Culture, Medicine, and Psychiatry

, Volume 34, Issue 1, pp 132–168 | Cite as

Post-Soviet Placebos: Epistemology and Authority in Russian Treatments for Alcoholism

  • Eugene RaikhelEmail author
Original Paper


The dominant modalities of treatment for alcoholism in Russia are suggestion-based methods developed by narcology—the subspecialty of Russian psychiatry which deals with addiction. A particularly popular method is the use of disulfiram—an alcohol antagonist—for which narcologists commonly substitute neutral substances. Drawing on 14 months of fieldwork at narcological clinics in St. Petersburg, this article examines the epistemological and institutional conditions which facilitate this practice of “placebo therapy.” I argue that narcologists’ embrace of such treatments has been shaped by a clinical style of reasoning specific to a Soviet and post-Soviet psychiatry, itself the product of contested Soviet politics over the knowledge of the mind and brain. This style of reasoning has facilitated narcologists’ understanding of disulfiram as a behavioral, rather than a pharmacological, treatment and has disposed them to amplify patients’ responses through attention to the performative aspects of the clinical encounter and through management of the treatment’s broader reputation as an effective therapy. Moreover, such therapies have generally depended upon, and helped to reinforce, clinical encounters premised on a steeply hierarchical physician–patient relationship.


Alcoholism Substance dependence treatment Addiction medicine Placebo Pharmaceuticals Russian psychiatry 



My deepest thanks go to the patients and narcologists in St. Petersburg who agreed to share their stories with me. The fieldwork described in this paper was generously funded by a Fulbright-Hays Doctoral Dissertation Research Abroad Fellowship, and further research was supported by the Fellowship of Woodrow Wilson Scholars at Princeton University. Laurence Kirmayer has been extremely supportive of this project during a Postdoctoral Fellowship funded by the CIHR Strategic Training Program in Culture and Mental Health Services Research at the Division of Social and Transcultural Psychiatry at McGill University. Thanks for their many helpful comments go to the participants in the 2006 SSRC Eurasia Dissertation Development Workshop and the Comparative Human Development workshop at the University of Chicago, and to discussants and audience members at the 2006 Society for Cultural Anthropology meeting and the 2007 American Anthropological Association conference. This paper also benefited greatly from the readings and suggestions of Lauren Ban, Eduardo Kohn, Anne Lovell, Kelly McKinney, Alessandra Miklavcic, Kavita Misra, Tobias Rees, Roger Schoenman, Iris Bernblum and this journal’s anonymous reviewers. Ian Whitmarsh and Hanna Kienzler gave particularly close readings and vital suggestions at critical stages of writing. Much of this paper’s content was shaped by conversations with John Borneman, Joao Biehl, Carol Greenhouse, Stephen Kotkin, Amir Raz, and Allan Young.


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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Comparative Human DevelopmentUniversity of ChicagoChicagoUSA

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