Friday May 24, 2019

From Russia With Love

If only 007 could see it now…

I spent the last two weeks in Moscow and St. Petersburg, first working and then visiting a world that has been colored for me by great (and long) Russian novels filled with palaces and czars, and Bond films portraying Cold War drama and intrigue.

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1. Bond. James Bond. From Russia with Love is the second Bond film. Based on Ian Fleming’s 1957 novel and released in 1963, it stars Sean Connery as Agent 007 of the British Secret Intelligence Service. The 26 Bond films are formulaic and the characters iconic. Bond, for all his sexism and bad habits, is a hero time and again for his willingness to risk his life to save the good guys and the free world from the bad guys and their evil governments. In From Russia with Love, SMERSH, the Soviet counter-intelligence agency aims to assassinate Bond in such a way as to discredit both the man and his government. It was a thin veil for the Cold War rivalries and propaganda that dominated the latter part of the 20th century.

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2. Andrei Vladimirovich Snezhnevsky. As opposed to Bond, Snezhnevsky (1904 -1987) was a real person. A psychiatrist who served as director of several psychiatric societies and Russian national institutions, he is also remembered as the key architect of broadly expanding the diagnosis of schizophrenia for political purposes. He invented the Soviet concept of “sluggish schizophrenia,” a diagnosis that was used to discredit and remove political opposition from society. Dissidents were diagnosed with “sluggish schizophrenia” and then banished to faraway psychiatric wards. Such co-opting of psychiatric practice for covert political purposes peaked under General SecretaryLeonid Brezhnev. Although no longer common practice, this history of political abuse of psychiatry has cast a long shadow that contributes to ongoing distrust of mental health systems in Russia.

 

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3. Ivan Petrovich Pavlov. The tainting of psychiatry during the height of the Soviet Union stands in stark contrast to Russia’s gloried contribution to the study of human behavior in the latter part of the nineteenth century and early twentieth century. Most famous among these scientists was Ivan Pavlov (1849 – 1936) who was awarded the Nobel Prize in 1904 for his discovery of classical conditioning. A physiologist and psychologist, Pavlov began his career studying the digestive system of dogs. He observed that dogs salivated naturally when food appeared. He also noted that, over time, they began to salivate as soon as they saw the white lab coat of the researcher in anticipation of being fed. Based on these observations, Pavlov developed the concept of a classical conditioning. The core idea is that a previously neutral stimulus produces a “conditioned response” as a result of its association with something else (the unconditioned stimulus) that naturally produces the response. It started with dogs, food, and white lab coats. Today we understand that classical conditioning sits at the foundation of a range of psychological disorders including trauma-related conditions. It is classical conditioning, for example, that accounts for the sweaty palms and racing heart we might experience in anticipation of getting behind the steering wheel when we resume driving after a car accident. These associations originate in the cerebral cortex of the brain, and our understanding of how these conditioned responses are mapped in the brain informs many of today’s treatment strategies.

 

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4. Maya Kulygina, Valery Krasnov, and Olga Karpenko George Kostyuk. Professors Kulygina and Krasnov have been the leading mental health professionals to represent Russia in the development of the new WHO classification system, the ICD-11. They have enlisted the participation of their colleagues and hundreds of Russian psychologists and psychiatrists in studies that were conducted in Russian on the Global Clinical Practice Network, an online community of over 15,000 mental health professionals from 156 countries. And they spearheaded the two-day ICD-11 training for mental health professionals from around the country. Drs. Olga Karpenko and Kostyuk served as the scientific chair and co-chair of the international conference that followed the ICD-11 workshop. As Director of the Mental Clinic No. 1 named after N.A. Alexeev and Chief Psychiatrist of Moscow Healthcare Department, Dr. Kostyuk is poised to advance the science and integrity of mental health research and care in Russia. Collectively, their leadership is shaping Russia’s national and international mental health agenda.

 

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5. I don’t know their names. But they are the future of psychiatry in Russia. I am speaking of the hundreds of medical residents and young mental health professionals who attended the 2-day ICD-11 Workshop and the international conference that followed. Their questions about changes in the diagnostic system were well-informed, challenging, and scientifically grounded. Their familiarity with global standards of treatment and state-of-the-art research was evident. Their commitment to advancing research and delivering appropriate care was unmistakable in the programs they are developing and evaluating. The fate of mental health in Russia is in their hands.


Personally, it was a dream come true to visit and experience these two great cities first hand – from Moscow’s subway system built as palaces for the people to the Peterhof Palace outside St. Petersburg built to rival Versailles, from the ballet to the circus to the opera, from St. Basil’s Cathedral at the Kremlin to the Jewish Museum and Tolerance Center. Professionally, it was an honor to be among the invited faculty for this set of milestone meetings in Russia. Bond would not recognize this Russia, and that’s probably a good thing.