The New Socialist Citizen and ‘Forgetting’ Authoritarianism: Psychiatry, Psychoanalysis, and Revolution in Socialist Yugoslavia

Abstract

This chapter explores the importance of revolution and ideas of radical reform for the development of socialist psychiatry, focusing on the case of post-1945 Yugoslavia. It looks at how the experience of social and political revolution transformed the clinical practice and intellectual frameworks of Yugoslavia’s ‘psy’ disciplines but also how the concept of revolution and reform was worked into psychiatric theories and initiatives. Following the Second World War, Yugoslav psychiatrists’ theorisation of the interplay between broader societal influences and individual psyche developed in a direction much more radical than mainstream social psychiatry in western Europe had ever seen. At the same time, in addition to reshaping psychiatry, the revolution became one of its central themes, and Yugoslav psychiatry dedicated significant efforts to describing, interpreting, and treating psychological consequences of the socialist revolution.

Introduction

In the aftermath of the Second World War, the socialist revolution which unfolded in Yugoslavia (and the rest of Eastern Europe) radically changed all aspects of political, social, and cultural life. The resistance movement, led by the Communist Party of Yugoslavia, successfully liberated the country in the spring of 1945 and went on to turn its victory into immense social and political capital. Following the traumatic ideological split with the Soviet Union and the Cominform (the leading organisation of the international communist movement in late Stalinism) in 1948, the country eventually moved away from the Soviet model and sought to define its own unique version of socialism. The overall effect of these changes on Yugoslav society was enormous, and various scientific and medical disciplines developed new paradigms and theoretical frameworks.

Psychiatry and other ‘psy’ disciplines were deeply affected, sometimes in surprising ways. The socialist period proved to be a golden age of the Yugoslav ‘psy’ sciences, and of psychoanalysis and psychotherapy in particular.¹ Not unlike other European countries, social psychiatry rose to prominence, benefiting from both the overall focus of Marxist practitioners on socio-economic factors and their increasingly dynamic international collaboration. Moreover, psychoanalysis and psychoanalytically informed psychotherapy gradually became influential clinical models in psychiatry.

This was highly unusual: nowhere else in socialist Eastern Europe was psychoanalysis practised so openly and awarded such a prominent clinical and intellectual position. In recent years, many historians have revised the proposition that East European psychiatry was fully subservient to the Soviet diktat, and developed within the rigid constraints of the materialist-organic and neurological Pavlovian framework.² Even though such biological approaches persisted in different parts of the Eastern bloc, the picture gradually became more nuanced, with psychotherapeutic and psychodynamic clinical practices gaining strength in the decades after Stalin’s death in 1953. In Yugoslavia, the traditional biomedical paradigm certainly survived the war, and soon after the end of the Second World War influential medical circles devised plans to initiate a full-blown ‘Stalinisation’ of Yugoslav medicine.³ These were cut short by the country’s dramatic break with the Soviet Union, which left Yugoslavia determinedly socialist but relatively free to formulate its own social, political, and medical responses. Because of this unique constellation of political events, the move away from and ‘forgetting of’ the biological paradigm was particularly effective in Yugoslavia, where social psychiatry and psychoanalytic approaches thrived to an unprecedented extent when compared to other socialist societies.⁴ This was partly also because Yugoslav psychiatry became thoroughly internationalised and by the 1960s the country had the most developed and vibrant psychoanalytic and psychotherapeutic profession in Eastern Europe.⁵ Yugoslavia’s psychiatry and psychoanalysis, I will argue, experimented with revolutionary concepts and practices in a genuinely unique manner, and ‘psy’ practitioners saw themselves as important carriers of revolutionary progress.

This chapter focuses on the importance of revolution and ideas of radical reform for the development of socialist psychiatry. I will look at how the experience of social and political revolution transformed the clinical practice and intellectual frameworks of Yugoslavia’s ‘psy’ disciplines, but also how the concept of revolution and reform was worked into psychiatric theories and initiatives. On the one hand, external socio-political circumstances significantly changed the face of Yugoslav psychiatry: in the interwar period, mainstream psychiatry was almost exclusively shaped by the Central European biomedical model. Following the war, psychiatrists started paying more attention to the role of broader social factors in causing and exacerbating mental pathology. The Yugoslav discourse of socialist psychiatry was marked by unique revolutionary political references. By the 1960s and 70s, Yugoslav psychiatrists’ theorisation of the interplay between broader societal influences and individual psyche developed in a direction much more radical than mainstream social psychiatry in western Europe had ever seen. On the other hand, in addition to reshaping psychiatry, the revolution became one of its central themes. Yugoslav psychiatry dedicated significant efforts to describing, interpreting, and treating psychological consequences of the socialist revolution.

The history of Yugoslav psychiatry has so far received little scholarly attention, and researchers have not yet fully examined the significance of the socialist revolution for the development of the country’s psychiatric profession.⁶ Moreover, the broader history of East European ‘psy’ sciences remains rather under-explored: while recent research has demonstrated that the region’s psychiatry was far from monolithic or irrelevant,⁷ the role of Eastern Europe in European or global psychiatric knowledge production has been completely neglected. This research is the first to shed light on the contribution of East European psychiatrists to post-1945 transcultural psychiatry and to global decolonisation debates. Moreover, it offers the first detailed exploration of transnational exchanges of psychiatric ideas between Eastern and western Europe in the Cold War. I will argue that socialist psychiatrists’ faith in the therapeutic potential of revolutionary changes rested on their belief that both the profession and society at large needed to ‘forget’ their authoritarian past and psychological dispositions, as well as their early links to Soviet psychiatric practice. This also applied to a transnational context: Yugoslavia’s transcultural psychiatrists argued that decolonising societies needed to forget and eliminate the oppressive social and psychological structures of colonialism in order to achieve mental health and stability. Reformed socialist psychiatry was in the service of struggling against authoritarianism in both Eastern Europe and the decolonising world.

As I will demonstrate, psychiatrists’ relationship to the multiple disruptions caused by the revolution was ambivalent. In the immediate aftermath of the war, a rapidly growing number of ‘war neurotics’ among the victorious partisan resisters caused major concern for both the Communist political leadership and the psychiatric profession. Mental health professionals linked the outbreak of war hysteria to the disruptive potential of the revolution itself, and clearly lacked faith in the positive outcome of the reform and radical social change they were experiencing.

In the subsequent decades, the Yugoslav version of socialism developed in the direction of workers’ self-management and radical political decentralisation. In their search for an alternative political model following the country’s exit from the Soviet bloc, the most important ideologues of Yugoslav Communism developed their doctrine of socialist workers’ self-management, which was partly based on Engels’ notion of the ‘state that withers away', on Marx’s early writings and analysis of the Paris Commune, on Gramsci’s theories, and partly inspired by the Yugoslav Communists’ wartime experiences of popularly elected and popularly responsible committees/councils. Such reforms ultimately helped build a more pluralistic society.⁸ The Yugoslav political and intellectual elite thus promoted this concept of humanist, democratic Marxism in contradistinction to the authoritarian Stalinist model, and it required a new type of socialist citizen—one characterised by independence of mind, autonomy, and self-initiative instead of blind political obedience. Such a dramatic ideological change opened up new possibilities for the psychiatric profession in the early 1950s. A new generation of socialist psychiatrists stopped worrying about the revolution’s disruptive potential and became the most ardent promoters of radical political change and reform, increasingly preoccupied with notions of individual emancipation. Heavily influenced by the Frankfurt school, and by psychoanalytic thinkers such as Erich Fromm, Igor Caruso, and Karen Horney, they developed original ideas about revolutionary psychiatry and psychoanalysis, which primarily aimed to undermine—to forget—lingering authoritarian structures in social institutions (including the family), and to aid patients on their road to personal liberation and emancipated authentic existence as democratic Marxist citizens.

Finally, Yugoslav socialist psychiatrists were the only ones in Eastern Europe to get involved in transcultural psychiatric discussions and research and to travel to a variety of countries in the Global South as part of technical assistance missions and exchange programmes. This cross-cultural global context offered them an opportunity to reflect on the psychiatric, social, and political meaning of revolutions in different cultural settings. In the 1960s, they drew parallels between African and Yugoslav experiences of revolutionary war, resistance, and liberation. They also radically redefined the role of social and political conflicts in causing mental illness and focused on their positive reformist potential.

As Greg Eghigian argued in relation to psychiatry in the German Democratic Republic, Yugoslav psychiatrists imagined the socialist subject as a psychiatric and psychotherapeutic project—and this meant that the profession as a whole came to participate wholeheartedly in the development of this new type of personality.⁹ By the 1960s, the psychiatric ideal of non-conformist, revolutionary personality was shaped by a combination of international psychoanalytic and psychotherapeutic theories and the specific characteristics of Yugoslavia’s self-managing socialism. The profession moved from critiquing and pathologising the revolutionary dislocation in 1945 to fully adopting the project of radically reforming social structures and individuals in their own consulting rooms. For socialist ‘psy’ practitioners, the possibility of reforming the discipline along Marxist lines meant new hope for a previously marginalised profession and renewed faith in their ability to bring about effective therapy, recovery, and progress for their patients and for society at large.

Socialist Revolution and ‘Reactionary’ Biological Psychiatry

In the aftermath of the 1948 break, Yugoslav psychiatry quickly moved away from the organicist framework. This radical transformation could not have been solely due to the growing international connections of Yugoslav psychiatrists, and the strong influence exerted upon them by the British and American social psychiatry movements. The increased interest in broader social and environmental contexts of mental illness was in evidence well before 1948 and conditioned to a large extent by the experiences of war, resistance, and postwar socialist revolution.

In 1946, at the first postwar conference of Yugoslav psychiatrists and neurologists in Zagreb, leading psychiatrist Nikola Nikolic called for a ‘new type of social doctor, prophylactic doctor, therapist—a neuropsychiatrist’, who would be able to help cure those illnesses that ‘had their roots in social and economic conditions, and which could be treated with social and economic measures.’¹⁰ Nikolic argued that new socialist psychiatry could seamlessly become a part of the radical social medicine turn and that it was the ‘backward socio-economic system’ inherited from the pre-war Yugoslav regime that led to the most serious forms of psychiatric damage, as much as the wartime suffering did. A reactionary and ‘backward’ interwar regime also produced a reactionary psychiatric profession, which completely ignored such damning social and economic factors, and focused exclusively on organic, neurological, and physiological causes of mental illness, thereby making it impossible to hold the regime (and the broader social system) to account. A wholesale political and social revolution, as implemented by the new Yugoslav regime, was needed to reduce the rate of psychiatric illnesses.

The sheer brutality of the Second World War on Yugoslav soil further accelerated these trends. One of the core characteristics of the interwar psychiatric paradigm in Yugoslavia (and Central Europe as a whole) was its disinterest in the notion of psychological traumatisation, and in the influence of external factors on the origins and development of mental illness. In 1946, the speech of Bosko Niketic, the first officer for mental hygiene of the Yugoslav Committee for the Protection of People’s Health, announced a dramatic change in this respect. For Niketic, the postwar socialist government’s most formidable mental health challenge was dealing with the consequences of the psychological scarring caused by the war and the occupation. The crimes committed on Yugoslav soil by the occupying powers, as well as the heroic sacrifices of the resistance movement, became central to the foundational ideological narrative of the new state, but within the framework of biological psychiatry they would have likely been marginalised or forgotten. Unlike interwar clinicians, the new revolutionary psychiatric profession could hardly write the wartime suffering out of the country’s and its own history. As Niketic noted, the ‘fascist criminals’ caused the Yugoslav population immeasurable ‘sorrow, worries, unbearable uncertainty and fears, psychological suffering, insults, and humiliations.’¹¹ A renewed and reformed psychiatric service had to address this.

The revolutionary nature of these proclamations cannot be overemphasised: this was the very first time that any mainstream psychiatric professionals—let alone a state-funded national conference of psychiatrists—in Yugoslavia and Eastern Europe discussed broader social and environmental factors in the origins and development of mental illness, and accorded them such a large role in their interpretive framework. These new psychiatric approaches were explicitly linked to the political programme and revolutionary language of the new socialist Yugoslavia and legitimated with direct reference to the Marxist ideological framework (and its socio-economic concerns).

This rejection of the view that heredity was the sole factor in the aetiology of mental illness became one of the cornerstones of Yugoslavia’s new Marxist psychiatry. In a 1949 article, the head of one of the largest psychiatric hospitals in the country, Dezider Julius, emphasised the harmful effects of earlier ‘biologizing tendencies,’ which were both ideologically reactionary and also the reason for pre-war psychiatry’s general methodological and epistemological crisis: ‘We need to finally relinquish that bourgeois belief in definitively pre-constituted personalities, in an inevitable, fateful role of heredity. This perspective ignores completely important effects of societal factors, and leads in the final analysis to educational nihilism and desperation.’¹²

For Julius, the ideological tenets of socialism required a radically reformed psychiatry, one in which the socio-economic conditions of human upbringing were not being sidelined in favour of purely organic considerations. Marxist societies were in the business of developing a new socialist consciousness in all their citizens, and this educational task could not be accomplished without psychiatrists’ careful attention to the multitude of ways in which social and historical developments altered the human psyche.

Towards the end of the war, another set of events occurred which pushed psychoanalytic and psychotherapeutic approaches to the fore: the victorious resistance army was hit by an unusual predicament, a sudden outbreak of a unique type of ‘partisan neurosis’. In this acute political crisis, it was two Vienna-educated psychoanalysts, Stjepan Betlheim and Hugo Klajn, who were appointed and given resources by the new government to handle the illness.

A Moment of Fear and Ambivalence

In 1945, the Communist Party-led Yugoslav People's Army, having faced and triumphed over numerous formidable wartime challenges, was plagued by an internal problem which appeared impossible to resolve or even fully understand: a virtual epidemic of war neurosis, which did not show any signs of subsiding after the end of fighting.¹³ This was a disorder that bore no resemblance to war traumas in other nations that participated in the conflict: it did not manifest itself in the form of an urge to withdraw from the frontlines, as was the case in the British and US armies, where battle exhaustion, anxiety, and demoralisation emerged as the most popular diagnoses by 1944.¹⁴ Rather, Yugoslav war neurotics demonstrated a heightened willingness to fight, as their new disorder consisted of violent and potentially harmful epileptiform seizures which simulated wartime battles and attacks.¹⁵ The seizures could occur at any moment and under any circumstances, usually when there was audience—in the middle of a conversation, at lectures or meetings, while driving a car, or in front of superiors.

Crucially, the Yugoslav form of war neurosis apparently most frequently affected the uneducated, socially immature, and emotionally less sophisticated—in some reports even ‘primitive’¹⁶—members of the partisan troops, who were given important political responsibilities but experienced severe trauma and anxiety due to their own inadequacy and unpreparedness. Because of this, and in a highly volatile and disruptive broader social context, ‘partisan hysteria’ became an opportunity for psychiatric professionals to express their anxiety over, and even open disapproval of, increasing upward social mobility and socio-political transformation following the socialist revolution of 1945, and to criticise the effects of the creation of a new political and military elite from the ranks of workers and peasants. Given the greater visibility and social authority of the urban and rural poor from 1945 on, ‘partisan hysteria’ gave psychiatrists an opportunity to define this new source of social instability, and devise ways to solve it—through education, control, or limits on upward social mobility. In other words, witnessing a true social revolution outside the hospitals, Yugoslav psychiatrists found it very difficult to shed their long-time beliefs about the volatile nature of the ‘masses’ and pathologised the upward mobility and other revolutionary societal changes of the new Yugoslav socialist republic. At this early stage in the revolution, even progressive psychiatrists struggled to embrace the social (and medical) reform, and ‘forget’ the hierarchies of the old political system. Klajn, who was the most prolific in dealing with partisans’ war neurosis, concluded that the illness was a ‘sign of a certain slowdown in development, certain infantilism’, or an ‘underdevelopment of character.’¹⁷ But for him, the problem was not the incapacity itself. The original conflict was actually determined by the patients' desire to fulfil their new tasks, and by their exceptional ambition for professional and political advancement and recognition in a revolutionary context. The unique nature of the partisan army organisation and postwar Yugoslav society was that it offered an unprecedented opportunity for people from the lowest sectors to achieve high-ranking, responsible, and socially prestigious positions. Their capacity to succeed in their new tasks was doubted by virtually everyone: the Party, psychiatrists, and, finally, themselves. For Klajn, this was one of the main sources of neurotic reactions: this ‘need to make independent decisions in a number of tasks, and thereby take personal responsibility for their solutions’ had a particularly strong ‘pathogenic effect’ on those soldiers with ‘immature characters’, who were ‘perhaps also intellectually and otherwise less than developed’.¹⁸ In addition, the very possibility of achieving professional and social success stimulated many partisan soldiers extraordinary ambition and a very powerful desire to be rewarded. When peacetime circumstances made the achievement of that recognition more difficult or even impossible, it was argued, soldiers resorted to hysterical seizures as (immature) forms of protest, or as a roundabout strategy for realising their goals.

In fact, Klajn highlighted the ‘wish for being recognised’ as the single most important psychological factor in the development of partisan neurosis: this also explained why so many new cases were registered after 1944 and 1945. The distribution of officer ranks, distinctions, and status rewards within the victorious army in the spring of 1943 was held responsible for the seizure of many ‘incompetent’ and overly ambitious partisans, who found themselves in lowly positions within the hierarchy: these changes ‘incited envy and awoke ambition and desire for rewards among the partisans, especially in uneducated, young and psychologically immature soldiers’. When advancement was denied or jeopardised, ‘the wish emerged in immature and vain partisans to vent their anger and receive what they thought was a deserved award’.¹⁹

Therefore, in the final analysis, partisan neurosis was the typical mental condition of a highly socially mobile revolutionary community. This idea was perhaps expressed most clearly in Klajn's description of the case of Misa M., a 20-year-old non-commissioned officer, who in 1945 started suffering seizures while attending a radio-telegraphic course in which his results were unsatisfactory, and also had one ‘at a political class when a comrade criticised his statements. He is very ambitious, and wants to remain a political official.’²⁰ In that sense, Klajn's work criticised the wartime radical politics and social mobility of the partisan units, which were being translated into a postwar social system.

The expectation that this created in unstable and immature persons frequently drove them to aggression and indiscipline. This became particularly clear to Klajn and Betlheim while they were involved in a failed attempt to treat around 100 partisan war neurotics at the Military Psycho-hygienic Institute in Kovin in northern Serbia. In his descriptions of his experiences in Kovin, Klajn indicated the potential social danger of strong ambition being awoken in the lower classes. In Klajn's account of some patients’ behaviour, the anticipation of an imminent eruption was clearly present: Niko N. ‘is permanently dissatisfied, walks around with a stick, threatens and stirs up others … he leaves the Institute on his own, does not recognise the commissar as his superior’²¹; Jovan O. is ‘undisciplined, leaves without permission and returns late … he broke a window. … Threatens the superintendent and the clerks.’²² Klajn also explained how the ‘fighting spirit’ that, according to his interpretation, characterised this particular neurosis, made the patients ‘very unpleasant’, inclined to act violently, attack the medical and administrative staff at the facility where they were placed for treatment, behave extremely disobediently, participate in beatings, and become destructive. Klajn reported that five particularly undisciplined soldiers even threatened to murder all members of the Institute's management. He remained resolute in his claim that the issue of partisan neurosis was a social problem much larger than ‘neuropsychiatry itself, and which also falls within the scope of social psychology and politics, pedagogy, military discipline, military court system, and even criminology.’²³ In other words, the source of the neurosis was to be found in some of the most widespread social circumstances. Klajn's and Betlheim's disconcerting experiences in the microcosm of the Military Psycho-hygienic Institute demonstrated partisan hysterics' potential to permanently upset social order and to develop into uncontrollable factors in a larger social setting.This image of destruction and chaos that resulted from the fear of the lower classes taking over thus persisted after 1945: the social revolution had apocalyptic potential.

Still, the psychiatric profession maintained that they were best placed to deal with its consequences. Yugoslav ‘Partisan hysteria’ turned out to be a major political issue, not least because its expression was so theatrical and because it affected the celebrated heroes of the resistance movement. As we saw above, Klajn and Betlheim diagnosed it as a sign of ‘primitivism’, emotional immaturity, infantilism, and lack of education in very young peasant soldiers, and offered ‘pedagogical therapy’, ‘enlightenment’, and re-education as a solution. These were to be delivered by sympathetic but authoritative teacher-psychiatrists, whose attitude was to be that ‘of a mature educator towards an immature pupil’.²⁴ They thus inserted themselves directly in broader political and social debates about the revolutionary changes and the population’s seeming unpreparedness to take part in them. In other words, the issue of the socialist revolution propelled the psychiatric profession to the centre of the political stage, and they used the crisis as an opportunity to reassert their significance beyond the asylum. Following the first few years of the war, a new generation of psychotherapists and psychoanalysts started thinking about the revolution (and their role in it) in more complex terms and worked on reconciling Yugoslavia’s unique form of Marxism with the ‘psy’ disciplines.

Building an Activist Psychoanalysis

As the immediate postwar period was coming to a close, a new generation of socialist psychiatrists and psychotherapists emerged, which redefined their profession’s relationship with and role in political and social revolution. For these young and ideologically committed clinicians, the idea of revolution and reform was not automatically tied to disruption, aggressiveness, or harmful insubordination; on the contrary, the revolutionary ideals of Yugoslavia’s ‘humane socialism’ provided important new avenues for reforming and reinvigorating the psychiatric profession. The new generation of socialist ‘psy’ practitioners had genuine faith in the significance of constructing new democratic Marxist citizens in Yugoslavia, and their faith was closely linked with their vision of a radically transformed socialist psychiatry. This reformed profession was to play a pivotal role in the revolutionising of Yugoslav citizens’ minds, and in the collective effort to weed out traditional authoritarian mentalities and social structures.

The ‘Westernisation’ of Yugoslav psychiatry and psychoanalysis was a complex and layered process, and mental health practitioners often re-framed the concepts and techniques of British and French psychoanalysis to respond to the pressing social and cultural problems of building democratic socialism and revolutionising society. In this extraordinary case of transnational borrowing and adaptation, West European psychoanalytic experiences and insights were used to help raise Marxist children and construct proper Marxist families in Yugoslavia, and Yugoslav child psychoanalysts hoped to employ a psychoanalytic approach both inside and outside the clinic to revolutionise patriarchal, authoritarian and hierarchical social relations. This was to be a revolutionary and activist psychoanalysis, which was meant to contribute to broader discussions in Yugoslavia about constructing a society based on genuine Marxist collective and individual emancipation, an alternative to both Stalinist state socialism and western capitalism/liberal democracy.

This was truly unique: in most East European countries psychoanalysis was confined to various degrees of underground existence, and informally integrated in a series of therapies and approaches labelled as ‘dynamic’ or ‘psychotherapeutic’.²⁵ Moreover, as Christine Leuenberger pointed out with regard to the GDR, psychoanalysis was more likely to be perceived as ‘politically subversive’ and to ‘[offer] an alternative conception of human nature’ than the one promoted by orthodox Marxism-Leninism or Pavlovian approaches.²⁶ It was arguably only in Yugoslavia that the clinical and theoretical aims of psychoanalysis aligned quite closely with the political revolutionary agenda of workers' self-management, so that psychoanalysis became directly involved in the process of overhauling social and psychological conditions in order to build a democratic socialist person.

Moreover, Yugoslav psychoanalysts styled themselves not only as perceptive social critics and subversive intellectuals but also as direct revolutionaries in their everyday clinical practice. Even though they participated in broader social and political discussions, their primary field of political action and involvement was the consulting room, where they proposed to directly transform archaic social relations and promote self-management by undoing traditional Yugoslav patriarchal and authoritarian families. In his commentary on Marxist psychoanalyst Igor Caruso's work, one of socialist Yugoslavia’s leading psychiatrists Vladimir Jakovljevic put forward the concept of ‘engaged psychoanalysis', and treated it as identical—or at least highly comparable—to revolutionary Marxism in its emancipatory potential: ‘just like revolutionary Marxist praxis, engaged psychoanalytic practice aims to help individuals become freer creators of their own and social history, shedding light on the conditions and forms of their alienation and on possibilities for overcoming it.’²⁷ According to Jakovljevic, it was a natural mission of psychoanalysis—in its ‘anthropological' and activist guise—to play a central role in developing authentic personalities and deepening consciousness. The discipline's potentials for constructing authentic citizens and a free society were virtually unlimited, and this form of Marxist and anthropologically minded psychoanalysis was indispensable for achieving socialist revolution on both personal and societal levels.

Other practitioners, too, tended to draw direct parallels between psychoanalysis and Marxist revolution (and radical reform), and even between Freud and Marx themselves as personalities who intervened in modern history in forceful ways.²⁸ Both Marx and Freud, the ultimate believers in Reason as a substitute for God, drew attention to core conflicts and struggles: between the conscious and the unconscious in the case of Freud, and between different social structures in a historical process in the case of Marx. In this way, psychoanalysis yet again became a tool for revolutionary Marxist praxis in the sphere of individual consciousness, which Yugoslav mental health specialists seemed to embrace wholeheartedly as much for therapeutic as for political reasons.

The Yugoslav path to socialism turned out to be significantly different from the Soviet model: very soon after the break, the Yugoslav political leadership began searching for an alternative ideological and political basis for legitimation, which would move away from Stalinist totalitarianism without endangering the socialist essence of the Yugoslav revolution. In 1949, the Communist Party's leading ideologue, Edvard Kardelj, suggested that socialism meant ‘such an organisation of a people’s community which would represent a mutual cooperation of equal, free people' and would eliminate ‘a uniformity imposed from above and hierarchical subordination to the centre.'²⁹ The political image of an ideal citizen of this novel system, consequently, changed quite significantly. Yugoslav socialism now rested on a very complex set of ideas centred around workers’ self-management and ‘withering away of the state,’ and inspired by Marx’s early writings. The new Yugoslav self-managing worker needed to possess robust assertiveness, independence of mind, and a host of other critical psychological and intellectual qualities in order to sustain the political experiment. He or she would also need to leave behind dogmatic, authoritarian, or subservient frames of mind which characterised previous models of social relations.³⁰ Central to this was forgetting one’s authoritarian upbringing in a traditional Yugoslav family.

The increasingly dynamic psychiatric and psychotherapeutic profession offered to participate in the project of building this new type of democratic revolutionary person. A social institution which, according to psychiatrists, presented the most serious obstacle and required immediate restructuring was family: according to leading child psychoanalyst Vojin Matic, Yugoslav (traditional) family remained one of the last ‘niches of coercion’ in a rapidly revolutionising society, and it was within traditional families that deeply harmful violent and dictatorial structures needed to break first in order to allow for the development of truly liberated humanist Marxist individuals. Throughout psychiatric discussions, patriarchy and authoritarianism were marked as the authentic cultural traits of the Yugoslav family and social structure. One of the central characteristics of the Yugoslav family was that ‘expressions of disobedience and resistance to parents, teachers and other adults, especially if they were higher up on the hierarchical scale, were condemned and punished, while obedience and submissiveness were encouraged. Parents and adults were sacred beings who may not be called in question or disputed.’³¹ Patriarchal parents were guilty of producing automatons and weak personalities, who would only be capable of fulfilling other people's orders. On the contrary, the fledgling Yugoslav society of self-managers needed independent young people, ‘who thought with their own heads'.³² From the 1960s, then, the Yugoslav psychiatric profession proposed to liberate and revolutionise society by revolutionising the traditional Yugoslav family.

It was, in particular, psychoanalysis which was to become the intellectual tool for making families and parent–children relationships more socialist, egalitarian and self-managing. In 1950s and 60s Yugoslav child psychiatric circles, psychoanalysis was seen as ‘a democratic, liberating psychotherapy, which stands for independence and personal liberties of individuals’.³³ As psychotherapist Vladeta Jerotic later confirmed, psychoanalysis coupled with self-analysis presented a unique way to achieving unsurpassed human autonomy, self-actualisation, and educational growth: unlike traditional psychiatry, it educated without relying on authoritarianism, and, by increasing patients' self-knowledge, ‘created pre-conditions for the constitution of a mature and autonomous personality' and for attaining the ‘freedom of self-development.'³⁴ For Jerotic, the ethics of psychoanalysis required that practitioners shun any attempts at manipulation or indoctrination, and focus on advancing a democratic dialogue with the patient. For these reasons, a society of true socialist self-managing workers was impossible without psychoanalytic guidance.

Many of the Yugoslav child psychotherapists proposed original ideas regarding an activist psychoanalysis, which might abandon its ‘aristocratic’ position in the cabinet and get involved in proper social change. They often criticised western psychoanalysis for its failure to focus more on collective than individual freedoms, and to take detailed theoretical account of the numerous economic, political, racial, or religious pressures in modern societies: ‘the psychoanalyst… most frequently closes his eyes before the social and political issues of his time.'³⁵ What they had in mind for their profession was radically different, and it involved changing society by revolutionising family relationships and structures through clinical practice. Such an unusually activist stance might be one of the defining features of East European (socialist) psychoanalysis, and it was founded on the ideas of self-management and its continuous implementation in both families and society at large. In her book on psychopathology and youth, Nevenka Tadic drew a direct parallel between a ‘patriarchal family’ and ‘bureaucratised social’ relations, equating non-democratic familial arrangements with dictatorial political structures, and concluding that youth needed to liberate itself from both in order to realise its own authentic emotional, cognitive, and social capacities.³⁶ Family became yet another experimental site in which hierarchical relations were to be gradually unravelled and patients were to be encouraged to replace them with more egalitarian and self-managing structures.

Importantly, while in western Europe or the US such clinical experiences primarily aimed to advance the individual transformation and emancipation of child patients, Yugoslav therapists placed these personal psychological goals explicitly in a political context: human freedom and its relationship to authoritarianism came to the very centre of the psychiatric understanding of child and youth psychotherapy. Tadic used very peculiar terminology to describe the position of a child psychotherapist who was asked to treat a patient by parents or a state agency: ‘a psychotherapist must be aware of a trap, in which they often fall, to become a protector and advocate of the interests of the family and of the society, and to serve their interests uncritically.’ This was particularly important because it was most often the case that the decision regarding psychotherapy was not made by patients themselves, but by their parents, schools, or psychological centres, who ‘should take responsibility for their part in the development of mental disturbances in children and youth.’ Furthermore, sending a child to a therapist could be ‘the last and most decisive pressure and enslavement.’³⁷ Clinical contexts thus became arenas for political experimentation and activism: ‘The therapist should not act like a person who offers freedom to the enslaved while smiling at and encouraging the enslaver,’ but should instead increase the political awareness and liberation potential of the enslaved.³⁸ Speaking of relationships inside the consulting room, Vojin Matic stated that ‘a child, with his individuality, already attained the right of citizenship in medicine', and this attainment, a new realisation of the psychological essence of children's personalities, should now be the first step towards a transformed political subjectivity.³⁹

Although she did not directly refer to them, Tadic’s critical proclamations about the role of psychiatry in perpetuating societal oppression echoed some of the most important principles of radical psychiatry, a contemporaneous and mainly western movement that emphasised alienation, hierarchy, inequality, and social coercion in modern societies as the core causes of mental suffering. As Claude Steiner, the movement’s founder and one of its most prominent theorists, wrote in an influential 1971 article, ‘[p]sychiatry has a great deal to do with the deception of human beings about their oppression,’ and it is precisely this collusion that Tadic’s vision of activist psychoanalysis attempted to unravel: by proclaiming their ‘neutrality’, psychiatrists in fact became ‘[enforcers] of the domination and [their] lack of activity becomes essentially political and oppressive.’⁴⁰ On the other hand, radical psychiatrists (as well as Tadic and her colleagues) sought to counter the deception, make patients aware of their own oppression, and enact liberation through an explicitly politicised therapeutic process. Tadic and Matic appeared to closely follow Herbert Marcuse’s injunction—that psychiatry should be a ‘subversive undertaking’ which would ‘prepare the mental ground for [the struggle against society]’, that any action to tackle psychological illness would need to take place on a political level, and that psychiatrists should act as political saboteurs of any oppressive elements within the social order, preventing their patients from ‘[collaborating] in their own repression’.⁴¹ As per the advice of the Massachusetts-based Radical Psychiatry collective, Tadic invited her colleagues to see their (child) patients ‘as oppressed people who must be liberated’ rather than ‘“sick people who [needed] “treatment”’.⁴²

In socialist Yugoslavia, therefore, psychiatry and psychotherapy became directly engaged in discussing crucial questions about shaping and reshaping political minds, and building, as the Communist Party called it, a genuine democracy.

‘Revolutionary Personality’: Psychiatry of Non-Alignment

In Vladimir Jakovljevic’s Marxist interpretation, psychoanalysis was both non-conformist as a discipline and primarily focused on non-conformist, potentially revolutionary or disruptive, personalities: ‘from Freud to Fromm … psychoanalysis always viewed individuals as potential rebels of sorts, who strove to overcome dominant models of the society in which they had developed.’⁴³ In this reading of psychoanalysis, therefore, the discipline becomes a handmaiden of revolutionary thinking: an intellectual framework which both explains and enables the development of rebellious personalities and sows the seed of social revolution.

Jakovljevic’s research into revolutionary psychology and behaviour was greatly advanced through his involvement in global transcultural psychiatry networks and research in the 1960s. As a representative of a non-aligned country and as part of Yugoslavia’s technical assistance missions to a range of decolonising countries, Jakovljevic travelled to Guinea, a former French colony in western Africa, to help establish local psychiatric services and organise education for local mental health staff.⁴⁴ He practised psychiatry in Guinea for over three years and also engaged in extensive anthropological research of local conceptualisations of mental illness and normality. As a result of his psychiatric-anthropological work in Guinea, Jakovljevic produced the only explicitly Marxist publications in transcultural psychiatry, which explored the complex relationships between socio-economic, cultural, and individual psychological factors in the onset of mental illness. Even more importantly, he drew direct comparisons between revolutionary experiences in Guinea and Yugoslavia, arguing that there existed significant parallels between Guinea’s anti-colonial struggle and decolonisation, and Yugoslavia’s recent history of anti-fascist resistance and socialist revolution. In line with his interest in the notion of non-conformism in psychoanalysis, he developed a theory of revolutionary personalities, which was much more optimistic about the possibility—and psychological cost—of reform and transformation in underdeveloped societies.

This was a new platform for Marxist psychiatry and psychoanalysis, and it radically redefined the role of social conflict in causing mental illness. Jakovljevic emphasised the revolutionary (rather than only pathological) potential of conflicts between individuals and their (‘backward’ or underdeveloped) social environment: ‘socially caused conflicts might constitute a progressive factor in the development of a society’ and lead to revolutionary resistance against the social organisation or structure.⁴⁵ While a discord or conflict between an individual and their social environment (which traditional psychoanalysis tended to see as the core origins of neurotic disorders) might lead to mental pathology, pathogenic socio-cultural factors did not necessarily cause psychological disorders, if a robust individual in an ‘abnormal' society found ways to overcome their circumstances. In fact, such intra-psychic conflicts need not lead to mental illness at all, and might even result in the ‘growth of personality and society, which happens precisely as a consequence of ever more complex internal conflicts and new solutions built into that society by the personality [in question]’. On the contrary, a ‘conformist adaptation of an individual to an abnormal social environment might lead to an even more fundamental form of [psychological] abnormality.’⁴⁶ In that sense, what Jakovljevic defined as a ‘non-conformist' personality was a phenomenon critically different from a mentally ill individual, although it emerged from a similar structural setting. In fact, the ‘non-conformist personality' was the healthiest type of individual in any reactionary or ‘anachronistic' society. Jakovljevic articulated his theory of revolutionary personality following his work in Guinea but based it on his research findings in both Africa and Yugoslavia.

It was in this context of non-conformist and revolutionary personalities that Jakovljevic implicitly recognised one of the strongest connections between Eastern European and Guinean/African experiences of dramatic social change. While revolutionary activity in wartime and postwar Yugoslavia established the foundations of the new state, Guinea had undergone comparable political experiences, primarily in the course of its recent decolonisation struggle which produced different forms of anti-colonial cultural and political expressions. The Guinean and Yugoslav experiences demonstrated that ‘pathogenic' social and political situations were not necessarily destructive. On the contrary, certain personalities might be ‘stimulated [by such illness-inducing settings] to develop creatively new forms of reacting (such as the creation of novel political forms in the context of fighting colonialism instead of conformist subordination)’.⁴⁷ This creative potential allowed both Yugoslavia and Guinea to turn possible psychological disorders into reformist and progressive political behaviour. It was in this theory of revolutionary personality and its complex relationship to mental illness that the original contribution of Yugoslavia's postwar Marxist psychiatry lay.

And since Jakovljevic’s ‘revolutionary personality’ was a universal concept drawn from his transnational research, it was as applicable to the Yugoslav revolutionary situation. In fact, Tadic’s and Matic’s visions of radical psychotherapy, discussed in the previous section, seemed in large part grounded in similar theoretical and clinical tenets. For Yugoslav psychotherapists—and for child psychoanalysts in particular—raising non-conformist, revolutionary individuals remained a key political preoccupation and a precondition for building a truly free society. For this reason, authoritarian and backward-looking social structures needed to be unravelled and ‘forgotten’ through psychotherapeutic work. In Jakovljevic’s research, the situation in Yugoslavia was linked to the revolutionary conditions in Guinea, where non-conformist individuals were needed to reform the old structures and establish a new post-colonial socialist society.

Conclusion

The experience of socialist revolution affected Yugoslav psychiatric profession in a number of ways: it started influencing clinical practice immediately after the Second World War ended, while the concept of political and psychological revolution radically transformed the theoretical landscape of Yugoslav psychiatry and psychotherapy.

The first meaningful change was to move away from the reductive organicism of traditional psychiatry, and to consider the role of sociological, cultural, and political factors in patients' personal histories. For Marxist practitioners, this was of the utmost ideological and clinical importance: a psychiatric framework that reduced psychological conflicts to biological, chemical, or neurological explanations removed any potential for social critique or engagement, and undermined Marxist psychiatrists' ability to relate their work to broader socio-political trends and objectives.⁴⁸ As the case of ‘partisan hysteria’ demonstrated, mental health practitioners used crisis situations to engage in a broad political discussion about the state of Yugoslav society and emphasised their own role in addressing unprecedented social dislocation.

Following this turbulent period in which revolutionary changes were often seen to lead to volatile and dangerous situations, a new generation of psychiatrists started conceptualising ‘revolution’ in more positive ways and even embraced it as one of their profession’s most important goals. By the 1960s, psychiatrists and psychotherapists actively sought a major role for themselves in the realisation of the revolution of individual psychological and family planes. This was a profession many of whose members were increasingly committed to a radical social/political agenda, and whose most prominent representatives aimed explicitly to reconcile revolutionary Marxist worldview with psychotherapeutic and psychiatric practices. They aimed to develop their own version of revolutionary and activist psychoanalysis and psychotherapy. Many used overtly political language to frame their professional aims and experiences and turned their consulting rooms into revolutionary sites.

Historians have already showed that, in the Eastern bloc, a variety of psychodynamic approaches was allowed to develop, while the Cold War did not prevent socialist psychiatrists’ involvement in transnational collaboration with western colleagues. Such historical analyses argue that East European psychiatry was perhaps ‘socialist by default’—i.e. shaped by necessity by the socialist context—but not deeply grounded in socialist ideology and therefore not fundamentally different from its West European or North American counterparts.⁴⁹ However, as the Yugoslav case demonstrates, East European ‘psy’ disciplines could become radically reformed as a result of their interpenetration with Marxist intellectual frameworks, and informed by broader socialist or revolutionary principles. This was by no means always a sign of political authoritarianism and professional subordination: Marxist psychiatry in its Yugoslav version developed original emancipatory approaches, even on the global level, and engaged in innovative and experimental projects. This was then a specifically socialist psychiatry, although it was not necessarily abused by the Communist Party: rather, it was meant to participate in the broader political project precisely by raising a new generation of non-conformist citizens.

Moreover, it would be useful to reconsider the role of Eastern Europe in the history of ‘psy’ disciplines. If we look more closely at the Yugoslav case, it becomes clear that socialist psychiatry was neither a helpless political handmaiden nor a mere imitation of western psychiatric techniques. Instead, it was only in Eastern Europe that a truly radical and revolutionary psychiatry received full state support instead of existing on the social and political margins, and it was practised in a range of mainstream state-funded clinical establishments. The consulting room became a revolutionary field, in which broader social, cultural, and political changes played out. In that sense, this East European socialist experiment, in which a new activist psychotherapy became the norm, remains central to understanding the ‘psy’ disciplines as a tool for socio-political critique and activism in the second half of the twentieth century.

Notes

• 1. Matthew Savelli, ‘The Peculiar Prosperity of Psychoanalysis in Socialist Yugoslavia', Slavonic and East European Review, 91(2), 2013, 262–288.

• 2. Christine Leuenberger, ‘Socialist Psychotherapy and Its Dissidents’, Journal of the History of the Behavioural Sciences, 37(3), 2001, 261–273; B. Buda, ‘Psychotherapy in Hungary During the Socialist Era and the Socialist Dictatorship’, European Journal of Mental Health, 4(1), 2009, 67–99; Matthew Savelli, ‘“Peace and Happiness Await Us:” Psychotherapy in Yugoslavia, 1945–1985’, History of the Human Sciences, 31(4), 2018, 38–57.

• 3. See, for instance, Nikola Nikolić, ‘Vladimir Iljić Lenjin i Zaštita Narodnog Zdravlja’, Medicinski Glasnik, 1, 1947, 5; G. Nikolić, ‘Oktobarska Revolucija i Razvoj Sovjetske Medicine’, Vojno-Sanitetski Pregled, 4, 1947, 11–12; V. Stojanović, ‘Velika Oktobarska Revolucija i Zaštita Narodnog Zdravlja u SSSR,’ Medicinski Glasnik, 2, 1947, 2, Nikola Nikolić, ‘Razviće Sovjetske Medicine’, Medicinski Glasnik, 1, 1947, 9.

• 4. Savelli, ‘The Peculiar Prosperity of Psychoanalysis in Socialist Yugoslavia’, 262–288.

• 5. Ana Antic, ‘The Pedagogy of Workers’ Self-Management: Terror, Therapy, and Reform Communism in Yugoslavia After the Tito-Stalin Split’, Journal of Social History, 50(1), 2016, 179–203.

• 6. For an argument about the limited relevance of socialism for the development of Yugoslav (and East European) psychiatry, see Savelli, ‘Beyond Ideological Platitudes: Socialism and Psychiatry in Eastern Europe’, Palgrave Communications, 4(45), 2018, https://doi.org/10.1057/s41599-018-0100-1; for in-depth studies of Yugoslav psychiatry, see also Savelli, ‘Diseased, Depraved or Just Drunk? The Psychiatric Panic Over Alcoholism in Communist Yugoslavia’, Social History of Medicine, 25(2), 2012, 462–480; Heike Karge, ‘Making Sense of War Neurosis in Yugoslavia’, Peter Leese, and Jason Crouthamel (eds.), Psychological Trauma and the Legacies of the Great War (Basingstoke: Palgrave Macmillan, 2016), 217–235; Ana Antic, Therapeutic Fascism: Experiencing the Violence of the Nazi New Order (Oxford: Oxford University Press, 2017).

• 7. Sarah Marks, and Matthew Savelli, ‘Communist Europe and Transnational Psychiatry’, Sarah Marks, and Matthew Savelli (eds.), Psychiatry in Communist Europe (London: Palgrave MacMillan, 2015), 1–27.

• 8. Marie-Janine Calic, Geschichte Jugoslawiens im 20. Jahrhunert (Munich, 2010), 240.

• 9. Greg Eghigian, ‘The Psychologization of the Socialist Self: East German Forensic Psychology and Its Deviants, 1945–1975’, German History, 22(2), 2004.

• 10. Nikola Nikolić, “Drugovima neuropsihijatrima!, Narodno zdravlje: Organ Komiteta za zaštitu narodnog zdravlja F.N.R.J., 1946, 3, 1.

• 11. Boško Niketić, “Otvaranje konferencije,” Narodno zdravlje: Organ Komiteta za zaštitu narodnog zdravlja F.N.R.J., 1946, 3, 4.

• 12. Dezider Julius, ‘Pitanja socijalne psihopatologije’, 5.

• 13. Arhiv Sanitetske sluzbe Ministarstva odbrane, R-19, ‘Neuropatija (slicna histeriji)’, 1–2.

• 14. Ben Shephard, ‘Pitiless Psychology: The Role of Prevention in British Military Psychiatry in the Second World War’, History of Psychiatry, 10, 1999, 491–524; Edgar Jones and Stephen Ironside, ‘Battle Exhaustion: The Dilemma of Psychiatric Casualties in Normandy, June–August 1944’, Historical Journal, 53, 2010, 109–128.

• 15. Isak Alfandari, ‘Ratna neuroza’, Vojno-Sanitetski Pregled (VSP), 4(5), 1944, 119–122.

• 16. See, for instance, Josip Dojč, ‘Inozemstvo-Mania, nova zarazna bolest!’, Arhiv Sanitetske sluzbe Ministarstva odbrane, R-202; Dojc, ‘O biti zivcanih napadaja u ratu (ratna neuroza)’, Vojno-Sanitetski Pregled (VSP), 1946, 3, 118.

• 17. Hugo Klajn, Ratna neuroza Jugoslovena (Belgrade: Tersit, 1995—reprint, originally published in 1955), 84.

• 18. Ibid., 88–89.

• 19. Ibid., 17–18.

• 20. Ibid., 81–82.

• 21. Ibid., 78.

• 22. Ibid., 82.

• 23. Ibid., 149.

• 24. Klajn, Ratna neuroza Jugoslovena, 151.

• 25. See Greg Eghigian, ‘Was There a Communist Psychiatry? Politics and East German Psychiatric Care, 1945–1989', Harvard Review of Psychiatry, 10(6), 2007, 364–368.

• 26. Christine Leuenberger, ‘Socialist Psychotherapy and Its Dissidents’, Journal of the History of the Behavioural Sciences, 37(3), 2001, 268.

• 27. Vladimir Jakovljevic, ‘Predgovor za knjigu I. Karuza: Drustveni aspekti psihoanalize', Prilozi sa socijalnu patologiju (Belgrade: Sloboda, 1984), 257–259.

• 28. Muradif Kulenovic, ‘Izgnanstvo i smrt u tudjem gradu', Psihoterapija, 6(2), 1976, 196.

• 29. Radovan Radonjic, Sukob KPJ s Kominternom I drustveni razvoj Jugoslavije, 1948–1950 (Zagreb, 1979), 281.

• 30. Kardelj, Borba, 14 January 1950.

• 31. Tadic, Psihijatrija detinjstva i mladosti (Belgrade: 1989, reprinted), 30.

• 32. Pesic, Vladimir Jakovljevic (1925–1968), 25.

• 33. Tadic, Psihijatrija detinjstva i mladosti, 20.

• 34. Vladeta Jerotic, ‘Psihoanaliza, autoanaliza i autonomija licnosti,' Psihoterapija, 2, 1975, 215–217.

• 35. Tadic, Psihijatrija detinjstva i mladosti, 19.

• 36. Ibid., 18–19.

• 37. Ibid., 19.

• 38. Ibid., 20–21.

• 39. Vojin Matic, ‘Dete u bolnici: Dusevno-higijenski osvrt’, Medicinski Glasnik, 7–8, 1954, 275–277.

• 40. Claude Steiner, ‘Radical Psychiatry: Principles’, The Radical Therapist (New York, 1971), 16–17.

• 41. Herbert Marcuse, Negations: Essays in Critical Theory (Boston, 1967).

• 42. Rough Times Collective, ‘Introduction’, The Radical Therapist (London, 1974), 8–9.

• 43. Vladimir Jakovljevic, ‘Da lie je psihoanaliza neuspela’, Harry Wells (ed.), Neuspeh psihoanalize (Belgrade: Kultura, 1967), 5–51.

• 44. Vladimir Jakovljevic, Kulturna sredina i psihički poremećaji ličnosti: transkulturno-psihijatrijsko proučavanje u Afričkoj Gvineji, unpublished doctoral dissertation, University of Zagreb, 1967, 4.

• 45. Vladimir Jakovljevic, ‘Transkulturno-psihijatrijska proucavanja u Gvineji’, Neuropsihijatrija, 11(1), 1963, 21–36; Vladimir Jakovljevic, ‘Prilog proucavanju sociopsihogeneze neurotickih poremecaja licnosti’, Sociologija, 2, 1959, 76.

• 46. Jakovljevic, ‘Prilog Proucavanju Neurotickih Poremecaja', 76–77.

• 47. Jakovljevic, Prilozi za Socijalnu Patologiju, 163.

• 48. Stjepan Betlheim, ‘Kakav je stav lekara prema psihoanalizi’, Nas Vesnik, 204, 1956, 3.

• 49. Matthew Savelli, ‘Beyond Ideological Platitudes: Socialism and Psychiatry in Eastern Europe’, Palgrave Communications, 4(45), 2018, https://doi.org/10.1057/s41599-018-0100-1