One of the challenges facing historians of east European psychiatry, like in any underdeveloped subject, is that there are few survey-style overviews that capture historical change over a long period. Instead, scholars in this area—and indeed we are growing in number—confront something of a staccato historiography: a number of fascinating articles and book chapters, but little that ties it all together. Grégory Dufaud's recent monograph should thus be warmly received, even more so for the fact that Dufaud draws broadly from the work of historians writing in English, French, and Russian, many of whom do not necessarily read each other's work. And while the author has done well to integrate these historiographical strands, the book is not a mere synthesis; Dufaud consults a wide array of primary sources, ranging from psychiatric textbooks and medical journals to hospital records and ministerial files pulled from both federal and regional archives. The result is a genuinely insightful monograph that simultaneously presents new ideas and arguments while also acting as something of a report on the state of the field.

On the whole, historians of eastern Europe have been slow to turn their gaze to psychiatry, even when other aspects of social life have received significant attention. Such a situation is not merely a pity; it is a problem. As Dufaud underscores, psychiatrists are responsible for setting the boundaries between normal and abnormal thoughts, feelings, and behaviors. In this regard, they are intimately involved in the shaping of social norms, which are themselves important to the everyday exercise of power. In addition, they are caregivers charged with mitigating citizens’ suffering; by studying mental healthcare, historians also learn something of how political leaders attended to—or not—the distress experienced by the population over which they rule. For these reasons, as Dufaud illustrates throughout the monograph, the study of psychiatry is thus useful for non-medical historians, in that it offers up new perspectives on political and social life within the Soviet context.

The book's chronology runs from the late Tsarist period up to death of Brezhnev, with chapters dedicated to specific episodes familiar to historians of east European mental healthcare, including revolutionary enthusiasm for using the human sciences to transform society, challenges to psychiatry that came from physiologists, the so-called Pavlovian controversy, and the political misuse of psychiatry against those protesting against aspects of Soviet life. At the same time, the book also breaks new ground, with fascinating subsections that draw upon new archival material. For instance, readers learn of the letters that patients and their families sent to complain about the conditions within psychiatric hospitals (“a single toilet for 63 patients”) and of the production difficulties related to Aminazine, the Soviet equivalent of the blockbuster drug chlorpromazine.

Dufaud expends significant effort pushing back against Cold War era distortions that framed psychiatry as little more than a tool to manipulate Soviet citizens and enforce ideological purity. This work further demonstrates that psychiatry was not a monolith simply in service to the state; practitioners often enjoyed a fair degree of autonomy, engaged with ideas from abroad, debated vigorously within the discipline, and made decisions with their own professional interests in mind. Aside from the period immediately after the revolution, psychiatrists rarely concerned themselves with radical attempts to alter society. Even if authorities might sometimes pay lip service to psychiatry's potential role in social transformation, the work of psychiatrists was fairly modest and primarily consisted of caring for those with psychiatric illness. While they might make the most of opportunities offered by the revolution, such as pushing for more outpatient care at the expense of hospital-based treatment, they were usually guided by professional goals (ensuring that psychiatry remained firmly affixed to medicine), rather than ideological ones.

None of this is to suggest that the changing political winds were immaterial; one of the strengths of the book is its exploration of how psychiatrists navigated the challenging political and scientific circumstances associated with revolution, Stalinist rule, and the Khrushchev and Brezhnev eras. But Dufaud's work demonstrates that the challenges faced by clinicians were as likely to be material as ideological. In this regard, the book does an outstanding job of giving historians much greater insight into the day to day practices of Soviet psychiatry—and consequently an understudied portion of the Soviet population, the mentally ill—both within and outside of the historiography's major discussion points.