The Appropriation of Suffering by Vieda Skultans
March 19, 2012
Blimey this blogging is harder work than it looks. And trying to produce enough commentary for it to actual function as a blog whilst also indulging my/our inner desire to be all scholarly and thorough is more difficult than it looks. Maybe once the last essay is marked and the summer is here…
One intended function of this blog was to provide a space for discussing the conceptual stuff that we do not necessarily find time to write about or even think about especially deeply but which floats across our consciousness and makes us think ‘Hmmmm’. The ideas that we encounter between Trusts tutorials and exam scrutiny meetings but only ever file in the big pile of articles we keep on our desks and plan to return to one day.
I have a big pile so I thought I would institute a tradition of posting a blog post about one paper from my pile once a week. The traditional day for doing things like this is Friday but I do not work as an academic on Fridays. (On Fridays I work as a parent contemplating such great imponderables as ‘Where have you hidden your shoes?’, Why are you so quiet?’ and most importantly ‘How long till naptime?’.)
So this is my first such post. The article that had drifted to the top of my pile had looked absolutely fascinating when I came across it by chance when flicking through Theory, Culture and Society for something else. The full cite is:
Vieda Skultans, ‘The Appropriation of Suffering: Psychiatric Practice in the Post-Soviet Clinic’  Theory, Culture and Society 24:27 DOI: 10.1177/0263276407077625. A copy of the paper can be found online here (pdf)
Skultans is a medical ethnographer and conducted a considerable body of observational research looking at psychiatric practice in Latvia in the years before and after the end of the Soviet Union. This paper primarily examines how psychiatric practice changed in the post-Soviet era but it starts with a discussion about what was culturally distinctive about Latvian psychiatry in the Soviet era. Many of these features are common to other Soviet states, such as the distinctive cultural valency of the concept of ‘normality’. Skultans suggests when someone described their situation as ‘normal’ it meant ‘as good as can be expected given what we have to put up with’. Thus a certain degree of pessimism about one’s situation was built-in to everyday life and expectations, and measurements of pathological sadness or anxiety had to be assessed against this. She explores how this resonates with Canguilhem’s theories of pathology, that pathology and normality do not exist in opposition to each other but that pathology may be the condition necessary for exposing what we understand by health.
In addition, Soviet psychiatry recognised that social and especially economic factors were determinative of mental well-being. So whilst a certain degree of gloom about one’s situation was normal it was nonetheless the responsibility of the state to accept responsibility for mental disorder since their actions were implicit in creating the social circumstances which brought about this suffering. Spa treatments were prescribed for people suffering from fatigue and malaise to restore them to a functioning level of misery.
In the post-Soviet era market forces entered Latvian psychiatry for the first time. Major pharmaceutical companies paid for the translation of the DSM and ICD into Latvian and new diagnostic categories became available, whilst other, specifically Soviet, diagnoses fell out of favour. Pharmaceutical companies also paid for training in new diagnostic techniques based on the DSM and ICD categories and promoted attendant medication to treat these disorders which had previously gone unrecognised in Latvia.
Skultans argues that the changing economy also placed new demands upon Latvian workers who had to try to be more than merely manageably miserable, they had to aim to be happy instead. Manageable misery became pathological sadness. More significantly the moral burden of responsibility for this pathology fell upon the individual rather than the state.
Skultans’ close analysis of a specific encounter between a psychiatrist and a patient was illuminating but of less interest to me than the broader points her paper highlights about how culturally, economically and politically specific our understanding of mental well-being is. Neither pre nor post-Soviet Latvian psychiatry sounds utopian. Both sets of practices have obvious shortcomings (although interestingly Skultans observes good therapeutic relationships throughout although this may be a characteristic of the settings she was permitted to observe rather than a defining feature of Latvian mental health practice).
Skultans recognises that there is nothing radical in the observation that psychiatric diagnoses may be interactive kinds as Ian Hacking puts it – dynamic classifications that are constitutively by the milieu in which they are given – but this is a rare example of a real life study of interactive kinds emerging in psychiatric practice rather than being retrospectively observed through the lens of history.