suits of his research on the involvement of the pitui-
They regard this kind of meeting
tary and the adrenal cortex in the anesthetic effect
induced by acupuncture in white rats. We also met
Professor Chang Hsiang-Tong (a Yale University
PhD) and his co-workers in the Shanghai Institute of
Physiology of the Academy of Sciences. They are
actively engaged in neurophysiological research.
The Chinese use the shuttle box or Skinner box to
study memory and retention. The EEG is used for
localization studies of brain functions, and analyses
of chemical changes, particularly of neurotransmitters
and maoromolecules such as RNA and protein, have
been done. They also use drugs to analyze the brain
functions related to learning and memory.
One final observation is that almost every week
the Chinese have political meetings where the par-
ticipants can express their gripes and criticize the
system, people, or themselves. They often criticize
the way the profit is distributed, those who are not
working hard, the responsible person who is uncon-
cerned about their welfare, the quality of the doctor's
service, or even that a woman's husband is not co-
operative enough in household chores. The group tries
to solve the problems by changing the system or by
criticizing, persuading, and mediating between the
Mental Health Care in the USSR
VYTAUTAS J. BIELIAUSKAS Xavier (Ohio) University
ABSTRACT: The author received a scientist exchange
grant from the National Institutes of Health and visited
the USSR as a health-science representative from May 29
to July 1, 1976. He had an opportunity to work with the
University of Vilnius and to visit the Bekhterev Institute
in Moscow, the University of Moscow, and the Institute
of Psychiatry of the Academy of Science of the USSR.
His special interests dealt with mental health care, aca-
demic and professional status of clinical psychology, and
Preparation of this article was made possible through a
travel grant from the John E. Fogarty International Cen-
ter of the National Institute of Health, U.S. Department
of Health, Education, and Welfare.
I wish to express my appreciation to the authorities of
the United States and the USSR for their support of my
travel and for their hospitality and cooperation. A special
note of thanks belongs to my professional colleagues in
Lithuania, Moscow, and Leningrad.
Requests for reprints should be sent to Vytautas J.
Bieliauskas, Department of Psychology, Xavier (Ohio)
University, Cincinnati, Ohio 45207.
376 MAY 1977 AMERICAN PSYCHOLOGIST
concerned parties.
as a means to improve the welfare of everybody and
prevent the emergence of an elite group of people who
enjoy special privileges. At the same time this lets
people know of others' needs and feelings so that they
become more concerned and sensitive toward each
other and the society. This I feel is not unlike what
we aim to accomplish in our sensitivity or encounter
sessions.
Psychology is well and vigorously alive in China.
Although there is no comparison to psychology in the
United States in terms of multiplicity of areas, the
Chinese beliefs that science should serve people and
that the researcher should never become divorced from
the masses are something all of us can understand.
REFERENCES
Dimond, E. G. Medical school curriculum in the People's
Republic of China. Journal of the American Medical
Association, 1976, 236, 1489-1491.
Kessen, W. Childhood in China. New Haven, Conn.:
Yale University Press, 1975.
Walls, P. D., Walls, L. H., & Langsley, D. G. Psychiatric
training and practice in the People's Republic of China.
American Journal of Psychiatry, 1975, 132, 121-128.
some aspects of research in the area of mental health.
Mental health services in the USSR are provided primarily
by the medical profession through state mental hospitals
and psychiatric sections in general hospitals and clinics.
Drug therapy is the main treatment method used there,
but psychotherapy is beginning to make some inroads.
Relationships between psychiatry and psychology are
experiencing some problems in the USSR, but in some
republics they seem to progress amicably. Family therapy
settings are the newest additions to preventive mental
health care.
Since 1957, when a document of cooperation in health
programs was signed by the United States and the
USSR (see Quinn, 1969), individuals and delegations
from both countries have been able to exchange visits,
learn about methodologies and health care procedures
from each other, and exchange ideas in the areas of
research and prevention. Most visitors have been
members of the medical profession, with the exception
of representatives of the mental health professions
 which, at least from the American point of view,
include psychologists and social workers. Inclusion of
a representative of other than the medical profession
is still the exception in this program, because the
healing arts of all types in the USSR are in the hands
of its medical profession, which has a difficult time
understanding that nonphysicians (e.g., clinical psy-
chologists) can be involved in independent diagnosis,
treatment, and research in mental health.
There are also problems with governmental sub-
divisions that do not follow parallel lines in both
countries. Our Department of Health, Education, and
Welfare (DHEW) has partial counterparts in various
independent departments of the USSR such as the
Ministry of Health, the Ministry of Education, and the
Ministry of Higher Education. Since the ministries
in the USSR are quite independent in their bureauc-
racies, communication problems are presented when
DHEW tries to deal with its counterparts in the
USSR, especially when interests cross the boundaries
of different ministries. My own peculiarly "complex"
status can be given as an example of one such problem.
I was interested in visiting the University of Vilnius,
which belongs to the Ministry of Higher Education
and works also with clinical psychologists and psychia-
trists in health installations under the jurisdiction of
the Ministry of Health. My original invitation came
from the University of Vilnius, but my travel as an
exchange scientist was approved by our National Insti-
tutes of Health (NIH). For some time it looked as if
all our efforts would be lost in what appeared to be
insurmountable bureaucratic chaos. However, to my
great surprise, the red tape was cut with the greatest
of ease in a very brief time.
I had an opportunity to spend brief periods of time
in Leningrad and Moscow, which was very beneficial
and interesting, but my mastery of the Lithuanian lan-
guage enabled me to be a much more active participant
in the exchange program in Lithuania. There is no
doubt that there are differences among Soviet republics
not only in language and culture, but also in scientific
achievements and methods of service delivery. How-
ever, the similarities surprisingly surpass the differ-
ences. The main training and research centers in the
USSR are in Moscow and Leningrad, and this is where
the beginnings of innovations and new trends come
from. From these centers, the knowledge is then dis-
tributed to all the republics. This pattern of dis-
semination of knowledge applies not only to health
care and mental health care but to all other areas of
Soviet life as well.
Mental Health Care
Mental health care in the USSR is under the juris-
diction-of the Ministry of Health. The Central Min-
istry of Health has its counterpart in each republic,
which implements directives from Moscow, sometimes
in a semiautonomous manner (Storey, 1970). In
Lithuania (as in the other republics), the Ministry of
Health includes a section dealing with mental health.
This section operates under the direction of the Neuro-
pathologist of the Republic. Since mental health
services are provided through state hospitals, the main
task of the Neuropathologist is to supervise these
hospitals. However, under the newest five-year plan
("The Soviet Five-Year Plan for Public Health,"
1973), some ambulant treatment is being provided in
the polyclinics, the network of which is being expanded.
Therefore, a position of the Psychiatrist of the Re-
public has recently been established in the Ministry
of Health, and the holder of this post is specifically
concerned with organization of the mental health units
in the clinics. The psychiatry section seems to be
very much concerned with treatment and prevention
in the area of mental health and is therefore much
more open to alternative treatment methods. In the
area of prevention, strong interests were shown in
adolescent therapy, family therapy, and coping with
drug abuse. Lithuania is proud of being the first re-
public to establish a family therapy center (in
Vilnius). In the area of drug abuse, probably the most
abused drug is alcohol, and the Ministry of Health is
embarking on a strong campaign to curb alcoholism.
MENTAL HOSPITALS
According to statistics in 1960, there were 2,425 hos-
pital beds for mental patients in Lithuania, located in
six institutions (Kleiza, 1972). No new statistics were
made available to me, but my educated guess would be
that in 1976, there were at least 3,500 mental patients
in various mental hospitals. The equivalents of our
state mental hospitals appear well-kept on the outside,
but a foreign visitor is carefully prevented from having
much of an opportunity to see the inside of an institu-
tion. From what little I was able to see, the mental
hospitals there did not differ much from our state hos-
pitals, but the staff members were somewhat embar-
rassed that their hospitals didn't look any better (one
would wish that the staff of some of the state mental
hospitals in the United States would feel justifiably
more embarrassed because of the status of their
institutions).
The main method of treatment in these hospitals is
drug therapy. The USSR's pharmaceutical factories
produce their own psychotropic drugs, which, in many
respects, are similar to tranquilizers, psychoenergizers,
etc., produced in the United States. These drugs are
used extensively in the treatment of mental patients.
Schizophrenia and depression are apparently the most
frequently encountered diagnostic categories. If, after
a prolonged period of time, a patient's condition
doesn't improve or if a patient becomes chronic, he
AMERICAN PSYCHOLOGIST MAY 1977 377
is usually transferred to special centers for "invalids,"
where drug therapy is continued as an auxiliary to
custodial care.
PSYCHIATRIC SECTIONS AT CLINICS AND HOSPITALS
Psychiatric sections at various clinics and general hos-
pitals can be looked upon as Soviet counterparts to
the community mental health centers in the United
States. These sections are only in an initial stage at
present. Since this represents innovation, new treat-
ment methods are also being searched for. Psycho-
therapy is beginning to make some inroads, but at
present there is only one school attempting to develop
training programs for psychotherapists. These at-
tempts are being made at the Psychology Department
of the University of Leningrad.
Psychology itself has only recently gained recogni-
tion in the USSR (cf. Brozek & Mecacci, 1974), and
clinical psychology is fighting for its recognition within
the profession. The Soviet scene is still dominated
by Pavlovian thinking radiated from Moscow, and this
does not provide a good atmosphere for psychotherapy.
However, Leningrad is slowly 'becoming a center for
applied psychology, while Moscow remains the strong-
hold of the "purists-scientists." Therefore, testing
and psychological diagnostic methods have much more
fertile ground in Leningrad. Younger professionals
have become familiar with Western diagnostic tech-
niques such as the Minnesota Multiphasic Personality
Inventory (MMPI), the Wechsler intelligence scales,
the Science Completion Test (SCT), the Rorschach
Test, and the Thematic Apperception Test (cf. Jovaisa,
1975). At present, they have translated some of these
techniques, but they need to restandardize them in
order to be able to use them locally. Younger psy-
chologists and psychiatrists are very much interested
in psychotherapy, but it will be some time before
training programs can be developed for young profes-
sionals. They all know that it is very difficult to
learn the skills of psychotherapy from books only.
Clinical psychology is quite new in Lithuania because
psychology is new. The University of Vilnius has only
in recent years opened a psychology chair in the
Department of Journalism. Among a teaching staff of
two dozen, there is not a single faculty member in
psychology with a PhD. Most of these faculty are
young scientists preparing their dissertations to be
defended at either Leningrad or Moscow Universities.
Undoubtedly, many of them will complete their work
soon, and this is only a temporary situation.
There is an interesting phenomenon concerning
training in clinical psychologynamely, the fact that
several physicians, upon receiving additional training,
have switched from medicine to psychology and are
working as clinical psychologists. Therefore, there
seems to be a very pleasant working relationship be-
378 MAY 1977 AMERICAN PSYCHOLOGIST
tween psychology and psychiatry. They are not
greatly concerned with who is doing what but are
rather interested in developing better skills and pro-
viding better service to the patients. This cooperation
again is coming from Leningrad; the situation in
Moscow is completely different. There, psychologists
administer some tests and do researchany kind of
therapy is strictly the domain of the physician.
UNIVERSITIES
Universities are the training and research centers for
professionals in the field of mental health. However,
due to the complicated structure of Soviet ministries,
training and research can be conducted by the Insti-
tutes of the Academies of Science of the USSR and
of different republics. Therefore, some training and
research takes place under university auspices and
some takes place under the auspices of different
institutes subject to different ministries. Students and
faculty members are very much interested in foreign
scientists and especially in their lectures. I gave a
series of 10 lectures at the University of Vilnius, the
Medical Institute of Kaunas, and the Ministry of
Health. No restrictions were imposed on my lectures,
and the questions were interesting and the discussions
lively. My lectures included such topics as motivation
and the will, sociopsychological bases in psychiatry,
recent research findings concerning psychological as-
pects of sexual differences, projective testing and the
House-Tree-Person Test (H-T-P), etc., which have
obvious humanistic overtones and which I delivered
with the same content as I would have done at home
in the United States. This fact led me to conclude
that there is probably greater freedom for exchange of
information in the USSR than we are accustomed to
believe. My audience showed a great deal of familiar-
ity with our literature and with the literature of the
West in general. My hosts gave me to understand
that they would appreciate it if I would avoid political
and theological topics in my discussion, which I had
no difficulty doing because these topics are not in the
field of my expertise. There is no question that a
certain amount of suspicion and paranoia tended to
develop on both sides, but such experience is inevi-
table in a closed political system such as that of the
USSR. This is associated with the level of insecurity
we all experienced. In the centers such as Leningrad
and Moscow, my hosts were more secure and more re-
laxed, and therefore I felt the same way in those cities.
RESEARCH IN MENTAL HEALTH
The most impressive research is conducted not in the
provinces but in the centers. In Leningrad, the
Bekhterev Institute represents the avant-garde in ap-
plied research in mental health. Bekhterev Institute
 is a treatment and training center that includes a and interest in it represents a more recent priority in
mental hospital, a rehabilitation training center, and the USSR. The equivalents of our state hospitals are
research and diagnostic facilities. Neuropsychology is primarily dependent upon drug therapy, but the newly
still the most predominant field of interest. The developing psychiatric units in clinics and general hos-
preferred research uses physiological and psychophys- pitals are searching for alternative methods of treat-
ical measures and involves problems of cerebral local- ment. This trend is also beginning to spread among
ization, the organic basis of schizophrenic hallucina- the state mental health institutions. Interest in
tions, and patterns of perception (Bazhin, Meerson, psychotherapy is vivid, but training centers for profes-
& Tonkonogii, 1973; Bazhin, Wasserman, & Tonkonogii, sional psychotherapists are lacking. Once psycho-
197S; Gorian, Meyerson, Tonkonogii, & Tsukerman, therapy achieves more acceptance, the problem will
1972). At the same time, a great deal of interest is be one of how to fit this method of therapy into the
being shown in restandardization of the local versions Soviet system, which emphasizes group rather than indi-
of the MMPI, SCT, and the H-T-P, which I brought vidual values. Clinical psychology and psychiatry are
with me (cf. Bieliauskas, 1972). very young disciplines in the USSR, and they are rep-
The University and the Institutes in Moscow are resented by young professionals who are enthusiastic
dominated by the "purists." An excellent experimen- and forward looking.
talist, Bluma Zeigarnik (known in the United States This attempt to appraise mental health care in the
as the discoverer of the Zeigarnik effect), is carefully USSR is based primarily on the author's experience in
researching thinking patterns in schizophrenics. Her the Republic of Lithuania. However, since there is
former student Yury F. Polyakov, now chief of the a surprising uniformity in the application of the prin-
Pathopsychology Laboratories of the Institute of ciples developed in Moscow in all republics, one can
Psychiatry of the USSR Academy of Sciences, is in safely assume that the above observations do apply to
charge of a research project dealing with cognitive all other parts of the USSR. Lithuania is an active
disturbance in schizophrenia, and some of his 'findings participant in medical research and treatment innova-
will be published soon in the NIH Schizophrenia Bul- tions, and therefore, mental health care may be even
letin. Both Zeigarnik and Polyakov are excellent re- more advanced there than in other Soviet republics.
search scientists, but they are "purists" in the sense
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projects dealing with oncology, genetics, and social Sviesa, 1975.
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AMERICAN PSYCHOLOGIST MAY 1977 379