The difficult
518 AMERICAN JOURNAL OF PSYCHOTHERAPY

situations which cause neuroses can be eased if there are changes in the
patient's "system of orientation." Therefore the goal of psychotherapy
should be to change the patient's orientation i n relation to the situations
which give rise to his neurosis.
The author of the present article and his associates discussed some aspects
of the theory of psychotherapy i n the form of a study of personality, the
motives for activity, goals, teachings about the "psychologic field," the
ecological environment, and interpersonal relationships (57). I n this work
they dealt with the effect of establishing strict treatment regimes for anxious
patients, thus transforming the uncertain future into a likeness of the known
past. I t analyzed the role of small groups, the effect of a group on treat-
ment, the role of conformity and leaders i n the therapeutic process, the
structure of relationships in the group, the role of discussions, and feelings
of group responsibility. I n conclusion we examined the problem of com-
munication between doctor and patient. ( I t should be noted that these
efforts to use contemporary Western theories, both psychodynamic and
sociopsychologic, are encountering resistance; the group's report to the Fifth
Congress of Psychiatrists was condemned by some leading psychologists as
a "return to personalism"). Nevertheless, new articles on this subject have
appeared (58).
The work of A. M . Svyadoshch, who has discarded his former con-
ditioned-reflex hypothesis of psychotherapy, provides an example of in-
formation theory (59). He now writes that psychotherapy is treatment by
information. From his point of view suggestion supplies the patient with
basic or semantic information and also transfers to the patient supplemen-
tary or verified information which enhances the basic information. Causal
psychotherapy (analysis) can be examined as the exchange of information
between doctor and patient which leads to the development of an aware-
ness of psycho traumatic experiences.
P. V . Simonov proposes the following hypothesis based on his informa-
tion theory of emotions (60). Since negative emotions (fear, depression)
are generated by unfulfilled strivings, psychotherapy should change or trans-
form socially unacceptable needs (in other words, sublimate). Negative
emotions can arise as a result of errors of anticipation i n a given situation
as well. I n this case the therapist's task is to eliminate the deficit of in-
formation (for example in preparing a woman for labor). As can be seen,
this hypothesis restates widely known psychotherapeutic methods in terms
of information theory.
A. A. Brudny and V . V . Solozhenkin have analyzed the heuristic com-
ponents of mental activity (61). They have proposed that the mechanism
of psychotherapeutic influence can be linked to the activity of a "compre-
hension operator"—a hypothetic organ which serves as the functional center
T H E T H E O R E T I C A L BASES OF SOVIET PSYCHOTHERAPY 519

for defined and integrated conscious activity. The comprehension operator

can be influenced through several paths. I f the therapist uses the rational
path, he studies first of all the patient's "scale of meaningfulness" and then
turns to the patient's "basic values" to bring about the desired changes in
the patient's system of meaningfulness. Under hypnosis, important elements
of the comprehension operator are turned off and input-output distances are
shortened. I t should be emphasized that most of these theoretical essays
are not presented in fully worked-out form, but rather as separate short
articles.
Some works are also devoted to the psychotherapy of various disorders,
neuroses, alcoholism, schizophrenia, somatic diseases, and others (47, 62¬
66). However, theoretical parts of these publications usually have a
speculative character.

SUMMARY

Beginning i n the 1930's contacts between Soviet and foreign psychiatrists

came to an end. A l l Western psychologic theories, especially Freudianism,
were labeled reactionary and "antiscientific." Only Pavlov's physiologic
theory remained as the sole "truly materialistic" theoretical basis for Soviet
psychotherapy. Only in recent years has theoretical research shown any
signs of life. I t is true that the official leadership condemns psychodynamics,
existentialism, and other "bourgeois" theories. But a number of works now
point to the role of the unconscious in the genesis of neuroses. I t is empha-
sized that psychotherapy cannot be reduced to "speech therapy" (which
Pavlov thought) but that its task is to influence the entire personality, in
particular its social functions.
Cybernetic hypotheses, information theory, certain concepts from social
psychology, and even psychologic tests are now being used more widely.
But no original, profound, and systematic research is being conducted in
the field of the theory of psychotherapy.

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