Peasant Survival Strategies in Late Imperial Russia : The Social Uses of the Mental Hospital

This paper examines the social functions of the asylum in late imperial Russia based upon analysis of asylum annual reports and related documents. Seasonal variations in patient admissions and discharges suggest that the use of asylums fluctuated according to the requirements of the peasant economy. My evidence also indicates that the asylum fulfilled essentially the same functions for workers and patients, and that to a certain extent the two statuses were interchangeable. While the asylum remained a powerful and coercive means of social control, the beleagured peasant population managed to incorporate the institution into its increasingly desperate strategies for survival. Article: The late eighteenth and nineteenth centuries witnessed the elaboration and rapid expansion of institutional solutions to the problems posed by many of the misfits in Western societies. A prime example was the transformation of madness into mental illness and its subsequent confinement within the asylum. Madhouses, or as they were later termed, mental hospitals, were among the most rapidly growing of such institutions. The concept was introduced into virtually every society of North America and Europe. Wherever planted the seed took root and spread at a remarkable rate. Existing asylums filled to overflowing. Many attained gargantuan proportions, and new institutions were continually under construction. Demand seemed insatiable. The emergence of the asylum was one aspect of the transformation of the societies of the Western world into urban industrial capitalist orders. Its relationship to this process has made the asylum a subject of considerable theoretical interest and importance. Historical studies have greatly enhanced our understanding of elite support for this institutional response to deviance and the asylum's contribution to the rise of the new medical speciality of psychiatry (Dain, 1964; Foucault, 1965; Grob, 1973, 1983; Rothman, 1971, 1980; Scull, 1979). More recently, researchers have begun to focus upon the users of the asylum (primarily inmates and their families), the great majority of whom were recruited from the bottom rungs of society (Bellingham, 1986; Friedberger, 1981; Tomes, 1984; Walton, 1981). Here, I examine patterns of asylum use in late imperial Russia. As was true elsewhere, the inhabitants of Russian asylums came overwhelmingly from the ranks of the least privileged. However, in Russia, unlike the West, these were largely peasants. I will argue that the stratum which contributed both inmates and workers to the asylum was in some measure an active force, using the new mental institutions and, to the extent possible, shaping them to meet its own needs. This new institutional form was introduced into the empire of the tsars in clear imitation of the West and was viewed by elites as an increasingly important component in the structure of social control. Nonetheless, its peasant users were more than an inert quantity acted upon by social and political forces completely beyond their control. While the asylum remained a powerful and coercive institution, the beleagured peasant population managed to incorporate the "foreign" institution into its increasingly desperate strategies for survival. Resort to the Asylum: The Western Experience Scholars have begun to devote more attention to the "inner history" of the various social welfare institutions spawned by Western societies over the last century and a half. Consequently, there is a growing body of knowledge about the changing priorities of individual institutions (Zaindaldin and Tyor, 1979) and about the motivations of asylum users. A central theme in this literature has been the use of the institutions as a "last resort" (Friedberger, 1981). In most cases, the decision to institutionalize an individual has been less a product of that person's ability to benefit from the institution than a reflection of the needs of the group which has had the primary responsibility for the individual's care: Individuals committed for insanity shared neither a common social background, a similar mental condition, nor even a customary "route" to the asylum. What united them, instead, was a type of relationship to other people.... They became insane when other individuals decided they could no longer be tolerated (Fox, 1978:79; also see Walton, 1979). In those instances where the family made the decision, we learn that it was a particularly painful one, which they reached "only after a prolonged period of escalating tension and desperation [which] culminated in a crisis" (Tomes, 1984:109). By the same token researchers have pointed out that the asylum could serve as a haven (Walton, 1981). It certainly had many unpleasant characteristics. Nonetheless, in some instances, life outside was even worse. For the Russian masses, recurring and escalating crises marked the half-century before the First World War and the ensuing revolutions. These events not only enveloped the nation as a whole but affected the functioning of its smallest social units. In the following pages I analyze how the asylum reflected those social and economic pressures. The largely illiterate peasants of that era left few written testimonies to their struggle with economic privation. However, the record of their resort to the asylum survives as one indicator of its character, while simultaneously providing further insight into the social functions of the institution. Data Sources The emergence and expansion of asylums occurred somewhat later in Russia than in the West, and the proponents of institutional psychiatry in that country rather self-consciously compared the events in their asylums with those in other societies. Asylums were not fundamentally different in Russia. On the contrary, there were striking similarities between Russian asylums and those elsewhere. However, several features of the environment within which Russian psychiatry developed encouraged its practitioners to record their activities in great detail. Russian psychiatric institutions (and consequently psychiatric physicians) were widely dispersed throughout the empire. Because of the vastness and difficulty of the terrain to be traversed and the poorly developed systems of transportation and communication, Russian professionals had relatively few opportunities to discuss issues privately. Consequently, they communicated voluminously with each other by means of the written word. In particular, their journals served as forums for communication of developments they considered news-worthy and for discussion of controversial issues. 1 The insistence of the tsarist government upon controlling professional groups also contributed to the completeness of the written record. The government bureaucracy required that the proceedings of those few meetings which did take place be recorded in detail. It subsequently paid to print and distribute the heavy tomes. The research reported here relies heavily upon data included in asylum annual reports from the late nineteenth century, most of which appeared in professional journals. These reports provide detailed statistical information about asylum admissions and discharges, distribution of asylum inmates and workers by gender, social background, and, in the case of the former, by diagnosis. They also chronicle the psychiatrists' perceptions of what was going on in their institutions and communities. The reports span mental institutions in 12 provinces of European Russia between the years 1880 and 1896. 2 As researchers on Western asylums well know, the statistical information included in such reports is not flawless. Nevertheless, the findings I describe are consistent enough that minor misreporting is probably not significant. Moreover, Russian psychiatrists participated in a tradition which focused upon preventive medicine and stressed the collection of accurate medical statistics as a means to that end (Frieden, 1981:81). In fact Russian psychiatrists devoted considerable effort to standardization of their reporting procedures during the period under consideration. In addition to institutional annual reports, the other materials I used in this research include: proceedings of four empire-wide psychiatric conferences and several meetings of the Psychiatric Section of the Pirogov Society of Russian Physicians; numerous monographs written by members of the psychiatric profession and interested observers of the psychiatric scene; and miscellaneous reports prepared by zemstvos (local self-governments), municipal governments, and the tsarist ministries concerned with health policy and funding. I collected most of these materials in the libraries and archives of Leningrad and Moscow. Virtually all of it is published material. The research would have been enhanced by examination of institutional records themselves. Indeed, without such materials certain theoretical arguments cannot be adequately assessed. Unfortunately, those records are not readily accessible. The ravages of wars and revolution destroyed many of the relevant documents. Others survive in Soviet archives, but, due to general lack of interest on the part of Soviet scholars, they remain in disarray. I was unsuccessful in gaining access to them. The Emergence of the Asylum in Russia The first asylums for the insane in Russia were established in the late eighteenth century during the reign of Catherine II ("the Great"). They were clearly modeled after Western institutions. 3 The legislation which created them leaves little doubt that their primary purpose was the protection of society from what was perceived as a "dangerous element." The buildings were to be "large and sturdy so that escape [would] be impossible." Their creation was at least in part the product of a perception in high places that social and political order was being threatened by a large influx of workers into the empire's cities (Brown, 1983). Nonetheless, throughout the first half of the nineteenth century, most of the madhouses remained small. Some were filled to capacity, while others were half empty. As a rule, the peasantry avoided the institutions, preferring to maintain their insane members at home if at all possible. Conditions within the madhouses (referred to by the population as "yellow houses") were terrible and, on occasion, life-threatening. The populace was equally reluctant to work in the institutions. Many madhouses were staffed with disobedient soldiers and unruly serfs who were sent to work in the "yellow houses" as punishment for their misbehavior (Shul'ts, 1865). The rapid expansion in asylum populations occurred in the aftermath of the so-called "Great Reforms" of the 1860s and, in large measure, reflected a shift in the circumstances of the peasantry. The "Great Reforms" brought a number of changes to Russia. In 1861 serfdom was abolished, and over the next several years the educational, judicial, military, and administrative institutions of the empire were significantly restructured. In the provinces of European Russia a system of limited local self-government (the zemstvos) was established and given responsibility for providing a number of services which had heretofore been under the aegis of the landed aristocracy. The zemstvos became responsible for education, public health, roads, insurance, and famine relief. To their chagrin, they also inherited the existing madhouses. The "yellow houses" which had often stood half empty in the pre-reform era filled to overflowing during the 1860s and 1870s. The local self-governments sought to extricate themselves from responsibility for the institutions, most of which were bursting at the seams—both literally and figuratively. However, their efforts failed. The growing utilization of asylums by the newly emancipated peasantry seemed to convince the tsarist government of their importance, and in the mid-1870s it ordered the zemstvos to expand the asylums to accommodate all comers (Brown, 1983). The sources of revenue available to the zemstvos were quite limited. Consequently, the requirement that they provide asylum beds for all those who might profess to need them potentially represented a substantial fiscal burden. The government's justification for placing this heavy weight on the backs of the zemstvos was the need to remove "dangerous" madmen from society quickly. However, the evidence suggests that in many—perhaps most—cases the government's role in the decision to institutionalize individuals was at best a secondary one. Rather, patterns of utilization were determined by the peasantry—in accordance with its survival needs. Scholars generally agree that emancipation did not bring a marked improvement in the economic condition of the peasantry (Robinson, 1960; Seton-Watson, 1967; Vucinich, 1968). Many former serfs received no land allotment. Those who did receive land were required to reimburse the landlords for it. In the majority of cases, the allotments were niggardly and the redemption payments far beyond the capacity of the peasants. The result of these and other emancipation provisions was overpopulation and underemployment in the countryside, which translated into the growing impoverishment of the peasantry. In 1860, on the eve of emancipation, there were 43 madhouses in Russia with a combined inmate population of 2,038 (Shul'ts, 1865). A half-century later, the number of institutions had nearly quadrupled to 160 and within their walls resided a staggering 42,489 individuals (Vvedenskii, 1912:848). During this same period, the overall population of the Russian Empire approximately doubled from an estimated 60 million in 1850 to 129 million in 191L While the rise in overall population undoubtedly accounts for some of the increase in asylum populations, the growth of the latter so far outstripped the former that its explanation must be sought elsewhere. Asylum Utilization and the Peasant Economy Late nineteenth-century psychiatrists noted a correlation between the worsening economic situation of the peasants and the rise in asylum populations. They interpreted this as evidence that "poverty is one of the most important causes of insanity" (Korsakov, 1954:461; see also Merzheevskii, 1887). They were also certain that the growing asylum populations indicated that the peasantry was gaining confidence in psychiatrists and mental institutions (Arkhangel'skii, 1887; Chechott, 1889; Govseev, 1889a). Closer examination of the data on admissions to and discharges from mental institutions suggests an alternative interpretation: the peasants used the "yellow houses" they so detested as a shelter in hard times. They moved into and out of the institutions in such a way as to maximize the advantage they could gain from them. Asylum annual reports throughout European Russia almost always included a breakdown of annual admissions and discharges by month. Careful reading of these data reveals remarkably uniform seasonal variations. These patterns are depicted in Figure 1. Asylum physicians were cognizant of the patterns and offered a variety of explanations to account for them. They either presumed a direct relationship between asylum admissions and rates of insanity among the general population, or they attributed the differences to the impact of climactic conditions on mental well-being. However, as I will now demonstrate, asylum utilization ebbed and flowed, not in response to changing levels of individual pathology, but in accordance with the survival requirements of the peasant community. The peasantry contributed by far the largest contingent of inmates to the asylum: between 80 and 90 percent in many institutions. It did so according to patterns which reflected the rhythms of peasant life. Significantly, the only asylum which failed to exhibit these seasonal patterns was a private asylum which catered almost exclusively to the privileged (Platonov, 1890). Seasonal Patterns of Asylum Utilization The pace of peasant life was dictated by the natural rhythms of the seasons. The annual cycle was punctuated by periods of great activity and relative idleness; seasons of plenty alternated with seasons of deprivation. Such was the lot of peasants in many societies. However, in Russia the fluctuations in tempo and material well-being were accentuated by the climate and increasingly by the effects of government policy as well. The period of greatest activity was the brief summer. The individual days were long in that northern clime, but the overall time was short in which to complete the harvest so necessary for survival during the harsh winter months to come. Everyone was expected to work except the very young, the very old, and the utterly incapacitated. Those who did not work were left during the long daylight hours to fend for themselves in the village. Infant mortality rates skyrocketed during the harvest season as a consequence of neglect, and reports frequently surfaced of villages which were burned to the ground by young children who had been left unsupervised (Frieden, 1978). The peasants were certainly aware of the problem yet saw no alternative to leaving dependents unsupervised. Psychiatrists increasingly sought to alert them to the dangers posed by the insane during that period: It is easy to envision how, on a torrid summer day when all the adult population of a village is in the fields, one of those "holy fools" or "idiots" who are to be found in almost every hamlet could very easily destroy the whole village as a result of smoking a cigarette in a hayloft, cooking kasha near a building, or merely playing with matches or a smouldering piece of wood (Bazhenov, 1887:242). The usual presumptions about the institutionalized insane include the notions that they are dependent, require supervision, and are often dangerous as well. Given the problems faced by peasant villages during the late summer, one would hardly expect to find that asylum populations would drop during that season. Yet, as Figure 1 demonstrates, that is precisely what happened year after year throughout European Russia. Asylum admission rates dropped noticeably in mid-summer at the beginning of the harvest season. However, it would be a mistake to conclude that the population was merely too busy to take the time to free itself of burdensome members. As is also evident from Figure 1, discharge rates peaked during those same harrowing weeks. Despite the great demands of the season, peasant families did take the time every year to engineer the release of some of their "mad" members. One reasonable interpretation of this temporal pattern is that the peasant households were calling home all available hands to help with the harvest. In other words, the peasants expected everyone who could conceivably work to contribute their labor at this most critical time of the year. This even included some of those who earlier had been institutionalized as insane. Fall was the season of greatest well-being in the peasant village. With the harvest completed, the work remaining to be done was much less demanding. Household larders were as full as they would ever be, and demands upon these provisions were relatively light during the pre-Christmas fast (Matossian, 1968). Significantly, asylum populations during this season were at their lowest level of the year. Once the fieldwork was completed, there commenced an annual exodus of peasant men (and to a lesser extent women) from the villages in search of winter work in the cities (Engel, 1986; Glickman, 1984). The migration of peasant-workers to urban areas had been accelerating throughout the nineteenth century (Johnson, 1979; Vucinich, 1968). Not surprisingly its rate increased most rapidly in those regions with the lowest agricultural output, as the local population was compelled to supplement its insufficient earnings off the land (Engel, 1986). However, emancipation provisions restricted the movement of individual peasants and rigidified their ties to the village. The effects of these policies were, on the one hand, to slow the development of a distinctively urban working class in Russia, and, on the other, to produce a peculiar breed of peasant-workers with one foot in the village and the other in the city. By the end of the nineteenth century this pattern was breaking down. Despite the fact that legally they remained members of their peasant households, a growing number of skilled workers took up relatively permanent residence in the cities. Thus, by the period under consideration here, only the least skilled and least employable peasants continued to participate in the seasonal cycle of summer agricultural labor supplemented by temporary winter work in nearby urban areas (Johnson, 1979). Evidence suggests that some of their number passed at least a portion of the winter in the asylum. Asylum admissions rose steadily throughout the winter months, a reflection of the harsh demands of the longest season. In the villages hard times were augered in by the annual land redemption payments which were due the government in November. As Figure 1 illustrates, it was at this point that asylum admission rates began to increase. Winter was a time of confinement and increasing scarcity. There was relatively little work to be done, and each additional body huddled in the cold, cramped conditions of the typical peasant hut (izba) accelerated the rate at which both food supplies and human endurance dwindled. A mid-twentieth century writer vividly described the effects of this seven-month confinement: Inside a good izba it is stifling. Every chink is stopped with rags or moss, and the living space between the rough wooden ceiling and raised floor is even less than one would expect. The long wandering flue often smokes and the accumulated breath of a large family, of smoke and heavy clothing, bed, cooking, stored food, dog, cat, and cockroaches takes a little getting used to. . . . To come through so many thicknesses of doors and curtains into such a fug, to be stuffed into such a little choked and steaming chamber and still be cold—it gives some inkling of the impotence and despair generated through centuries by the Russian winter (Miller, 1961:24). As coffers grew bare the villages increasingly emptied themselves of their dependent populations. As one contemporary observer commented: "Under the pressure of need, the village, like a besieged fortress, casts out all unproductive mouths" (Iakobii, 1900:72). Individuals who could hope to arouse special sympathy (children, the elderly, the physically or mentally handicapped) and even entire families who had exhausted their reserves took to the streets to beg. Some remained in their own communities; however, many others followed the lead of the peasant-workers who had recently headed off to the cities in search of any opportunity to keep life and limb together (Bradley, 1985; Lindenmeyr, 1982). Asylum populations were at their peak from late winter into early summer. The increase is accounted for in some measure by those individuals brought directly to the institutions by families, which, presumably, could no longer afford to feed them nor tolerate their disruptive presence around the crowded hearth. However, family requests accounted for only a portion of admissions. In the Simferopol' asylum, for example, only 10 percent of male patients and 24 percent of female patients were brought to the institution by their families (Greidenberg, 1887, 1888, 1889). The experiences of other institutions were similar (Droznes, 1886; Iakobii, 1900; Sovetov, 1885, 1886). Most mental institutions were located in those provincial cities to which the surplus rural population was drawn in the fall and early winter. The greatest proportion of new admissions to the asylum came from those groups which had already left the village to work or to beg, and who subsequently proved unable or unwilling to adjust to the requirements of the urban environment. A few of these were transferred to mental institutions from hospitals; however, asylum reports indicate that most were young men admitted by the local authorities for "inappropriate" behavior, such as alcohol abuse, begging, brawling, and consorting with prostitutes (Greidenberg, 1886, 1887, 1888; Iakobii, 1900; Sovetov, 1886). Psychiatrists waxed eloquent about the mental health risks lurking in the urban environment: "these 'dark masses' are attracted to the cities by promises of luxuries which are out of their reach. In the futile effort to attain them, they work too hard [or] they are drawn into illegal and unhealthy activity" (Evgrafov, 1895:14). Some of these individuals were reclaimed by the village during the spring and summer. Discharge rates from the asylum began a slow rise with the onset of the spring planting season. While direct family petitions accounted for only a small proportion of asylum admissions, most discharges were at the request of the family (Chizh, 1888; Kovalevskii, 1880). According to institutional reports, a much higher percentage of patient discharges during the spring and summer occurred against psychiatric advice and "without satisfactory improvement" in the individual's mental condition (Ginzberg-Shik, 1889, 1892; Kovalevskii, 1880). Based upon the patterns in his own institution, the one psychiatric physician who pondered the economic implications of asylum utilization concluded that spring brought what was tantamount to a patient exchange: the most able-bodied were withdrawn from the institutions by their families to help with the summer's work, while their number was replaced with the quietest and least demanding of the "feeble-minded," who had been kept as long as possible at home (Iakobii, 1900). 4 Spring brought with it increased demands for labor; however, it remained a period of acute scarcity. What was left of the previous year's harvest was meagre (if indeed the cupboards were not totally bare), and the first fruits of the new season were still some weeks away. Only as the harvest commenced and the family coffers began to be replenished did the large summer exodus from the asylum take place. Assumptions about madness include the notion that the mentally disturbed are incapable of meeting the usual obligations of everyday life. The patterns of movement into and out of mental institutions in late imperial Russia suggest that, by wintering in the institution, at least a portion of Russia's "mad" population was in fact behaving in a manner consistent with obligations to community and family. When their labor was needed at home, they managed to work alongside the "sane" members of their household. When their presence became burdensome at home, they reappeared at the gates of the asylum. Access to the Asylum The preceding argument rests upon the assumption that the asylum gates were easily opened from either side. This was the case for the most part. As a rule, access to mental institutions during this era was nearly "free" in more than one sense of the word. In the first place, the cost to a family or peasant communal organization of institutional care for one of its members was minimal at most, and, increasingly, charges were eliminated altogether in zemstvo asylums. This was consistent with both the economic realities of the countryside and zemstvo medicine's overarching ideological commitment to rural public health. In fact, zemstvo medicine's most distinctive trait was its abolition of the commercial relationship between physician and patient that was the norm in Western Europe and urban Russia. Medical care, in short, became a public service which the community bore collectively through its taxes (Ramer, 1982:280). The elimination of fees for institutional care in a given province invariably resulted in a rapid rise in the number of individuals who appeared at its doors—a development few would seek to explain in terms of changing levels of individual pathology. In theory, the gateway to the institution was controlled by the psychiatric physicians who managed it. In practice, these official gatekeepers offered few obstacles to those who sought to avail themselves of whatever services were provided within. Russian peasants quickly learned what Western social scientists rediscovered a century later: psychiatric gatekeepers rarely sought to forestall admissions, as they were ardent believers in the efficacy of institutional treatment and were predisposed to see widespread manifestations of pathology (Rosenhan, 1973). In the relatively infrequent event of a psychiatric refusal, there were other alternatives. The populace learned early on to elicit the assistance of the police. If the physician in charge refused to admit someone to the asylum, that person could be taken to the local police, who, in turn, would escort the individual to the asylum and insist upon admission. A request by the police was interpreted to mean that the individual was potentially dangerous, and the institution was obligated by law to accept him (Greidenberg, 1886; Iakovenko, 1885). Failure to comply subjected the psychiatrist to criminal penalties under a statute obligating physicians to provide medical care to those in need of it. 5 Russian psychiatrists complained vociferously about the role of the police in asylum admissions. Empire-wide, the police were responsible for roughly one-quarter of all admissions. In some areas, however, more than 60 percent of the patients admitted to mental institutions had been brought by the police (Kotsovskii, 1902). Psychiatric opposition to this practice was in some measure an objection in principle to lay interference in what the profession regarded as purely medical concerns. Psychiatrists also complained that the police were extremely poor diagnosticians of insanity. They asserted that the persons whom police brought to the asylum were not those who might benefit from psychiatric care, but rather individuals who were a public nuisance, particularly inebriated and boistrous young men. As I indicated earlier, most zemstvo mental institutions were located in those provincial capitals to which peasant men flocked in winter after the completion of the harvest. Some of these individuals invariably tangled with the city police, and not a few of those ended up in the admitting room of the provincial psychiatric hospital (Greidenberg, 1901). Recent scholarship on the urban police forces of that era lends support to the complaints of psychiatrists. The primary function of the police, according to one researcher, was not to solve crimes but to maintain "good order in the streets," a task rendered quite difficult because of the burgeoning urban populations and the limited capacity of most cities' jails (Abbott, 1977). The ready access to local asylums undoubtedly made them a convenient alternative. Psychiatrists also complained that the police delivered to them, as "dangerous," individuals who could under no circumstances be regarded as a threat to society. This was particularly true of female admissions. According to one report, as many as 80 percent of the women brought by the police to the provincial mental institution in Orel were completely tranquil and harmless (Iakobii, 1900). Their "danger" lay in the fact that they had no identifiable residence and no place else to go. One psychiatrist angrily reported two cases brought to his institution in Simferopol' by the local police in 1885. Both involved what he judged to be completely healthy women. One wasn't getting along well with the members of her household, especially her husband, who was trying to "send her away to the madhouse." The other woman was brought by the police simply because they had tired of her repeated requests for a three ruble note (Greidenberg, 1886:201). In short, psychiatrists had relatively little control over admissions to their institutions. To their perpetual dismay, much the same was true of discharges from the asylum. Members of the profession repeatedly complained that families came to reclaim their insane members from mental institutions against medical advice and without regard for their mental condition. Psychiatrists had no means by which to stop this practice, and as proof of its folly they pointed out that many of those same individuals reappeared at the asylum some time later (Kovalevskii, 1887). By and large they failed to make any connection whatsoever between family or communal needs and these peculiar patterns of asylum utilization. The Internal Order of the Asylum The purported aim of the mental institution in Russia as elsewhere was the treatment— even the possible cure— of mental disorders, although the preceding discussion suggests that it served other functions as well. The patterns of peasant utilization I described above are not inconsistent with a belief in the efficacy of asylum care. On the other hand, they hardly suggest that successful treatment was the primary consideration in resorting to the asylum. Examination of the internal order of the institution offers further evidence that the asylum functioned in a fashion relatively unrelated to its intended therapeutic purpose. Inmates and Attendants: The Similarity of Keeper and Kept One of the most striking features of the Russian asylum was the extent to which the patients and the staff in the institutions resembled one other. The attendants, who comprised the great majority of the workers in mental hospitals, were also overwhelmingly of peasant origins, and many of the character traits which their supervisors disliked in them were remarkably similar to the ones which the physicians were charged to "treat" in their patients. The seasonal variations described above apply with equal force to asylum workers and inmates. Indeed, the evidence suggests that at times the statuses were interchangeable—leading one to wonder if, on occasion, little more than chance determined whether one entered the asylum as patient or attendant. The poor calibre of asylum workers was a continuing refrain in the litany of psychiatric complaints in many countries. The majority of mental institution attendants were everywhere "recruited from the dregs of society" (Scull, 1979). In the view of the psychiatrists who supervised them, virtually all were totally unsuited for the work. Significantly, those qualities that were alleged to characterize the majority of attendants were precisely the ones which prompted the incarceration of many of their charges. As one American physician commented, male keepers and attendants were "criminals and vagrants, who have neither character nor discretion to take care of themselves" (Grob, 1973:212; also see Grob, 1983; Rothman, 1980). The workers in Russian asylums shared many of these traits with their counterparts in other societies. Russian asylum attendants were variously described as uncultured, rude, abusive, and incapable of rational decisionmaking. They were charged with violent acts: tormenting patients, breaking patients' bones, and even causing the deaths of patients. Many were also alleged to be alcoholics (Arkhangel'skii, 1887; Krainskii, 1911; Lion, 1883; Mendel'son, 1898). Anton Chekhov's famous portrait of a Russian asylum includes the following vivid description of Nikita, the attendant in the infamous "Ward No. 6": His face is coarse and drink-sodden, his hanging eye-brows give him the appearance of a sheep-dog, he is small and sinewy, but his carriage is impressive and his fists are strong. He belongs to that class of simple, expeditious, positive, and dull persons, who above all things in the world worship order. . . . He beats his charges in the face, in the chest, in the back, in short wherever his fists chance to strike; and he is convinced that without this beating there would be no order in the universe (Chekhov, 19o3:214). Russian psychiatrists went to great lengths to impress upon the public the dangers of asylum work. Patient attacks upon staff persons were regularly reported in both the professional and the popular press. These reports served the double purpose of reminding the public of the importance of asylum work and of how vital it was to institutionalize the insane. After all, those dastardly attacks could have occurred outside of the institution. Ironically, the psychiatric community found itself simultaneously attempting to downplay the frequency and severity of staff attacks upon patients. Although reliable data are not available, impressionistic accounts suggest that attendants were often at least as violent as patients (Krainskii, 1911; Lysakovskii, 1912). Amongst themselves, psychiatrists discussed the problem and sought means by which to upgrade the calibre of their workforce. However, they were understandably reluctant to bring the problem before the public and risk further damage to the already fragile credibility of their institutions. A large number of male patients were institutionalized because of their purported dangerousness and/or alcohol abuse. Russian psychiatrists increasingly protested that neither trait should be grounds for admission to mental "hospitals" (Brown, 1981). They also found those traits unacceptable in asylum workers. They would have preferred to eliminate both alcoholics and the "dangerous" from their institutions yet found they had little control over either. No other workers would consider asylum jobs, and they could do little to limit admissions of "undesirable" patients. With a few exceptions asylum attendants were drawn from that pool of unskilled seasonal laborers that regularly swelled urban populations. Asylum work was certainly not the most avidly sought after; however, it was probably not the least attractive either. The conditions such workers faced in the cities were notoriously poor. Wages were low, work was sporadic, and work environments were hazardous at best. The housing available for urban transients was crowded, noisy, and unsanitary. Describing a Moscow boarding house in the latter years of the century, a contemporary observed, These people live in impossible conditions: filth, stench, suffocating heat. One can't stay standing for half an hour in these apartments. They lie down together barely a few feet apart, there is no division between the sexes, and adults sleep with children. The air is saturated with the most dreadfully foul language (quoted in Bradley, 1985:206). The salaries of asylum workers were relatively low even by the standards of the time. In 1911 the average wage was between 8 and 13 rubles per month—comparable to the pay of casual female laborers such as washerwomen and rag pickers (Bradley, 1982). In addition, asylum workers were often fined when they broke the rules, thus reducing their take-home pay still further. Relatively few received paid holidays, and most worked 11 to 13 hours per day at least six days a week. A survey conducted in 1912 revealed that attendants in approximately one-third of the empire's mental institutions worked between 16 and 19 hours a day (Lysakovskii, 1912). The major drawback to asylum work may well have been the "yellow house" stigma which psychiatrists diligently sought without success to purge from the collective memory of the population. One of its principal advantages was that it provided housing. Attendants in most institutions were required to live within the institutions. This practice was not unique to the asylum. Factories frequently provided housing of sorts for skilled workers, and full-time residents in the cities had other alternatives as well. It was the unskilled transients who were most likely to be left to fend for themselves. Residence in a madhouse was certainly not ideal but, compared with the streets and the "flophouses" which were home to many seasonal workers, a bed in a "yellow house" probably did not seem quite so terrible. Psychiatrists recognized that those they hired as attendants were not highly committed to their work. In the words of one, "the workers look on the hospital as a temporary shelter for those who have fallen on hard times" (Lysakovskii, 1912:819). Indeed, one of the profession's major complaints was the high rate of turnover among asylum attendants. They felt compelled to fire the most irresponsible, abusive, and inebriated; however, too many others left of their own volition. A survey of 14 Russian mental institutions in 1908 revealed an average annual rate of turnover for male attendants of 167.2 percent (German, 1908). The time of greatest labor turnover in Russian mental institutions was the same as the time of greatest patient turnover: the summer. Peasant workers clearly viewed asylum work as seasonal, while retaining their primary commitment to home and family. As one psychiatrist lamented, We observe the same pattern repeat itself year after year. In the fall after the harvest is complete a mass of workers descends on the city . . . offering services in exchange for little more than sustenance. Each is content merely to have someone look after him. After all, that means one less mouth to feed in the family. If he earns a little money, it is clear profit. Once spring comes, he begins to think again of home. When the time comes for the first work in the fields, there ensues a massive exodus to the countryside (Timofeev, 1898:27). One would certainly not want to exaggerate the similarities between the "keepers" and the "kept." Even though their comings and goings were strictly monitored, the attendants were clearly freer to leave the institution. 6 Although there was a core of employees who remained for years, the stay of the average attendant was indeed shorter than that of the average inmate. Annual turnover rates for the former exceeded 100 percent; for the latter they were approximately 50 percent (Dzerzhinskii, 1905). Nonetheless, the similarities are striking enough to cause one to wonder if a young man's fate in a given winter was often less a result of his mental condition than of the circumstances he encountered after arrival in some provincial capital. If he were directed first to the employment office of the provincial mental hospital, he might have used his meagre wages to purchase those beverages whose effects so perturbed his employers. If, on the other hand, his initial destination was a tavern, his subsequent arrest for drunkenness and vagrancy might well have led to his confinement in that same institution as a patient. In either case, he probably rejoined the other members of his household in the fields for the next summer's harvest. The similarities between patients and staff in the mental institutions of late imperial Russia raise questions as to the validity of the distinction between "sane" and "disturbed" which presumably determined which side of the locked door one called home. The relevance of those questions is highlighted in accounts of frequent movement between the two statuses. It was quite common in many countries for former patients to be hired as attendants (Rothman, 1980; Scull, 1979). Russian psychiatrists also reported that released patients asked to remain at the asylum as employees. Others returned home temporarily but later reappeared at the institutions asking for work and complaining that "home was boring," or "I missed my friends," or "things are merry here" (Ryndovskii, 1895). Such individuals were almost always offered employment. Hospitals suffered from frequent labor shortages, and, from the standpoint of psychiatrists, ex-patients made ideal workers. They had too much to lose by misbehaving: Each of these attendants remembers that he was himself once a patient. [He also knows] that if he abuses one of the patients he could be made a patient once again. That individual could in turn be made an attendant and avenge the insult (Kovalevskii, 1880:99). Life within the Institution The most significant difference between the two statuses was undoubtedly one of power. In fact, attendants have probably been the most influential group in the asylum almost since its inception. By the turn of the century, the typical Russian mental hospital included at least several hundred patients and at most a half-dozen psychiatrists. The attendants ran the institutions. As one Russian psychiatrist complained, "Everything is in the hands of the attendant. The attendant is tsar, the absolute ruler of the ward" (Lion, 1883:211). Twentiethcentury research suggests that little has changed (Belknap, 1956; Cumming and Cumming, 1956; Scheff, 1961; Smith, 1965). It has also documented the multi.dimensional nature of the power wielded by attendants who, like Chekhov's Nikita, are in a position to decide which of the ward physician’s orders they shall elect to carry out.... The attendant can and does shape his report to the doctor on the conduct of given patients so that these patients are under the attendant's control (Belknap, 1956:94). In other respects there was little to distinguish the life of patient from that of worker. Of course the latter received a few rubles at the end of the month. However, both lived within the institution. In many instances, the patients and their attendants actually shared living quarters. In the "better" asylums a wall separated the cots of the keepers from those of the kept. Both ate institutional food, although the workers often complained that the patients received larger portions. Patients were also more likely to be clothed by the institution, a distinct advantage given the poverty and the distance from home of most asylum users. Despite the presumption that the inmates were incarcerated because of their inability to function normally in society, the daily regimen in the typical asylum bore a striking resemblence to life on the outside. The expectations for workers and inmates were as much in accord with their station in life as with their presumed mental condition. Except for the frail and the most severely disturbed, the patients were expected to work. In fact, work was the principal form of therapy provided to the patients. The primary intent was neither to teach new skills nor merely to occupy idle hands with "busy" work. The inmates were expected to engage in useful occupations, consistent with their social background, and the fruits of their labors enriched the coffers of the institution. In a few asylums the work done by inmates enabled the institutions to be nearly self-supporting. Dr. Ginzburg-Shik (1892:97-98) described the typical day in his institution in the province of Kherson as follows: In the spring and summer everyone wakes up at 5:30 (wake-up is 6:30 in the fall and winter). After bathing, the patients and attendants make the beds and clean up the ward. Prayers are at 7:00, followed by tea with white bread. At 8:00 everyone goes to work: some go to workshops, others do housework, saw firewood, work in the laundry, do kitchen or outdoor chores. Breakfast is at 10:00 followed by work from 11:00-2:00. Dinner is served at 3:00. Work resumes from 4:00-6:30. Tea is served at 7:00 and all retire for the night at 8:00. Although some patients were isolated because they were too violent or too overtly psychotic to adapt to institutional routines, most patients' lives within the asylum involved daily rituals similar to those on the outside. In a number of respects the daily experiences were similar for inmates and attendants. Both were expected to contribute to the maintenance of the institution; in return, it provided them with the bare essentials of life. Both the power differential between inmate and worker and the implied competition between them for scarce institutional resources promoted conflict between the two groups. On the other hand, their affinities also created the potential for cooperation. Indeed, although the historical record is somewhat incomplete, such alliances were reported during the revolutionary period of 1905-1906. In those years workers in many mental hospitals attempted to overthrow the existing hierarchy of institutional authority, and they often enlisted the support of patients in the effort to oust asylum directors (Brown, 1987). Conclusion There certainly have always been many individuals incarcerated in mental institutions who are seriously disturbed and so out of touch with reality as to be incapable of functioning on the outside. However, the evidence presented here suggests that explanations which attribute the dramatic rise in asylum populations in the last century to an increase in the number of such troubled souls are grossly inadequate. Similarly, explanations which attribute the growth of asylums to their effectiveness as a means of controlling those who threatened the "powerful" can divert us from consideration of the extent to which the various routes into and out of the institution have been manipulated by the "powerless." Yet, careful examination of the historical record does not lead to the conclusion that the inhabitants of the mental hospital were responsible for either its creation or its continuance. Rather, the data argue strongly that political considerations have been at the heart of state support for the asylum. In the Russian case, the first institutions were explicitly created to incarcerate the "dangerous." The expansion of the network of asylums was rationalized on similar grounds. As political threats to the tsarist regime mounted in the early twentieth century, the state openly exercised its authority to use the institutions for purposes of political control (Brown, 1983). By the same token, decisions to reduce the size of asylums were made without regard for the wishes of asylum users. So long as mental institutions in Russia were perceived as a relatively nonthreatening means of dealing with problem populations, they continued to grow. When social unrest in the institutions during the failed Revolution of 1905 altered that perception, elite support began to be withdrawn from them (Brown, 1985). Research on present-day asylum utilization in the West has found patterns consistent with those which I have described above (Braginsky et al., 1969; Weinstein, 1979, 1980). In brief, these studies show that some patients manipulate their "symptomatic" behavior to remain institutionalized. Given the nature of asylum existence, this "choice" stands more as an indictment of the totality of societal provision for "unfortunates" (as the Russians described them) than as a testimony to the success of the asylum. Moreover, as state support for the asylum system has declined, the options available to such individuals have been reduced rather than enhanced. A steadily growing body of literature has documented the unhappy fates of many of those who have been deinstitutionalized in late twentieth century North America. In the final analysis, the fate of asylum populations hinges upon policy decisions made at some distance from the institutions. Nonetheless, the users of the asylum have been more than an inert force acted upon by those with superior knowledge or power. Within the broad limits set by those with fiscal control, some of society's most desperate members have manipulated the institutions so as to ease their lot. For the most part, mental hospitals have functioned neither as "hospitals" nor as "prisons." Rather, they have been used by some ofsocieties' most disadvantaged members as one more painful weapon in the arsenal of survival. ReferencesAbbott, Robert J.1977 "Crime, police, and society in St. Petersburg, Russia, 1866-1878." The Historian 40:70-84. Arkhangel'skii, P. A.1887 Otchet po osmotru russkikh psikhiatricheskikh zavedenii. Moscow.Bazhenov, N. N.1887 "O prizrenii i lechenii dushevno-bol'nykh v zemstvakh i v chastnosti o novoi riazanskoipsikhiatricheskoi bol'nitse." Pp. 234-48 in Trudy pervago s'ezda otechestvennykh psikhiatrov. St.Petersburg.Belknap, Ivan1956 Human Problems of a State Mental Hospital. New York: McGraw-Hill.Bellingham, Bruce1986 "Institution and family: an alternative view of nineteenth-century child saving." Social Problems33:S33-57.Bradley, Joseph.1982 "The Moscow workhouse and urban welfare reform in Russia." Russian Review 41:427-44.1985 Muzhik and Moscovite Urbanization in Late Imperial Russia. Berkeley: University of CaliforniaPress.Braginsky, Benjamin M., Dorothea D. Braginsky, and Kenneth Ring1969 Methods of Madness: The Mental Hospital as a Last Resort. New York: St. Martin's Press.Brown, Julie V.1981 "The professionalization of Russian psychiatry: 1857-1911." Unpublished Ph.D Dissertation,University of Pennsylvania, Philadelphia.1983 "Psychiatrists and the state in tsarist Russia." Pp. 267-87 in Stanley Cohen and Andrew Scull(eds.), Social Control and the State. New York: Basil Blackwell 1985 "A socio-historical perspective on deinstitutionalization: the case of late imperial Russia." Pp. 167-88 in Steven Spitzer and Andrew Scull (eds.), Research in Law, Deviance and Social Control.Volume 7. Greenwich, CT: JAI Press.1987 "The deprofessionalization of Soviet physicians: a reconsideration." International Journal of Health Services 17:65-76.Chechott, O.A. 1889 "Sovremennoe polozhenie prizreniia pomeshannykh v S-Peterburge i ego gubernii i v kakomrazmere ono dolzhno byt' raschireno." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii7:38-57.Chekhov, Anton Pavlovich1903 The Black Monk and Other Stories. Freeport, NY: Books for Libraries Press. Chizh, V. F.1888 "Bol'nitsa sv. Pantaleimona v 1886 godu." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 5:193-226.Cumming, Elaine and John C.1956 "The locus of power in a large mental hospital." Psychiatry 19:371-83.Dain, Norman1964 Concepts of Insanity in the United States, 1789-1865. New Brunswick, NJ: Rutgers UniversityPress. Droznes, M. Ia.1885 "O preobrazovanii khersonskago 'doma umalishennykh' v lechebnitsu dlia nervnykh i dushevnykhbol'nykh." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 2:299-312.1886 "Otchet po otdeleniiu dushevno-bol'nykh pri khersonskom borougodnom zavedenii za 1887g."Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 4:238-95.Dzerzhinskii, B. 1905 "Organizatsiia personala, nabliudaiushchago za dushevno-bol'nymi, po otchetom bol'nits i koloniiza 1900-1903gg." Zhurnal nevropatologii i psikhiatrii im. S. S. Korsakov 5:1055-70.Engel, Barbara Alpern1986 "The woman's side: male out-migration and the family economy in Kostroma Province." SlavicReview 45:257-71.Evgrafov, K. R. 1890 "Otchet za 1888g po psikhiatricheskomu otdeleniiu penzenskoi gubernskoi zemskoi bol'nitsy."Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 16:101-12.1895 O vazhneishikh prichinakh dushevnykh boleznei. Penza.Foucault, Michel1965 Madness and Civilization. New York: Mentor Books.Fox, Richard W.1978 So Far Disordered in Mind: Insanity in California, 1870-1930. Berkeley, CA: University ofCalifornia Press.Friedberger, Mark1981 "The decision to institutionalize: families with exceptional children in 1900." Journal of FamilyHistory 6:396-409.Frieden, Nancy1978 "Child care: medical reform in a traditionalist culture." Pp. 236-59 in David L. Ransel (ed.), TheFamily in Imperial Russia New Lines of Historical Research. Urbana, 1L: University of IllinoisPress.1981 Russian Physicians in an Era of Reform and Revolution. Princeton, NJ: Princeton University Press.German, I. S.1908 "K voprosu o zhenskoi prisluge v muzhskikh otdeleniiakh psihiatricheskikh bol'nits." Zhurnalnevropatologii i psikhiatrii im. S. S. Korsakov 8:268-88.Ginzberg-Shik, D. G.1889 "Kratkii meditsinskii otchet za 1887g." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii13:90-99. 1892 "Meditsinskii otchet za 1890g po khersonskoi gubernskoi zemskoi lechebnitse i kolonii dliadushevno-bol'nykh." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 20:86-103.Glickman, Rose L.1984 Russian Factory Women: Workplace and Society, 188o-1894. Berkeley, CA: University of California Press.Govseev, A. A. 1889a "Osnovy lecheniia i prizreniia dushevno-banykh v primenenii k ustroistvu psikhicheskikhotdelenii gubernskikh zemskikh bol'nits: pervaia chasf." Arkhiv psikhatrii, nevrologii i sudebnoipsikhopatologii 13:81-114.1889b "Osnovy lecheniia i prizreniia dushevno-bol'nykh v primenenii k ustroistvu psikhicheskikhotdelenii gubernskikh zemskikh bol'nits: vtoraia chast'." Arkhiv psikhiatrii, nevrologii i sudebnoipsikhopatologii 14:81-137. 1890 "Osnovy lecheniia i prizreniia dushevno.banykh v primenenii k ustroistvu psikhicheskikh otdeleniigubernskikh zemskikh bol'nits: zakliuchenie." Arkhiv psikhiatrii, nevrologii i sudebnoipsikhopatologii 15:1-2LGreidenberg, B. S.1886 "Otchet ob otdelenii dushevno.bol'nykh pri Simferopol'skikh bogougodnykh zavedeniiakh za1885g." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 1:196-237. 1887 "Otchet ob otdelenii dushevno-bol'nykh pri simferopol'skikh bogougodnykh zavedeniiakh za1886g." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 5:315-37.1888 "Otchet ob otdelenii dushevno-bol'nykh pri simferopol'skikh bogougodnykh zavdeniiakh." Vestnikklinicheskoi i sudebnoi psikhiatrii i nevropatologii 6:429-35.1889 "Ochet po otdeleniiu dushevno-bol'nykh simferopol'skikh bogougodnykh zavedenii." Vestnikklinicheskoi i sudebnoi psikhiatrii i nevropatologii 7:332-38. 1893 "Otchet po otdeleniiu dushevno.bol'nykh simferopol'skikh bogougodnykh zavedenii za1892g." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 10:236-45.1901 Otchet po psikhiatricheskim otdeleniiam khar'kovskoi gubernskoi zemskoi bol'nitsy za 1900g.Khar'kov.Grob, Gerald N.1973 Mental Institutions in America: Social Policy to 1875. New York: Free Press. 1983 Mental Illness and American Society, 1875-1940. Princeton, NJ: Princeton University Press.Iakobii, P.1900 Osnovy administrativnoi psikhiatrii. Orel.Iakovenko, V. I.1885 "O prizrenii dushevno.banykh v Moskovskom i Tverskom zemstvakh." Vestnik klinicheskoi isudebnoi psikhiatrii i nevropatologii 2:288-98.1900 Dushevno.bol'nye moskovskoi gubernii. Moscow.Ignat'ev, M. B.1896 "Opyt statisticheskago izsledovaniia o dushevno-bol'nykh v Rossii." Vestnik klinicheskoi isudebnoi psikhiatrii i nevropatologii 11:273-95.Iudin, T. I.1913 "Zemskaia psikhiatriia v 1911 gody." Sovremennaia psikhiatriia 7:641-52.Johnson, Robert E.1979 Peasant and Proletarian: The Working Class of Moscow in the Late Nineteenth Century. NewBrunswick, NJ: Rutgers University Press.Korsakov, S. S.1954 Izbrannye Proizvedeniia. Moscow: Medgiz.Kotsovskii, A. D.1902 "Ocherk prizreniia dushevno.bol'nykh v Rossii." Voprosy nervno.psikhiatricheskoi meditsiny7:238-3o3, 357-425, 537-674.Kovalevskii, P.I. 1880 Rukovodstvo k pravil'nomu ukhodu za dushevnymi bol'nymi dlia rodstvennikov iokruzhaiushchikh. Khar'kov.1887 "Polozhenie dushevnykh bol'nykh v Rossiiskoi Imperii." Arkhiv psikhiatrii, nevrologii i sudebnoipsikhopatologii 9:72-85. Krainskii, N. V.1911 Pochemu v psikhiatricheskikh bol'nitsakh lomaiut rebra i kto v etom vinovat? Vil'nius. Lindenmeyr, Adele1982 "Work, charity and the elderly in late nineteenth century Russia." Pp. 232-47 in PeterStearns (ed.), Old Age in Preindustrial Society. New York: Holmes and Meier.Lion, M. E.1883 "Iz otchetov o sostoianii otdeleniia dushevno.bol'nykh pri Bessarabskoi gubernskoi zemskoibol'nitse s kontsa 1882.go goda." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 1:20616.Lysakovskii, I. V.1912 "K voprosu o polozhenii prislugi russkikh psikhiatricheskikh bol'nits." Sovremennaia psikhiatriia,6:819-29.Mal'tsev, A. F.1885 "Ocherk prizreniia dushevno-bol'nykh v Vologodskoi gubernii." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 1:336-54.Matossian, Mary1968 "The Peasant Way of Life." Pp. 1-4o in Wayne S. Vucinich (ed.), The Peasant in Nineteenth-Century Russia. Stanford, CA: Stanford University Press.Mendelson, A. L.1898 O professional'nom obuchenii nizshago personala psikhiatricheskikh zavedenii. St. Petersburg. Merzheevskii, I. P.1887 "Ob usloviiakh, blagopriiatstvuiushchikh razvitiiu dushevnykh i nervnykh boleznei v Rossii i omerakh napravlennykh k ikh umen'sheniiu." Pp. 15-37 in Trudy pervago s'ezda otechestvennykhpsikhiatrov. St. Petersburg.Miller, Wright1961 Russians as People. New York: E. P. Dutton and Company. Platonov, I. Ia.1886 "Otchet o sostoianii poltayskago doma umalishennykh za 1884g." Arkhiv psikhiatrii, nevrologii isudebnoi psikhopatologii 7:55-68.1890 "Kratkii otchet o deiatel'nosti chastnoi lechebnitsy dlia dushevnykh i nervnykh bol'nykh doktoraPlatonova v g. Khar'kove." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 15:78-100.Ramer, Samuel C.1982 "The Zemstvo and public health." Pp. 279-314 in Terrence Emmons and Wayne S. Vucinich(eds.), The Zemstvo in Russia: An Experiment in Local Self-Government. Cambridge: CambridgeUniversity Press.Robinson, Geroid Tanquary1960 Rural Russia under the old Regime. Berkeley, CA: University of California Press.Rosenhan, David L.1973 "On being sane in insane places." Science 179:250-58.Rothman, David J.1971 The Discovery of the Asylum. Boston: Little, Brown.1980 Conscience and Convenience: The Asylum and its Alternatives in Progressive America. Boston:Little, Brown.Ryndovskii, D. F. and A. A. Linitskii1895 Vosem' let 1887-1895 samostoiatel'nago razvitiia i organizatsii rabot dushevno-bol'nykh priKhar'kovskikh bogougodnykh zavedeniiakh (Saburova dacha). Khar'kov.Scheff, Thomas J. 1961 "Control over policy by attendants in a mental hospital." Journal of Health and Human Behavior2:93-105.Scull, Andrew1979 Museums of Madness: The Social Organization of Insanity in Nineteenth Century England. New York: St. Martin's Press.Seton-Watson, Hugh 1967 The Russian Empire, 18o1-1917. Oxford: Clarendon Press.Shteinberg, S. I.1887 "Mediko-khoziastvennyi otchet saratovskoi gubernskoi zemskoi psikhiatricheskoi lechebnitsy za1886g." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 10:137-205.1889 "Mediko.khoziastvennyi otchet saratovskoi gubernskoi zemskoi psikhiatricheskoi lechebnitsy za1887g." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 6:377-409. 1890 "Mediko-khoziastvennyi otchet saratovskoi gubernskoi zemskoi psikhiatricheskoi lechebnitsy za1888g." Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 8:263-333.Shul'ts, A.1865 "Prizrenie pomeshannykh v Rossii." Arkhiv sudebnoi meditsiny i obshchestvennoi gigieny 1:1-47.Smith, Dorothy E.1965 "The logic of custodial organization." Psychiatry 28:311-23. Sovetov, S. N.1885 "Kratkii ocherk vladimirskago doma umalishennykh za 1885g." Arkhiv psikhiatrii, nevrologii isudebnoi psikhopatologii 6:31-7.1886 "Kratkii otchet po psikhiatricheskoi otdeleniiu vladimirskoi gubernskoi zemskoi bol'nitsy za 1885-86g." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 8:102-1L1887 "Vladimirskii dom umalishennykh za 1887g." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 11:57-61.Timofeev, A. V.1898 "Po povodu prislugi v zavedeniiakh dlia dushevno-bol'nykh." Obozrenie psikhiatrii, nevrologii ieksperimental'noi psikhologii 3:26-35.Tolokonnikov, A.1886 "Ocherk iaroslayskago doma umalishnnykh za 1885g." Arkhiv psikhiatrii, nevrologii i sudebnoi psikhopatologii 8:187-94.Tomes, Nancy1984 A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-keeping, 1840-1883.Cambridge: Cambridge University Press.Vucinich, Wayne S. (ed.)1968 The Peasant in Nineteenth-Century Russia. Stanford, CA: Stanford University Press. Vvedenskii,I.N.1912 "Khronika." Sovremennaia psikhiatriia 6:648-60.Walton, John1979 "Lunacy in the industrial revolution: a study of asylum admissions in Lancashire, 1848-5o."Journal of Social History 13:1-22.1981 "The treatment of pauper lunatics in Victorian England: the case of Lancaster Asylum, 1816-1870." Pp. 166-97 in Andrew Scull (ed.) Madhouses, Mad-doctors and Madmen: The SocialHistory of Psychiatry in the Victorian Era. Philadelphia: University of Pennsylvania Press.Weinstein, Raymond M.1979 "Patient attitudes toward mental hospitalization: a review of quantitative research." Journal ofHealth and Social Behavior 20:237-58.1980 "The favorableness of patients' attitudes toward mental hospitalization." Journal of Health andSocial Behavior 21:397-401.Zainaldin, Jamil S. and Peter L. Tyor.1979 "Asylum and society: an approach to institutional change." Journal of Social History 13:23-48 Acknowledgements:* This research was supported by the International Research and Exchanges Board, Fulbright-Hays, and theKennan Institute for Advanced Russian Studies. I would also like to thank the anonymous readers for theirhelpful recommendations. Correspondence to: Department of Sociology, University of North Carolina at Greensboro, Greensboro, NC 27412-5001. Notes:1. One of the consequences of this necessary resort to public forums for discussion was that the professionconducted many of its petty intraprofessional squabbles in full view of the reading public. While a boonto later scholars interested in the development of the profession, this did little to enhance its status in theeyes of its contemporaries (Brown, 1981).2. The analysis is based upon information from institutions in the following areas (and years): Kherson (1884, 1887, 1890); Kursk (1893-1896); Orel (1880-1891; 1894-1895); Penza (1893-1896); Saratov(1887); Simferopol' (1885-1888, 1892); Tambov (1893-1896); Tula (1883-1890); Tver (1884-1885);Vladimir (1885-1887); Vologda (1882) and Voronezh (1886-1890; 1893-1896). Sources utilized in thisanalysis are as follows: Droznes (1885, 1886); Evgrafov (1890); GinzbergShik (1889, 1892); Govseev(1889a, 1889b, 1890); Greidenberg (1886, 1887, 1888, 1889, 1893, 1901); Iakobii (1900); Iakovenko(1885, 1890); Ignat'ev (1896); Iudin (1913); Lion (1883); Mal'tsev (1885); Platonov (1886, 1890); Ryndovskii and Linitskii (1895); Shteinberg (1887, 1889, 1890); Sovetov (1885, 1886, 1887); andTolokonnikov (1886).3. The Russian Academy of Sciences was charged with the task of studying Western asylums andpresenting a model for Russia to the tsarist government, The Academy collected information on asylumsin Germany and England for that purpose.4. Iakobii also gathered statistical information on other Russian asylums. His colleagues were critical of many of his conclusions; however, they did not challenge the accuracy of the data on which he basedthem.5. This law was unsuccessfully contested by Russian physicians throughout the prerevolutionary era(Frieden, 1981). A similar law remains on the books in parts of the USSR today.6. Although Russian workers were "free" to leave their employment after the abolition of serfdom, theirmovements were closely controlled by generally untrusting employers (Bradley, 1985).