Dual dependency: Conceptualisations of depression in Polish psychiatry between east and west

Abstract

Contrary to the argument that biological conceptualisations of mental distress serve as a smokescreen for the ills of capitalism in Western neoliberal societies, the findings show that the biological and individualised definitions of depression were present in the socialist Eastern Bloc. Taking the history of Polish psychiatry as a vantage point, this study introduces its historical development throughout late socialism and into the capitalist regime, revealing the continuity of biological conceptualisations of depression over time. It draws from archival research of the Polish Psychiatry journal, supplemented by interviews with psychiatrists from different generations. The study complicates the history of the European psychiatry during the Cold War period, by tracking knowledge transfers between East and West. It proves that the understanding of depression in late socialist Poland as an endogenous disease, an organic disorder independent of the social environment, was partly shaped by the Pavlovian paradigm and partly by Western neurobiological discoveries. Since the 1990s, with the dominance of American science, conceptualisations of depression as an endogenous disease have prevailed, albeit under a new wording of biological vulnerability. The study argues that the simultaneous impact of the Soviet and Western psychiatry in late socialist Poland was an instance of dual dependency resulting from the country’s geopolitical positioning. With the systemic transformation in the 1990s, a shift in the dependency pattern occurred, as Polish psychiatry clearly oriented towards the U.S. science.

Keywords

mental health discourse analysis narrative analysis

Introduction

Existing critical mental health studies often link the biologisation of mental disorders such as depression to the rise of neoliberal policies, emphasising how individualisation and pharmaceuticalisation became central to mental health care under market-driven systems (Cohen, 2016; Moncrieff, 2008; Rose, 2019). These accounts frame biologisation as a hallmark of Western psychiatry, reflecting the economic and cultural priorities of neoliberal societies. However, the history of psychiatry in socialist countries complicates this narrative, revealing striking parallels to Western trends, while emerging from a distinctly different political and ideological context. Drawing on archival research and interviews with psychiatrists, this study examines the development of Polish psychiatry during late socialism (1970s–1980s), particularly its conceptualisations of depression. I focus on the late socialist and early post-socialist period between 1967 and 1998. I have chosen two periods, 1967–1977 and 1985–1998, for a detailed analysis, as I wanted to understand, whether psychiatric discourse on depression differed significantly during the era of the late Polish People’s Republic (1970s and 1980s) and the Polish Republic (post-1989). Accounting for the globalising dynamics of the Cold War, I argue that Polish psychiatry exemplified a ‘dual dependency’; relying not only on Soviet models, but also on Western biomedical frameworks. Reconstructing the conceptualisations of depression in socialist and post-socialist Poland, I prove their continuity – rather than transformation. This novel perspective contributes to a more nuanced understanding of the globalisation of European psychiatry across the Cold War and its aftermath.

I argue that no significant qualitative shift in conceptualisations of depression occurred in the context of changing production regimes during Poland’s socio-political and economic transformation in the 1990s. The predominance of biological conceptualisations of depression testifies to a continuity in the discourse over time, although a quantitative shift in attention to affective disorders is visible since the 1990s. Situating the biologisation of depression within the dual-dependency (Zarycki, 2020) framework, I aim to expand current understandings of psychiatry’s globalisation and complicate Western-centric narratives about the rise of biological psychiatry. Such a perspective contributes to a more nuanced view of how globalising processes shaped psychiatry under both socialist and neoliberal systems.

While much research on the history of psychiatry in the Eastern Bloc has predominantly focussed on Russian psychology and psychiatry, this article contributes to a growing body of work examining psychiatry in former Soviet republics and satellite states. Recent scholarship discusses postwar psychiatry in Yugoslavia (Antic, 2022), GDR (Leuenberger, 2007; Thormann et al., 2014), Hungary (Kovai, 2015), Czechoslovakia (Marks, 2015), Romania (Doboş, 2015; Friedman, 2016), and Latvia (Lūse, 2011). Scholars reveal the complex transnational flows of ideas and practices shaping diagnostic categories, institutions, and treatments, alongside unique phenomena arising in local contexts. Contrary to the longstanding conflation of Soviet psychiatry with the field’s development across the Bloc (Savelli, 2018), existing research demonstrates the heterogeneity of psychiatry in Central and Eastern Europe during the Cold War. This heterogeneity manifests across temporal, geopolitical, internal, and external levels, proving the absence of a single, unified ‘Cold War psychiatry’ across the Eastern Bloc. Savelli and Marks (2015) show that the countries of the Eastern Bloc had varying extent of ideological integration with ‘the centre’: Moscow’s control over the cultural and scientific production and exchange of her many protégés was not complete. Active scientific and clinical exchanges with Western countries were evident among Polish, Yugoslav, Czechoslovak, and East German psychiatrists. These external influences, combined with internal diversity, resulted in various approaches, schools, and original research initiatives. Taking the relative importance of Poland within the Eastern Bloc, the scarcity of research on Polish socialist psychiatry in comparison with other countries of the region is surprising; current sociological scholarship mostly focuses on contemporary Poland (Brodniak, 2002; Nowakowski, 2015, 2016; Sokół, 2023; Wróblewski, 2016). This article shows how Polish psychiatry during late socialism developed biological understandings of depression similar to those in neoliberal societies, albeit rooted in distinct political, economic, and cultural dynamics of a socialist country.

In what follows, I first briefly outline the historical context, provide a rationale for the choice of dual-dependency lenses, and explain the methodology. Further, I show the liminal position of Polish late socialist psychiatry. Specifically, I focus on how it negotiated the ideological obligations towards the Soviets while at the same time distancing itself from Soviet psychiatric abuse and drawing from Western psychiatry. Next, I explain how the biological definition of depression as an endogenous disease became dominant, influenced by both Pavlovian biologism and Western biomedical paradigms. Since the 1990s, with the increasing influence of U.S. science and global psychiatry, biological conceptualisations of depression have continued to prevail, albeit reframed in terms of ‘biological vulnerability’. This shift has further obscured the social contexts of mental illness, reflecting a continuity from the socialist era into the neoliberal period.

Context

Following Poland’s incorporation into the Soviet sphere of influence in 1948, the country’s scientific disciplines, including psychiatry, were expected to align with the ideological framework of Soviet dialectical materialism (Graham, 1987). This alignment was formalised in 1952 when the National Congress of Psychiatry declared Ivan Pavlov’s materialist doctrine the official foundation of Polish psychiatry. As historian Michalik (2021: 450) notes, Pavlovism became the dominant influence on research, education, and institutional practices, with psychiatrists required to reference it in their work, even when unrelated to their studies. In the international context, Poland was respecting its socialist alliances. In 1949, together with the Soviet Union and other countries of the Bloc, Poland renounced its membership in the World Health Organisation, openly boycotting the forces of the ‘capitalist camp’, especially the United States, which was seen as dominatin the organisation (Fee et al., 2016). However, the ideological lead of the Soviets began to be questioned in the late 1950s. The grip of Soviet ideology began to loosen following the political thaw initiated by Nikita Khrushchev in 1956. The thaw encouraged critiques of Stalinist abuses and Soviet dominance. At the 1956 Congress of Polish Neurologists, Neurosurgeons, and Psychiatrists, Polish professionals openly challenged the ‘top-down, forced imposition of Soviet models’ (Michalik, 2021: 450).

While the rise of biological psychiatry is often linked to the increasing role of the neoliberal politico-economic frameworks in Western societies (Cohen, 2016), biological definitions of depression in socialist Poland might have been reinforced by the influence of Pavlovism. Serban (1959: 101) noted that the premises of Pavlov’s theory were linked with the social organisation of the Soviet state in which the state interest had a primacy over that of the individual. Because the social organisation of the communist state could not be questioned, psychiatrists blamed individual biology:

the psychiatrist. . . cannot admit that the conflict is caused completely by the social organisation. According to philosophical materialism, this society has solved the conflict of interests of the individual and society. Only the social productive relation and economic factors in the capitalistic order can be a source of personality conflict (Marx). The psychiatrist does not overlook the social factor, but. . . he admits that only some of them might have problems because of their type of nervous system.

Pavlov believed that failed conditioning occurs due to an organic process in a ‘weak’ or ‘imbalanced’ nervous system (Serban, 1959: 100). Aligned with historical materialism, Pavlov’s theory acknowledged that the human nervous system is shaped by the external environment: the consciousness not only has a material component – the brain – but also arises out of relationships and interactions in the material world. The socialist state provides proper conditioning of the nerves through education, culture and at the workplace. In this process, the automatic reactions become ‘conditioned reflexes’. These reflexes can become disrupted due to prolonged inhibitory reactions or excessive excitation exhibited by weak nervous systems (Serban, 1959). Though acknowledging the role of the social factors in shaping of the nerves, Pavlov prioritised inheritance factors as responsible for the development of the weak nervous-system-types. This meant that mental illness was ultimately a matter of genetic malfunction, a biological rather than social quirk.

The complex landscape of Soviet science on mental processes certainly extended beyond Pavlov’s doctrine. It is beyond the scope of this paper to discuss these issues extensively, but a few clarifications are necessary. Non-Pavlovian neurophysiological approaches, which linked the somatic processes to the environmental influences existed, but were actively fought against by Pavlovians (see the chapter on Nicolai Bernstein in Kozulin 1984), at least until the relative liberalisation of science in the 1950s. The 1950s and 1960s were a period of revival of Soviet psychology and brought publications of significant works by representatives of the ‘cultural-historical psychology’ (see Yasnitsky et al., 2014), most prominently Lew Vygotsky. Vygotsky’s approach emphasised the role of socio-cultural factors and language in the development of human psychic processes, contending that higher mental functions are shaped by social interactions and internalised through cultural tools such as language. During the Stalinist period (1930–1950s), Vygostky’s work had been ‘blacklisted’, and between 1956 and 1968 it was published only rarely and was not re-issued until at least 1984 (Kozulin, 1984: 22).

Despite a revival of non-Pavlovian approaches to psychophysiology, especially the rehabilitation of the cultural-historical psychology in the 1960s,¹ ‘Pavlovian teaching remained a grass-roots ideology in Soviet behavioural sciences’ (Kozulin, 1984: 73). The cultural-historical psychology was largely isolated from clinical psychiatric practice in Soviet Russia (see Kozulin, 1984). In the analysed data, I found no evidence that these ideas were impactful in Poland.

Data and methods

To unpack how Polish psychiatry conceptualised depression during the socialist and post-socialist periods, I undertook archival research on Polish Psychiatry, the first official journal of the Polish Psychiatric Association established in 1967 as a continuation of the pre-Second World War Psychiatric Yearbook. This outlet was chosen due to its institutional legitimacy. Polish Psychiatric Association has been playing an important historical role: its aims included the organisation of psychiatric care in Poland, establishing legislature related to mental health care; representing Polish psychiatry in international forums, and producing expert psychiatric discourse in Poland (Bilikiewicz, 1962).

Inquiries into the conceptualisations of depression throughout history initially guided the detailed study of the data. I performed issue-by-issue scanning using the keyword ‘depression’. After the first round of analysis, my original aim shifted towards uncovering how causal factors of depression and their relationships were articulated, prompting a search for keywords including ‘biological’, ‘endogenous’, ‘social’, and ‘psychosocial’. For each journal issue, I noted the number of articles on depression and their themes – whether they pertained to treatment, causal factors, or biological mechanisms.

The study includes elements of abductive analysis. As I immersed myself in the data, new evidence of Polish psychiatry negotiating its position between ‘the East’ and ‘the West’ emerged. I included articles discussing Soviet and Western psychiatry and took notes from the ‘Chronicles’ section, which documented international collaboration, conferences, and study visits abroad by Polish psychiatrists. In this section, I found reports from psychiatric summits and events held in both the Soviet Union and the United States, which I analyse in the sections below. This evidence unveiled another layer of inquiry into the geopolitical positioning and self-perception of Polish socialist and post-transformational psychiatry.

Between 2022 and 2024, I conducted nine semi-structured interviews with four male and five female psychiatrists from different generations. I used snowball sampling and direct contact through email and social media. Four interviews took place in person and five via telephone, ranging from 30 minutes to 3 hours. One participant was a medical student before psychiatric specialisation, while the others were psychiatry specialists with 6 to over 40 years of clinical experience. Two interviewees were involved in scientific research on depression, and two were established figures within the Polish Psychiatric Association. The study was approved by the Ethical Committee of the Institute of Philosophy and Sociology at the polish Academy of Sciences on June 21st, 2021 (approval no. 2/2021). All participants in the study gave verbal informed consent before the interview.

The interview questions covered an understanding of depression’s aetiology, biological mechanisms, and treatment. I also asked more senior psychiatrists about the conceptualisations and treatment of depression during their practice period. Two interviewees were professionally active before 1990 – one since the late 1970s and the other since the 1980s. The interviews explain how psychiatrists understand depression currently and how the interviewees assess the developments in psychiatry throughout the analysed period.

In the first step of the analysis, articles were selected, scanned, and coded, and interviews were anonymised, transcribed, and coded for further analysis. In the second step, I employed framing analysis. According to Entman (1993: 52), framing means ‘to select some aspects of a perceived reality and make them more salient in a communicating text, in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation’. Thus, I attend to the linguistic constructs in the data to identify depression conceptualisations: which aspects are described as causes, how the relationships between them are explained, and how Polish psychiatry constructs its position between the East and West using a particular language.

Late socialist period: Dual dependency

To account for psychiatry’s globalisation during the Cold War, this study employs a world-systems framework (Zarycki, 2020; see Wallerstein, 1974–1989), positioning Poland and other Eastern Bloc countries as ‘semi-peripheral states’ subject to overlapping influences from the Soviet Union and the capitalist West – a pattern which Zarycki calls dual dependency (Zarycki, 2020). This framework highlights how global economic shifts, such as the end of the Bretton Woods system and the oil crises of the 1970s, created conditions of dual dependency across the region. As Zarycki observes, these processes produced a ‘debt-ridden development’ in Poland and neighbouring countries, reinforcing their reliance on both Moscow and Western financial systems. This dependency pattern became particularly pronounced after 1971, when Western influences gained prominence throughout the region in the 1970s (Zarycki, 2020: 489).

Psychiatry of the late socialist period in Poland clearly demonstrates a pattern of ‘dual dependency’, balancing ideological obligations to the Soviets with increasing Western impact. In what follows I argue that the conceptualisations of depression as an endogenous disorder in Polish late socialist psychiatry emerged not only due to the impact of Pavlovism, but were significantly shaped in the dialogue with the West. To understand the predominantly biological orientation of Polish psychiatry during this period, I first sketch a geopolitical context.

Since the thaw, the theoretical commitment to Soviet frameworks had weakened, yet Polish psychiatry was still dependent on Moscow, as the Soviets exerted political control over Poland, embodied by the presence of the USSR troops until 1993 (Zarycki, 2020: 490). In the 1970s, the opposition to the communist regime was already distinct, and the anti-Soviet sentiment was foundational for Polish psychiatry’s identity. In the 1970s and 1980s, the scandal of Soviet political abuse emerged after protests from the international psychiatric community, leading to the exclusion of Soviet Russia from the World Psychiatric Association (van Voren, 2010). Polish psychiatrists aligned with the Western critique of Soviet psychiatry, condemning the grave abuses of human rights in the Soviet Union. The interviews show that the senior generation of psychiatrists saw Soviet psychiatry as abusive, ‘oppressive and used for political ends’. An interviewee with 30 years of experience (female) talked about political abuse in Soviet psychiatry and how Polish psychiatrists were ready to protest against it. She recalled that during a psychiatric summit in Moscow, the Soviets wanted to pass a resolution claiming that ‘in Soviet psychiatry everything is fine’, and ‘our delegates did not agree to sign it, and it was an act of great courage’.

While Soviet influence, both institutional and theoretical existed, in the 1970s and 1980s, Polish psychiatry worked to maintain its connections with Western institutions despite Soviet oversight. Reports from the 1985 First Summit of Psychiatrists from Socialist Countries in Moscow, published in Polish Psychiatry (Staniaszek, 1986), show that Polish representatives prepared to counter any Soviet demands to sever ties with Western organisations, referring to the statute of the Polish Psychiatric Association, which allowed for ‘simultaneous membership in multiple international organisations’ (Staniaszek, 1986: 399). Although no such demands were made, the incident underscores Polish psychiatry’s preferred alignment with the West over its obligatory ties to Moscow.

Both the review of the Polish Psychiatry journal and more senior interviewees confirm distinct orientation to the West during the late socialist period. Numerous reports from the journal describe different forms of collaboration and exchange: study visits in Western clinics, research centres, attendance at conferences and other professional events. Since the first publication of Polish Psychiatry in 1967, the majority of publications have featured abstracts in both English and Russian. One interviewee (male, 50 years of clinical practice) concluded: ‘We oriented exclusively towards the West, but we also drew a lot from our own experiences.

Polish psychiatry’s liminal position was not only one of dependency but also one of autonomy and uniqueness, fostering a sense of superiority over both Eastern and Western approaches. An article from 1973 describes Polish psychiatry as a ‘middle ground’ between perceived Western anarchy and Soviet dogmatism (Brzezicki, 1973). This balanced position was framed as more ‘realistic’, with Polish psychiatry standing ‘on the firm ground of reality’ (Brzezicki, 1973: 369). The article criticised the West’s ‘anarchy in medicine’ and dismissed Soviet psychiatry as overly rigid, hinting at its ideological dogmatism. Psychiatry in the West, ‘a small boat in a stormy sea tossed about in all directions . . . almost in danger of sinking’, is contrasted with its Soviet counterpart: ‘a large ship commanded by one self-confident captain’ (Brzezicki, 1973: 368). Comparing Western psychiatry’s agony with the secure path of the Soviets, the author added: ‘It seems that the captain is too self-confident and too calm, and the waters too calm, in comparison with the reality’ (Brzezicki, 1973: 368). This self-perception of Polish psychiatry as balanced and pragmatic reflected its liminality, which Polish psychiatrists framed as a strength.

In the next section, I show how this claimed uniqueness was undercut by Polish psychiatry’s increasing reliance on Western biomedical frameworks. Through the lens of historical conceptualisations of depression, I explore the continuing persistence of the biological explanations which became entrenched in Polish psychiatry during the late socialist period.

The era of endogeny and beyond

Somatic emphasis: Between pavlovism and western psychiatry

By the 1970s and 1980s, Polish psychiatry depicted depression as an endogenous condition caused by dysfunctions in the vegetative regulatory centres of the brain, dismissing the causal role of social factors. The resulting biologisation and individualisation of depression were dependent on the dual impact of Soviet Pavlovism and the Western biomedical model. Evidence of this dynamic can be found in the frequent dual-referencing of both Soviet and Western approaches. For instance, Jus (1970) acknowledged Pavlovian physiology while simultaneously referencing advancements in Western neurophysiology, genetics, and biochemistry. Citing The Neurological Foundations of Psychiatry by J.R. Smythies, published by Oxford University Press in 1966, he concluded: ‘Eventually, feeling states, behaviour, and mental states depend on the details of brain phenomena’ (Jus, 1970: 7).

This dual reference underscores significant theoretical and practical parallels between Pavlov’s theory and Western psychiatry, despite differing ideological underpinnings and disparate economic, political, and social factors in the Western and Soviet worlds. Most notable differences include, for instance, varying diagnostic classification systems. The difference was most notable between the U.S. psychiatry, which used the Diagnostic and Statistical Manual, whereas the Soviet psychiatrists relied on the International Classification of Diseases mixed with different Soviet classifications for many disorders. Furthermore, Soviet psychiatry functioned in a collectivist society, and the state maintained much higher level of institutional and ideological control than it had in the Western individualistic societies (Miller, 1985). This also relates to the conceptualisation of psychotherapeutic treatment. In the Soviet Union, psychotherapy was aimed at re-establishing the individual functioning in the collective (Miller, 1985; Wayne, 1960), while in the West its objectives were more centred on exploring, understanding, and correcting thoughts, emotions, and beliefs about oneself; there was also a greater variation in psychotherapeutic approaches. Interestingly, psychiatrists in the Soviet Union seemed to enjoy much higher professional status in comparison to psychiatrists in countries like U.S. (Miller, 1985; see Engel, 1977).

However, there were also some fundamental similarities between the Soviet and Western psychiatry, especially with increasing significance of biomedicine in Western psychiatry since the 1970s. Western biomedical explanations framed mental illness as resulting from biological abnormalities in the brain or neuro-hormonal tracts in the body, locating the disease within an individual (Cohen, 2016; Moncrieff, 2008). The biomedical model encompasses a series of beliefs concerning the aetiology and presentation of diseases, including the notion that ‘[a]ll illness and all symptoms and signs arise from an underlying abnormality within the body (usually in the functioning or structure of specific organs), referred to as a disease. All diseases give rise to symptoms, eventually if not initially, and although other factors may influence the consequences of the disease, they are not related to its development or manifestations’ (Wade and Halligan, 2004: 1398).

Thus, both Western and Soviet frameworks prioritised the brain as the central organ in understanding mental health, attributing mental disorders to physiological and neurological processes (Serban, 1959; Wayne, 1960). Both paradigms were grounded in empirical and experimental methodologies, with Pavlovian research relying on controlled behavioural experiments and the biomedical model employing clinical trials and laboratory studies. These similarities extended to treatment strategies, as both emphasised biological interventions such as pharmacology and somatic treatments. Whereas the Western biomedical model emphasised neurochemical imbalances and structural abnormalities in the brain, claiming primacy of the biological mechanisms in the origin of the disease (Engel, 1977); Pavlovism attributed the cause of mental disorders to the individual physiological qualities of the nervous system (Serban, 1959).

In late socialist Poland, the dominant approach to depressive states emphasised the somatic aspects. Resulting from inner psychic conflicts triggered by ‘various organic alterations’, such as ‘organic brain damage’ (Rutkowski, 1974), depression was treatable through medications targeting the central and autonomic nervous systems (Strzyżewski et al., 1972). One interviewee (female, 30 years of experience) emphasised that the global research on depression was driven by the discovery of antidepressant drugs’ effectiveness. In the Polish context, in the 1970s psychiatrists were busy discovering ‘what happens on the other side of the synapse and the receptors’ in depression pharmacological treatment, while later on, the research started to ‘dive into the nucleus’, as one of my interviewees observed.

Although some studies acknowledged social and relational aspects of mental illness, the dominant discourse largely minimised these elements. This tendency reflected a broader trend in Polish psychiatry during this period, where external factors were denied causal significance in favour of biological explanations. For instance, Sternalski’s (1973: 413) analysis of neurotic behaviour among female shoe-industry workers highlighted ‘traumatising events’ inherent to such conditions as environmental toxicity, conflicts in the workplace, or family problems such as the lack of support from alcohol-addicted husbands. Despite acknowledging these systemic pressures, Sternalski framed the women’s ‘excessive’ and ‘violent’ reactions as pathological and symptoms of ‘neuroses.’ Gerard et al. (1975: 132) questioned the pathogenetic and expressed scepticism towards (Gerard et al., 1975: 132). Similarly, Strzyżewski et al. (1972) dismissed the role of social and environmental influences in the context of depressive patients who displayed reluctance to return to professional activity after remission of symptoms. Having analysed ‘the family relationships of the sick, their housing conditions, and professional situation,’ Strzyżewski et al. (1972: 446) concluded that ‘no external causes of the behaviour of the sick were found’. attributing mental disorders to social relationships: ‘If mental disorders manifest themselves through disordered interpersonal relations, it is not at all clear that we should frame mental disorders as phenomena conditioned by the interpersonal relations’ relevance of tensions caused by the contemporary environment’ This statement underscores the premise of both Pavlov’s theory and Western biomedicine: the cause of the disorder is internal – rooted in the weakness of the nervous system, or the neurochemically imbalanced brain. But it also shows an important ideological dimension of biologically oriented psychiatry as an ally of the ruling class under differing socio-political regimes.

Though Soviet frameworks had been openly criticised since the mid-1950s, the somatic emphasis in Polish psychiatry might have been due to the heritage of the biologically-oriented Pavlovism as well as the Western neurobiological approaches.² The next section underscores the growing reliance on Western evidence-based medicine in the post-transformational period, and how it reinforced the primacy of the biological explanations of depression by reframing the concept of endogeneity.

Post-1989: The westernisation of psychiatry and dominance of American science

With Poland’s transition to capitalism in 1989, the dependency on the West – preferred during late socialism – became definitive. Polish psychiatry embraced Western, particularly American, science and practices. Unhindered by the constraints of the Iron Curtain, the exchange with the West intensified. Reports in Polish Psychiatry celebrated American achievements, calling the release of the DSM-IV ‘an undoubted bestseller’ (Rybakowski, 1994: 784). Since 1998, abstracts from Western journals such as the British Journal of Psychiatry and the American Journal of Psychiatry have become a regular feature, signalling Polish psychiatry’s alignment with global trends. In the 4th issue of 1998, the abstracts constituted a quarter of the journal’s volume (37 out of 160 pages).

The free market also introduced Western pharmaceutical companies into Poland, reshaping the landscape of depression treatment. Since the early 1990s, advertisements for antidepressants began appearing prominently in Polish Psychiatry, signifying a rising focus on affective disorders and a shift towards pharmaceutical treatment as the standard of care. In 1991, almost a whole issue was devoted to the pharmaceutical treatment of affective disorders, while an editorial from 1994 reads that affective disorders and their treatment are ‘currently one of the most frequently tackled topics of research studies’. Before the 1990s, black-and-white advertisements, squeezed in a box shape, were scattered throughout the whole issue and rare; since the 1990s, they have started appearing on the initial pages and in a new visual layout: colourful photographs and better-quality paper. The scale also increased: in an issue from 1994, advertisements occupy the first 5 pages, in 1997 they occupy 11.

Sponsored articles devoted to antidepressants appeared in the early 1990s. A report from the annual meeting of Polish psychiatrists (Araszkiewicz and Dróżdż, 1998: 538) states that the primary sponsors’ remote ‘educational’ sessions were a ‘significant element’ of the meeting, manifesting ‘a new quality of cooperation between the Polish Psychiatric Association and pharmaceutical companies’. The sponsors included Eli Lilly, Servier, Smith-Klein-Beecham, and others. In the opening of an issue from 1994, Eli Lilly wished the journal’s readers ‘lots of health and joy’ in the new year, while the next page featured an advertisement of Prozac illustrated by the Golden Gate Bridge, which played with Polish sentiments towards the West embodied by Ameryka (the U.S.). The advertisement ends with a statement about Prozac’s safety and efficacy: ‘We do not know how many people crossed the Golden Gate, for sure there were millions, but we know that within the last years, Prozac was used by 24 million patients in 90 countries across the world’. Pharmacology became the golden standard in depression treatment.

‘In Poland we treat depression the way it is treated all over the world – our standards do not differ from world standards, we treat depression the same way, not worse for sure, we have the same drugs, the same treatment methods’, an experienced psychiatrist, author of publications on depression, and a prominent figure in the Polish Psychiatric Association, told me in an interview. Explaining why Polish psychiatrists use the ICD for diagnostic purposes and DSM for research purposes, she noted that ‘U.S. science’ is ‘the most developed and most journals are based on’ it.

The next section examines how theoretically multifactorial conceptualisations of depression culminate in a master narrative of a ‘vulnerable brain’, thereby reinforcing the emphasis on somatic causation.

New endogeneity

In the context of increasing influence of Western biomedicine in the 1990s (Nowakowski, 2016), the existing conceptualisations of depression became entrenched, albeit under new wording. The transition to the post-socialist era in the 1990s marked a shift in terminology, as the concept of ‘endogenous depression’ became obsolete, as its usage diminished in research published in Polish Psychiatry. Reflecting on diagnostic changes during the transition from socialism to capitalism, psychiatrists noted the disappearance of ‘endogenous depression:’

Now, we rarely use the term ‘endogenous depression,’ but for some people, it fits, in the sense that you can see it is so deep, such a deep depression without any clear external causes (. . .), deeply debilitating, slowing down, that it cannot be linked to anything specific.

In the Polish People’s Republic (PRL), there was ’endogenous’ depressive psychosis, and then the era of endogeny ended. .

Although the term ‘endogenous depression’ disappeared and the theoretical understanding of causation became more sophisticated, the conceptualisation of depression as endogenous persisted, albeit in the new terminology of biological vulnerability (Pol. podatność biologiczna). This concept appears in research articles published in Polish Psychiatry between 1990 and 1998. In 1995, Bomba and Jaklewicz define biological vulnerability as ‘an impairment of the central nervous system and genetic transmission’ (Bomba and Jaklewicz, 1995: 162). They suggest that depression in children stems from the ‘depressive attitude’ of parents rather than prolonged economic hardship (Bomba and Jaklewicz, 1995: 171).

Despite psychiatrists acknowledging that biological mechanisms, including genetics, remain poorly understood and uncertain, biological substrates are prioritised in explaining their causation. An interviewee with a prominent position in the Polish Psychiatric Association (a woman with 30 years of clinical practice) describes the primacy of biological causation as biological vulnerability:

Depression is a dysfunction of the stress axis, some disorder in the immune system—this emphasizes that depression is also a biological disease (. . .) and such biological factors are overlaid with psychological factors. . . In general, a dominating paradigm is vulnerability-stress—vulnerability-environmental factors, that is, some biological vulnerability, which may have some genetic basis, but also some adverse factors in the prenatal period or early childhood. . . On top of these vulnerability factors are various traumatic, stressful situations that sort of activate these vulnerability factors and, as a result, give rise to the disease.

In this framing, vulnerability is not exclusively genetic; adverse developmental factors also impact the brain. Environmental influences ‘become the brain’, and the constellation of genetic predispositions and environmentally altered brain development constitutes ‘vulnerability’, which can lead to depression. Adverse social arrangements and harmful social bonds are framed as merely ‘superimposed’ on an already vulnerable brain. Ultimately, depression is conceptualised as a disorder of a vulnerable brain that becomes unbalanced.

Today, the need for pharmaceutical management of depression is widely accepted in Poland. All my interviewees claimed that drugs are necessary, effective, and safe. While the mechanism of depression remains non-specific, treatment focuses on addressing the ‘lack’ in the patient’s brain. Therefore, the medication itself stabilises the neurobiological conceptualisation of depression as a ‘lack in the brain’ (see Szulecka, 2023, 2024). One interviewee noted:

I do not have a single understanding of how it looks at the biological level, depression, that there is some serotonin deficiency in the brain or something like that. But when it comes to treatment, I look at how the patient functions and what they might be lacking, and I try to match the medications. . .

With the dominance of evidence-based psychiatry radiating from the Western capitalist core countries, the dual dependency of Polish psychiatry during socialism shifted towards an exclusive one in the post-transformational period.

Discussion and conclusion

This study argued that the biological explanations of depression emerged in late socialist Poland due to the dual influence of biological Pavlovism and Western biomedically-oriented psychiatry. The political dependency on the Soviet Union and the economic, cultural, and scientific dependency on the West in the 1970s (Zarycki, 2020) shaped psychiatry’s neurobiological orientation, enforcing the acceptance of the biomedical model of mental illness. Dual dependency was not unique to Poland. Thormann et al. (2014) noted that in the DDR, psychiatrists relied on Soviet as well as Western influences in their approach to depression. At the beginning of the 1960s, East German doctors abandoned Pavlovism to align more closely with Western frameworks (Thormann et al., 2014; see Leuenberger, 2007). Similarly, Lūse (2011) claims that in the socialist Baltic states, the influence of Western (German) biological psychiatry blended with the Pavlovian materialistic approach. Similar processes took place in Poland, which supports a complex view of psychiatry in the Eastern Bloc as not merely ‘socialist’ psychiatry isolated from the ‘capitalist’ impact, but an already global, transnational (and transcultural) field.

Contrary to the argument that biological conceptualisations of mental distress serve as a smokescreen for the ills of capitalism in Western neoliberal societies (Cohen, 2016; Moncrieff, 2008), the findings show that the biological and individualised definitions of depression were present in the socialist Eastern Bloc, which was not isolated from the developments behind the Iron Curtain. Such a perspective allows for rethinking the role of psychiatric discourse concerning the state and its production regimes. For example, Cohen (2016) underscores that psychiatry’s ability to naturalise and essentialise the biological causation of mental illness and the resulting biological and individualised definitions of disorders allow for psychiatry’s hegemony within Western neoliberal societies. Locating the pathology in an individual allows us to divert attention from the economic and political forces shaping material conditions of social life and its values. Instead of reflecting on the unjust social arrangements, societies are encouraged to look into their mental symptoms and heal from personal traumas. Consider the immense traction that biopsychological explanations of ADHD or depression have gained in contemporary liberal societies (Cohen, 2016; Conrad and Bergey, 2014) and their export in a global context (Clark, 2014; Lakoff, 2004; Mills, 2014). Psychiatric discourses which individualise distress and diminish the role of social factors in the emergence of mental illness, offer a protective shield for the interests of the capitalist ruling class. This synergy explains the global proliferation of the psychiatric discourse, in other words – its hegemonic position. However, as I have argued, the construction of the depression category in the socialist state bypassed the social causation of distress, attributing the disorder to organic malfunction. This supports Cohen’s argument that psychiatry is inherently an institution of social control (Cohen, 2016) – regardless of the production regime – but it also complicates the narrative about the ideological distinctions between ‘socialist’ versus ‘capitalist’ (or ‘neoliberal’) psychiatry. Recognising the dual dependency on both the West and the Soviets in the countries of the Eastern Bloc allows us to conclude, in agreement with Savelli (2018), that rather than being a pure reflection of the socialist doctrine, psychiatry in the socialist countries exhibited an ideological hybridity.

The shift towards the capitalist organisation of society in the 1990s strengthened the exclusive dependency on the Western biomedical frameworks, which further minimised the role of the social factors. Scholars studying post-socialist countries of the Eastern Bloc argue that psychiatry often obscured the structural pathologies of the capitalist transition by locating disorders within mentally pathological individuals, rather than questioning the broader socio-economic transformations shaping these conditions. For instance, Friedman (2016) discusses the transformation of psychiatry in post-socialist Romania within the context of the region’s turbulent transition to capitalism, illustrating how psychiatric practice depoliticised mental distress, framing it as a biological issue divorced from its social origins: ‘As the contribution of social problems to the suffering of those with mental illnesses has increased, some Romanian mental health practitioners have moved away from a concern with these social problems under the guise of aligning their psychiatric practices with (imagined) Western standards of biomedical care’ (Friedman, 2016: 4–5). Within this context, psychiatry in Poland and other CEE countries began to mirror the neoliberal logic of individual responsibility (Friedman, 2016; Lūse, 2011).

The experience of Poland during its transition further supports the argument that the biological explanations for depression fostered the depoliticisation of suffering induced by the socio-economic shift towards free-market frameworks. While inequality levels in Central and Eastern Europe (CEE) during the 1980s were comparable to those in Western Europe, the transition period after 1990 brought significant increases in inequality. In Poland, between 1993 and 2010, researchers observed ‘a moderate but steady growth in inequality’ (Brzeziński et al., 2013: 11). Although absolute poverty declined, relative poverty and social inequalities grew (Malinowska, 2016). This rising inequality accompanied a dramatic restructuring of social provisions. Adopting ‘recipes from Washington and Chicago’, the Polish government implemented Western-style shock therapy, dismantling social safety nets and imposing market-driven reforms (Morawski, 2010: 26).

These processes, accompanied by mass lay-offs, and raising unemployment, inflation, rapid restructuring of public enterprises into private companies (Hardy, 2009) induced dramatic sense of instability which had its emotional cost for significant numbers of Poles. In an ethnography of depression in Poland, Sokół (2023: 58) writes: ‘[a]s a new idiom of distress, depression began to emerge in the 1990s in the new problem space of the ongoing transformation, marked by rising unemployment, insecurity, and poverty, all initially understood as necessary costs of the transition to capitalism, in part a legacy of the ‘pathologies of socialism,’ in part a temporary feature of the chaos of transition’. This new idiom of distress intensified its presence in the 2000s with changing work and production regimes, as the new capitalist state was shaping self-responisble individuals (Sokół, 2023; Szulecka, 2023, 2024). These developments unfolded within processes of psychiatrization marked by public awareness raising on depression, adoption of international diagnostic systems in Polish psychiatry, and an influx of pharmacological treatments produced by foreign pharmaceutical companies (Sokół, 2023).

The history of depression as conceptualised by Polish psychiatry shows that mental health care and concepts are tied to international forces. The Polish case study is particularly heuristic, as it shows how several influences converged in producing an approach to depression: Soviet psychiatry on the one hand, and Western biomedicine on the other. These two influences were not as different as it is sometimes claimed, and in practice the individualisation of depression in Poland was mutually reinforced by both. This study thus demonstrateses that sociologists and historians of mental health should complicate their critique of Western psychiatry and refine it, through comparative case studies that reveal the historical and structural foundations of contemporary globalised conceptions of mental illness.

Footnotes

ORCID iD

Beata Radomska

Ethics considerations

The author has received the approval of the Ethical Committee of the Institute of Philosophy and Sociology of the Polish Academy of Sciences on June 21st 2021, the number of application 2(2021).

Consent to participate

I hereby confirm that all participants of the study gave verbal informed consent during the interviews led by the author between 2021 and 2023.

Author contributions

Beata Radomska - Conceptualisation, Writing.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Notes

Author biography

Beata Radomska is a critical mental health scholar affiliated with the Institute of Philosophy and Sociology of the Polish Academy of Sciences in Warsaw. Her research focuses on Polish psychiatric discourse on depression, contextualising it within a global and historical framework. Her other work has been published in journals such as Social Science and Medicine (under her maiden name, Szulęcka).

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