Abstract
Coming out of World War Two, the governments of Communist Europe almost unanimously emphasised the need to shift towards preventative medicine, including within the field of mental health. For Yugoslavia, health planners faced little choice in the matter; a shocking shortage of practitioners combined with the drive towards industrialisation to force psychiatrists to maximise their minimal resources. In short, prevention was a must. Over time, however, the justification for preventative psychiatry would shift. Prior to 1948, mental health care workers could point to Soviet healthcare services as a guiding light in their efforts to refocus care. After Tito’s break with Stalin in that year, however, practitioners turned instead towards the ideas of the British social psychiatry movement to legitimise their attempts to stop mental disorder before it began. This paper analyses the shift in rationale for prevention and examines key debates in three subfields: addiction services, military psychiatry and suicide prevention.
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Notes
- 1.
For elaboration on the impact of the war on people’s mental health, see the excellent descriptions found in Ana Antic, Therapeutic Fascism: Experiencing the Violence of the Nazi New Order (Oxford: Oxford University Press, 2016).
- 2.
Among others, see N. Nikolic, “Vladimir Iljic Lenjin i Zastita Narodnog Zdravlja,” Medicinski Glasnik 1, no. 5 (1947): 85; G. Nikolic, “Oktobarska Revolucija I Razvoj Sovjetske Medicine,” Vojno-Sanitetski Pregled 4, no. 11–12 (1947): 208–211; V. Stojanovic, “Velika Oktobarska Revolucija i Zastita Narodnog Zdravlja USSSR,” Medicinski Glasnik 2, no. 2 (1947): 23.
- 3.
Anon, “Osnovi Principi Nase Zdravstene Sluzbe,” Medicinski Glasnik 1, no. 3 (1946): 46; see also the untitled editorial by an unlisted author in Medicinski Glasnik 1, no. 1 (1946): 1. For more, see Federal People’s Republic of Yugoslavia, Public Health and Health Service Annual Report 1949–1950 (Zagreb: Council of Public Health and Social Welfare of the Government of the Federal People’s Republic of Yugoslavia, 1952).
- 4.
Stjepan Policer, “Lekari i Zdrastveno Prosvecivanje,” Medicinski Glasnik 2, no. 4 (1948): 71.
- 5.
Štampar has fascinated historians of medicine and the centrality of his role in establishing the social nature of medicine cannot be understated, either within Yugoslavia or more broadly. See Stella Fatovic-Ferencic, “‘Society as an Organism:’ Metaphor as Departure Point of Andrija Štampar’s Health Ideology,” Croatian Medical Journal 49, no. 6 (2008): 709–19; Zeljko Dugac, Protiv Bolesti i Neznanja: Rockfellerova fondacija u međuratnoj Jugoslaviji (Srednja Europa, Zagreb, 2005); Zeljko Dugac, “‘Like Years in Fermentation’: Public Health in Interwar Yugoslavia,” in Health, Hygiene, and Eugenics in Southeastern Europe to 1945, eds. Christian Promitzer, Sevasti Trubeta, and Marius Turda (Budapest: Central European University Press, 2011), 193–232; Martin Kuhar, “‘From an Impure Source, All Is Impure’: The Rise and Fall of Andrija Štampar’s Public Health Eugenics in Yugoslavia,” Social History of Medicine 30, no. 1 (2017): 92–113.
- 6.
For readers unfamiliar with the East European context, a significant rupture occurred between Yugoslavia and the Soviet bloc in 1948 after several clashes between Tito and Stalin . Yugoslavia was ultimately expelled from the Cominform (the Soviet dominated umbrella organisation that coordinated Marxist-Leninist parties across Europe) and a period of immense tension ensued as the Soviet Union and its allies declared Titoism as a dangerous heresy. Yugoslavia, fearing both a Soviet-led invasion and/or an internal coup led by Stalinists, rapidly disavowed anything that smacked of Soviet influence. Within the realm of medicine, for example, the near-monthly exaltations of Soviet health care that had peppered journals between 1945 and 1948 immediately ceased; subsequent appraisals of Soviet medicine were largely derogatory. Despite the Tito-Stalin split, the Yugoslav government remained ideologically devoted to the long-term establishment of Communism. In 1953, the country’s leaders declared a new and unique roadmap on how to actually achieve this transition, using the slogan ‘self-managing socialism.’
- 7.
Although exact figures are difficult to pinpoint, for roughly 15,000,000 citizens at the conclusion of the war, there were probably no more than two dozen mental health specialists.
- 8.
Details regarding some of the early post-war foreign training initiatives can be found in Ministry of Health files dated 11/02/1946 at the Federal Archive of Yugoslavia, Belgrade. See Vladimir Vujic, “Ministarstvu Narodnog Zdravlja FNRJ,” Komitet Za Zastitu Narodna Zdarvlje Vlada FNRJ (Arhiv Jugoslavije: 1946).
- 9.
Dusan Petrovic, interview with the author. Sept 8, 2007, Belgrade.
- 10.
Maxwell Jones, Social Psychiatry in Practice: The Idea of the Therapeutic Community (Harmondsworth: Penguin, 1968).
- 11.
Nick Crossley, “RD Laing and the British Anti-psychiatry Movement: A Socio–Historical Analysis,” Social Science & Medicine 47, no. 7 (1998): 877–89; Catherine Fussinger, “‘Therapeutic Community’, Psychiatry’s Reformers and Antipsychiatrists: Reconsidering Changes in the Field of Psychiatry After World War II,” History of Psychiatry 22, no. 2 (2011): 146–63.
- 12.
David H. Clark, “Therapeutic Community Memories: Maxwell Jones. Planned Environment Therapy Trust,” 2005, http://www.pettrust.org.uk/index.php?option=com_content&view=article&id=781:therapeutic-community-memories-maxwell-jones&catid=241&Itemid=407.
- 13.
Liam Clarke, “Joshua Bierer: Striving for Power,” History of Psychiatry 8, no. 31. (1997): 319–32. Much of this paragraph is indebted to Clarke’s work.
- 14.
For work on Lewis’ contributions to post-war British psychiatry, see the special supplement “European Psychiatry on the Eve of War: Aubrey Lewis, the Maudsley Hospital, and the Rockefeller Foundation in the 1930s,” eds. Katherine Angel, Edgar Jones, and Michael Neve, Medical History 22 (2003); David J. Harper, “Histories of Suspicion in a Time of Conspiracy: A Reflection on Aubrey Lewis’s History of Paranoia,” History of the Human Sciences 7, no. 3 (1994): 89–109; Michael Shepherd, “A Representative Psychiatrist: The Career, Contributions and Legacies of Sir Aubrey Lewis,” Psychological Medicine Monograph Supplement 10: 1–31.
- 15.
Michael Shepherd, “From Social Medicine to Social Psychiatry: The Achievement of Sir Aubrey Lewis,” Psychological Medicine 10, no. 2 (1980): 211–18; Edgar Jones, “Aubrey Lewis, Edward Mapother and the Maudsley, Medical History 47, no. S22 (2003): 3–38.
- 16.
Aubrey Lewis, “Social Aspects of Psychiatry,” Edinburgh Medical Journal 58 (1951), as cited in Shepherd, “From Social Medicine to Social Psychiatry,” 217.
- 17.
Dusan Petrovic, Institute for Mental Health Belgrade (Belgrade: Institut za Mentalno Zdravlje, 1972), 3.
- 18.
Petrovic, interview with the author. Svetomir Bojanin, who also worked there, described some aspects of the Institute as outright challenges to the authorities. Their policy of keeping card indexes containing broad information related to a person’s health status, personal identification, family history and other personal matters posed an obvious challenge to what Bojanin deemed the ‘police state nature’ of Yugoslavia. Svetomir Bojanin, interview with the author, Feb 26, 2008, Belgrade.
- 19.
Vladimir Hudolin, “Social Psychiatry Today,” in Social Psychiatry: Proceedings of the Eighth World Congress of Social Psychiatry, ed. Vladimir Hudolin (New York: Springer, 1981), 3.
- 20.
Hudolin, “Social Psychiatry Today,” 5.
- 21.
Vladimir Hudolin, “Politicization of Psychiatry and Political Psychiatry,” in Social Psychiatry: Proceedings of the Eighth World Congress of Social Psychiatry, 34.
- 22.
Uros Jekic, “Neki Mentalno-Higijenski Aspekti Alkoholizma,” Srpski Arhiv 85, no. 10 (1957): 1145–53.
- 23.
Uros Jekic, “Alkoholizam—Problem Zdravlje,” Srpski Arhiv 85, no. 4 (1957): 456–61.
- 24.
Aleksandar Despotovic and Slobodan Stojilkovic, “Socijalno i Medicinsko Znacenje Alkoholizma Psihijatrija,” Simpozij o Neurologije i Psihijatriji (Ljubljana: 6–8 July), 1969.
- 25.
Vladimir Hudolin, “Prevencija Alkoholizma, Lijecenje i Rehabilitacija Alkoholicara,” Medicinski Glasnik 15, no. 2 (1961): 76–80; I. Milakovic, “Alkoholizam—Sve Aktuelniji,” Zivot i Zdravlje 30 (1976): 1–2.
- 26.
For background information on alcoholism in Yugoslavia, see Mat Savelli, “Diseased, Depraved or Just Drunk? The Psychiatric Panic Over Alcoholism in Communist Yugoslavia,” Social History of Medicine 25, no. 2 (2012): 462–80.
- 27.
Vladimir Hudolin, “Prevencija Alkoholizma, Lijecenje i Rehabilitacija Alkoholicara,” Lijecnicki Vjesnik 82, no. 6 (1960): 473–85.
- 28.
“Program Akcije: Mesec Borbe Protiv Alkoholizma,” Savez Studenata Jugoslavije (Arhiv Jugoslavije: 1961).
- 29.
“Zapisnik,” Savez Studenata Jugoslavije (Arhiv Jugoslavije: 1961).
- 30.
Vladimir Hudolin, “Alcoholism in Croatia,” International Journal of Social Psychiatry 15, no. 2 (1969): 85–91.
- 31.
Branimir Ivan Sikic, Roger Dale Walker, and Dennis R. Peterson, “An Evaluation of a Program for the Treatment of Alcoholism in Croatia,” International Journal of Social Psychiatry 18, no. 3 (1972): 171–82.
- 32.
Branko Gacic, “Petnaest Godina Porodicne Terapije Alkoholizma—Rezultati i Implikacije,” Psihijatrija Danas 21, no. 1 (1989): 85–92.
- 33.
Dragoslav Nikolic, “Primary Health Care and Alcoholism in Yugoslavia,” Socijalna Psihijatrija 15, no. 3 (1987): 273–80.
- 34.
Joko Poleksic, “Alkoholizam U Industriji,” Engrami 7, no. 4 (1985): 59–60.
- 35.
Lev Milcinski, “Reflections on Specific Features of Suicide in Yugoslavia,” Socijalna Psihijatrija 3, no. 4 (1975): 289–98; C. Pahjlina, D. Boden, J. Barboric, V. Decko, M. Vrabic, and C. Kavcic, “Samoubojstva Na Podrucju Celjske Regije,” Engrami 3, no. 3 (1981): 45–54.
- 36.
Lev Milcinski, “Uvod,” Zbornik Radova 1. Jugoslavenskog Simpozija o Prevenciji Samoubojstva (Zagreb, 1973).
- 37.
Anica Kos-Mikus, “Diskusija Treceg Dana Simpozijuma: Grupa A,” Zbornik Radova 2. Jugoslavenskog Simpozija o Prevenciji Suicida (Galenika: Belgrade, 1975).
- 38.
Suicidologists debated the creation of a national register of suicides to combat this problem, although such a database was only realised in Slovenia. See the general discussion from the Second Yugoslavia Symposium on the Prevention of Suicide, “Opsta Diskusija,” Zbornik Radova 2.
- 39.
Lev Milcinski, “Pitanja Istrazivanja I Prevencije Samoubistva U Sloveniji,” Zbornik Radova 1.
- 40.
Janez Rugelj, “Samoubistva Alkoholicara Koji Su Bili Hospitalno Tretirani Metodom Kompleksnog Socijalno-Psihijatrijskog Lijecenja,” Zbornik Radova 2. See also his comments in the general discussion of that conference.
- 41.
Milojica Pantelic, “Savremena Koncepcija Opstenarodnog Odbranbenog Rata,” Prvi Jugoslovenski Simpozijum o Psihotraumatizovanim u Vanrednim Situacijama (held in Basko Polje, 4–6 May, 1970).
- 42.
For an excellent discussion of how the military envisioned these tactics, see Tomislav Dulic and Roland Kostic, “Yugoslavs in Arms: Guerilla Tradition, Total Defence and the Ethnic Security Dilemma,” Europe-Asia Studies 62, no. 7 (2010): 1051–72.
- 43.
Tomislav Kronja and Slobodan Stojilkovic, “Preventivne Mere U Okviru Zdravstvene Sluzbe Jugoslavije U Pripremi Ljudstva Za Opstenarodni Odbrambeni Rat,” Prvi Jugoslovenski Simpozijum.
- 44.
Janko Kostnapfel, “Rat I Mir Sa Stanovista Psihijatrije,” III Kongres Lekara Jugoslavije (held in Bled, 5–8 October, 1971).
- 45.
Vladimir Hudolin, “Politicization of Psychiatry and Political Psychiatry,” 31–32.
- 46.
Dusan Kecmanovic, Ethnic Times: Exploring Ethnonationalism in the Former Yugoslavia (Westport: Praeger, 2002).
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Savelli, M. (2019). Socialism, Society, and the Struggle Against Mental Illness: Preventative Psychiatry in Post-war Yugoslavia. In: Kritsotaki, D., Long, V., Smith, M. (eds) Preventing Mental Illness. Mental Health in Historical Perspective. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-98699-9_6
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