Hidden Madness: Mental Health Governance in Socialist Bulgaria
Hidden Madness: Mental Health Governance in Socialist Bulgaria

The Case of the Dispensary Method

Summary/Abstract: The history of psychiatry in socialist Bulgaria (1944–1989) is largely a blank. The scarce literature available on the subject offers a sanitized history written by Bulgarian psychiatrists themselves. The lasting impression is that they cannot or do not want to say what happened – what was the private, political, material, scientific life of the psychiatric field in this country in the period in question. Against the backdrop of the state of the Bulgarian mental healthcare system today and the specificities of the socialist period that will be outlined and discussed in this paper, it is only natural to ask about the legacy effects, i.e. whether, and in what ways, the socialist psychiatric system and professional community left a dire legacy in which we are still entangled today. Or, conversely, are there any distinct achievements and socialist good practices whose abandonment during the years of transition has further affected the quality of care? Arguably no other practice from that period has generated more contention among Bulgarian psychiatrists since 1989 than the so-called dispensary method. Psychiatric dispensary care is very specific1 because it embodied the great ambitions of the psychiatric system, was promoted by the professionals and maybe even experienced by the patients themselves as an instance of real care on the part of the state; at the same time, however, its core practice – putting people on a register with a lot of crucial information about their health – was always linked to fears about its implications for all aspects of their lives. Due to this specific status, the present study is mainly focused on it.

• Details
• Contents