Sleeping fitfully during the early hours of April 21, I repeatedly peered out the window of my Pan-Am jet to watch the Arctic midnight sun at the horizon of the frozen earth. In a few hours, Homer Curtis, Chuck Rothstein, Sandy Abend, and I—and our wives—would arrive in Moscow as representatives of the American Psychoanalytic Association. What a distance from the daily rhythm of analytic practice! We shared a sense of curiosity, hope, and determination, together with astonishment that such a trip was taking place.
A year or two ago this scene would have been impossible. As it was, the trip would never have taken place without Chuck Rothstein to put it together; he organized, planned, and prepared for the adventures that lay ahead of us. We were to be the guests of the Mental Health Research Center in Moscow, a governmental institution with responsibilities similar to the NIMH in the USA. Soon we would stand before an auditorium filled with Russian psychiatrists and psychologists, of whom we knew nothing. As we were to discover, many of them also shared our sense of hope and promise concerning psychoanalysis in Russia. We would attempt to bring to them a vivid awareness of the strength and vigor of psychoanalysis. We were going to demonstrate the usefulness of its insights in their work. In addition, we were hoping to stimulate some of them to pursue the long and arduous road of psychoanalytic training.
But at the moment of landing in Moscow the questions were all ours:
Would customs be impossible? It was a breeze.
Would we get along well with our Russian host and guides? Our host, Marat Vartanian, very much a part of Russian psychiatry of the Brezhnev era, was subdued, helpful, and mostly absent aside from formal moments of greeting and departure. Our guides were several research psychiatrists, Yuri, Slava, and Andrei, and a trained translator, Natasha. They were friendly, outspoken, interesting, and interested. They were also very much a part of the present day Russian upheaval—frustrated by the complex and stifling bureaucracy, poorly paid, intellectually alive and adventurous but worried about the future. We had a fine time together.
Would we be coopted by the officialdom of the Research Center from achieving our desire to meet with the unofficial groups that we knew had an active interest in psychoanalysis? No, they made no obvious gestures in that direction. We were free to go where we wanted, to do what we wanted. Though we toured the hospital and met members of the Soviet psychiatric hierarchy, we also met many young and middle-aged independent thinkers and clinicians from a wide variety of settings in Moscow and elsewhere.
The Mir (Peace) Hotel, where we stayed, was a bit of luck. It is used primarily by Comecom dignitaries and is plain but very comfortable in a slightly Scandinavian way. Unlike most of the Intourist hotels, it was centrally located. Next to it was a startling reminder of the Cold War, the newly built American Embassy which looks forbidding and is abandoned as unusable because of the many bugs planted by the Russians. Across the street was a reminder of the future, the handsome but stolid Parliament of the Russian Republic, Boris Yeltsin's turf.
As we were to discover, many of them also shared our sense of hope and promise concerning psychoanalysis in Russia.
That first afternoon we all went to an open street market which exemplifies periastroika and glasnost in a most direct and pragmatic fashion. Stretching along a tree-lined road was a mile of rampant capitalism, stalls selling everything from Russian dolls and purloined or fake icons to “modern” art, hilarious caricature masks of Stalin, Brezhnev and Gorbachev, and innumerable lapel pins depicting everything from Communist heroes to the most blatant parodies and critiques of Communist institutions, including the KGB. My favorite was a picture of the universally disliked Gorbachev (for his economic policies) gesturing in a pacifying way and saying, “There, there, everything will be all right!”
We spent Sunday, our first full day, at Zagorsk, the central monastery and seminary of the Russian Orthodox Church, where a faculty member, Professor Ivanoff, joined us in a discussion of everything from the place of religion in daily life in Russia and the USA to the chilling effects of psychiatric abuse of dissidents on the utilization of psychiatry for the care of sick patients.
From Monday to Thursday we worked—with enjoyment. After a breakfast of yogurt, rolls and coffee, we were driven to the Mental Health Research Center where, from 9:00 a.m. to 3:00 p.m. we presented a series of lectures, discussions, and a round table with a group of Pavlovians. No lunch break, though there was a “coffee break,” so called by the Russians as well as ourselves. The audience was mostly young and came not only from several different settings in Moscow but from Leningrad, Kiev and Siberia as well. Their interest was intense.
On the first day, Sandy Abend shouldered the considerable task of presenting a concise, yet historically accurate, view of the development of psychoanalytic theory. His emphasis was on the progressive working out of Freud's ideas through the correcting influence of clinical psychoanalytic data. His task of making contact with the audience was made easier by his impressive use of Russian in his introductory comments to the audience; everyone was delighted.
On the second day, Chuck Rothstein presented clinical data from a variety of
patients to concretely demonstrate many of the points which Sandy had made the day before.
On the third day, I presented two papers on child analysis. The first emphasized developmental issues in childhood psychopathology and included examples of analytic work with children; in the second, I gave examples of the broad applicability of child analytic principles and findings to such issues as day care, infant research, legal issues concerning children, the hospital care of infants and children, and to an understanding of the appeal of children's literature.
On the fourth day, Homer Curtis discussed and illustrated the clinical distinctions between psychoanalytic psychotherapy and psychoanalysis and Sandy Abend discussed analytic treatment of borderline patients.
It was a very full and demanding diet, all of it duly translated into Russian, a laborious procedure. What did the Russians make of it? There was a cadre of older psychiatrists who ignored the clinical aspects and directed their critical attention to formal aspects of unconscious thought and to a refutation of the importance of sexuality in neurosogenesis. There was also a group of thoughtful, sometimes puzzled, but actively questioning psychiatrists and psychologists who were clearly astounded at our emphasis on sexuality and on psychodynamics. And lastly, there was a large group of young psychiatrists and psychologists from Moscow University, from cooperative clinics, and from other cities, who couldn't get enough of it, who were actively interested in developing their psychotherapeutic skills and were seeking understanding and direction.
The general and assumed emphasis of the two “official” groups was on a Kraepelian, highly descriptive approach to all issues (they regularly asked what the DSM-3R diagnoses were of the patients we discussed!). Therapy, all of it physical in nature (medications, cold packs, sleep therapy, ECT), has been centrally dictated by Moscow officials until glasnost. Officially, there has been no provision for psychotherapy.
Our “round table discussion” with four Pavlovians was an exercise in mutual politeness; it was enjoyable and diplomatic but not revealing. The Russian experts were interesting to talk to privately, which we did at our most expansive vodka and caviar laden meal on the night before the “round table.” They included academician P. Simonov, Professor N. Bekhtereva, and Professor F. Yaroshevsky.
We did everything possible to make ourselves available during breaks and at the end of the sessions to talk in small groups and individually with members of the audience. Although time was limited by the Russian custom of providing a monster meal in the mid-afternoon, we had sufficient time to plan meetings with several of the less official groups of psychotherapists. A telling example was a meeting Homer and I had in the late afternoon and evening with a hastily gathered group of 17 psychologists at a cooperative clinic run by Aaron Belkin and Lev Gertzig. After Homer's introductory discussion of psychoanalytic psychotherapy and psychoanalysis, the audience presented one clinical problem after another, hungering for ideas and deeply appreciative of our thoughts. They were intensely naive about working with affect; although sensitive, caring individuals, they were without many of the rudiments of clinical psychodynamic understanding. Obsessional neurosis, transsexual behavior, obsessive guilt reactions, and panic behavior in veterans of the Afghanistan war, and many issues of children ranging from developmental disturbances to psychosis were among the problems discussed. Aaron Belkin finally ended the session and led us to his office for tea. As we sat down, there was a knock at the door and five young psychologists came bursting into the room, proclaiming that they “must” get our thoughts about yet another case. We spent more than four hours with this group. It was very gratifying.
We left with an exhilarating sense of witnessing history in the making, not only political and economic history, but psychoanalytic history as well.
Another indicator of the interest in psychoanalysis is Aaron Belkin's experience in publishing a collection of six of Freud's papers. We were told that 100,000 copies were sold within days of publication! Our experience with psychotherapists in Leningrad was much the same as in Moscow, though our stay was brief and there were no formal lectures. The original itinerary called for no discussion with Leningrad clinicians but, on the basis of contacts made in Moscow, we met with a neurophysiologist and with a group of practicing, and intensely interested psychotherapists.
Throughout the trip, there were many individual meetings, discussions, and visits. We were taken into private apartments, had meals in Russian homes, and shared humorous and serious moments. There was also time for the Moscow Circus, a dance concert, a visit to the Kremlin, and to the Hermitage.
Of the many human incidents that made the trip memorable, I will relate but one. A young Russian approached me at Red Square to practice his English. He spoke “American” English almost flawlessly; he had learned it all from tapes of The Voice of America. We talked for some time, then parted. Two days later, I met him again in GUM Department Store where I was trying, unsuccessfully, to buy toothpaste. He helped me out. Then, he carefully told me that he respects American psychiatry and would like to have a consultation! Not some time, but right then and there, in GUM Department Store. The desperate look in his eye warned me to not ignore his effort. In Russia, he explained, there is no help but medicine for his terrible obsessional neurosis—and it doesn't help. He calls his psychiatrist who tells him not to bother him. He worries a great deal and would like to have some way to talk about it. I listened to his story, then told him about Aaron Belkin's clinic, offered some direct reassurance, and pondered the irony of coming from America, where medicine is increasingly suggested as a replacement for human communication.
Throughout our visit, there were repeated invitations to return and teach over a longer period of time, not only in Moscow and Leningrad, but in another dozen Russian cities with psychoanalytic study groups but no analysts to provide direction or guidance. I was also assured by one very intelligent and very challenging young woman in Leningrad that “no American would share our food and share our apartments to come to teach us.” I would like to think that she was wrong. Our experience would suggest that such a venture would be rewarding to both parties.
We left Russia after eight fast-paced and exciting days. We left with an exhilarating sense of witnessing history in the making, not only political and economic history, but psychoanalytic history as well. If politics permit, the interests, capacities and culture of Russia seemed open to the possibilities of psychoanalytic ideas and clinical practice.