Chapter 7 of 13 · ~1,237 words
7. Ukrainian Psychiatry: Regions, Hospitals, and Clinical Traditions
From custodial care to specialized services
Family care, monastic shelters, brotherhood hospitals, and municipal charitable institutions preceded specialized psychiatric hospitals. The Kyiv-Pechersk Patericon preserves accounts of mental suffering and care within the monastery. In the eighteenth century, people with severe mental disorders were accommodated in places including the Kyiv-Pechersk Lavra and Mezhyhiria Monastery. Municipal institutions gradually assumed responsibility for ongoing accommodation, operating expenses, and medical supervision. [162]
Records of the Kyiv Board of Public Welfare for April 1790 describe a ward in Podil with six patients: three men and three women. In the early nineteenth century, care became concentrated in the former St. Cyril's monastery complex. This transition brought a permanent address, premises, staff, and administrative responsibility for people needing long-term care. [162]
During the nineteenth and twentieth centuries, several institutional traditions developed across present-day Ukraine. Austrian and later Polish university medicine influenced Lviv; Bukovyna experienced Austrian and Romanian periods; zemstvo services shaped large hospitals in the south and east. In the Soviet period, these networks formed a system of hospitals, dispensaries, academic departments, and research institutes. Local schools retained their own clinical interests and approaches to organizing work.
Lviv and Bukovyna
At Lviv's university clinical site in the late eighteenth century, a 47-bed ward served people with neurological and mental illnesses. Construction of the Kulparkiv complex began in 1870; the hospital opened in 1875, receiving patients from a broad region. Buildings expanded under pressure from demand for long-term accommodation. [163, 164]
In 1903, Henryk Halban, a pupil of Richard von Krafft-Ebing and Julius Wagner-Jauregg, became head of Lviv University's department of neurology and psychiatry. In the 1930s, the curriculum expanded to include child psychiatry and psychology. Hospital and dispensary networks grew after the war. In the early 1990s, Lviv departments worked on psychopharmacology, the course and treatment resistance of schizophrenia, alcohol-related psychoses, psychotherapy, and psychological assessment. [163]
In Chernivtsi, the first psychiatric hospital was built through public donations in 1833. Another 50-bed hospital opened in 1886, funded through a lottery. A new pavilion complex admitted patients on May 1, 1902: five two-storey buildings had been erected in a year and eight months, and four more were added by 1907. Placement depended on the patient's condition; charitable funds paid for care of those without means. [165]
After wartime destruction, the Chernivtsi hospital resumed work in 1944 with 280 beds and two physicians. A psychiatry department was established there in 1945. The subsequent network included a dispensary department, district psychiatrists, and children's services; the addiction service became separate in 1977. Workshops and agricultural work held a substantial place alongside hospital treatment. [165]
Odesa: Dispensaries, day hospitals, and social work
Odesa's addiction dispensary was already operating in 1922 to 1928. Its clinical context was the spread of morphine and cocaine in the port city. In 1930, Hryhorii Markelov established a psychoneurological institute in a sanatorium for people with consequences of head injuries; its interests included borderline disorders and the autonomic nervous system. The institute's dispensary department opened in 1936. [166]
The municipal dispensary restored in 1944 organized ongoing follow-up and social assistance, including housing and employment matters. A regional dispensary was established in 1952. Therapeutic work workshops, outpatient forensic psychiatric assessments, and addiction, sexology, and gerontology clinics followed. [166]
The 1964 polyclinic was designed for 250 visits per shift. In the late 1960s and early 1970s, two day hospitals with 100 places each were established: one for mental disorders and one for neuroses. An adolescent day hospital, also with 100 places, opened in 1972. This network allowed treatment while living at home and distributed work among inpatient wards, the polyclinic, and district clinics. [166]
Vinnytsia and Poltava
Vinnytsia's psychoneurological hospital opened on May 25, 1897, with 720 beds. Since 1936, it has borne the name of Oleksandr Yushchenko, associated with the biochemical approach in psychiatry. The opening of the medical institute in 1934 made the hospital a departmental clinical base, linking regional care with training students and physicians. [167, 168]
Vinnytsia's service turned to epidemiological work early: in 1929, dispensary staff surveyed the populations of three districts to assess the number and characteristics of people with mental disorders. Chief physician R. Ya. Marianchyk's 1966 dissertation developed this approach through service planning and rehabilitation. Research into affective disorders, including depression with prominent physical complaints, later became another focus of hospital and departmental work. [167]
In Poltava, Oleksandr Maltsev led the hospital from 1886 to 1926. A choir of patients and staff was organized as early as 1887. Reading, musical evenings, and plays formed part of hospital life; productions in 1900 included Natalka Poltavka and The Inspection. In 1933, occupational work involved 70% of patients. The 1960s saw a more open regime, self-care, outings, sports, and use of personal clothing and belongings. [169]
By the end of the Soviet period, prolonged stays had again become extensive. According to the Poltava account, in 1993, 23% of beds were occupied by people hospitalized continuously for over two years, and 10% by people who had lost housing and social ties. Thus the hospital provided treatment and a place to live when support outside was lacking. [169]
Kherson and Donbas: Work, family placement, and everyday surroundings
Kherson's services began with ten beds in the provincial hospital in the 1820s and 1830s. Psychiatrist M. Ya. Droznes transformed this unit into a psychiatric department in 1883; it became a separate hospital in 1886. The zemstvo built a colony in Hrafskyi Garden in 1889 and a new hospital in 1899. [170]
By 1914, the network had 1,600 places: 800 in the central hospital, 150 in an agricultural colony, 320 in chronic wards, 150 in the open Arnaut family-placement service, and 180 across three closed placement services. Workshops, a library, theatre, choir, and orchestras operated. Patients without means received clothing and financial assistance on discharge. Family placement allowed some patients to live with families and adapt to ordinary daily life. [170]
The Svato-Luch hospital in Donbas admitted its first patients in 1914. In Ukraine's modern network, it is known as the Svatove Regional Hospital for Psychiatric Care. [171] By 1941, its agricultural holdings included 500 hectares of arable land, livestock farms, an orchard, and an apiary; sewing, shoemaking, and weaving workshops operated. Approximately half the patients participated in work. Similar workshops were established at the Donetsk hospital from its opening in 1935. Farming supplied food and supported the institution, while activities structured patients' days. [172]
Crimea and the diversity of scientific schools
The Crimean academic tradition developed classical psychopathology and biological and behavioural research. Naum Balaban worked in clinical anthropometry in the 1930s. Anatolii Kornetov headed the department for 35 years from 1958; his school is associated with clinical genetics of schizophrenia and changes in mental state over time. [173]
Interest in ethology, the systematic observation of behaviour, developed in the 1980s. Viktor Samokhvalov published a review in 1984; international symposia and cooperation with ethologists, anthropologists, and physiologists expanded the research network. Alongside diagnostic interviews, attention turned to nonverbal behaviour, interaction, and evolutionary explanations. [173]
Regional centres shared experience through departmental teaching, professional societies, conferences, and journals. The Kharkiv collections History of Ukrainian Psychiatry (1994) and History of Saburova Dacha (1996) brought together Ukrainian- and Russian-language contributions from colleagues in many cities. Within this professional network, clinical psychopathology, biological mechanisms, psychotherapy, dispensary follow-up, and rehabilitation were discussed side by side. [174]