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RésuméAvec la révolution d’Octobre, une partie des psychiatres se rallia aux bolcheviks qui leur donnèrent « carte blanche » pour réaliser les réformes qu’ils réclamaient de longue date. La Commission de neurologie et de psychiatrie, créée en 1918, s’employa alors à améliorer le fonctionnement des institutions psychiatriques, les hôpitaux en premier lieu dans le but d’en faire de véritables structures de soin. Pourtant, en 1928, un projet de décret constatait, pour le dénoncer, que la production médicale y était des plus médiocres. C’est l’objet de cet article que d’étudier les retombées de la politique conduite en faveur des établissements psychiatriques et, par là, de faire ressortir les facteurs qui ont pu peser sur sa réussite. Pour cela, un parcours kaléidoscopique est proposé qui entend confronter les conditions héritées du tsarisme, les objectifs institutionnels, le rôle du personnel et la place des reclus.

Following the October Revolution, some psychiatrists rallied to the Bolshevik cause. The latter authorized them to carry out the reforms they had been long been asking for as they saw fit. The Neurology and Psychiatry Commission, established in 1918, subsequently busied itself with improving the running of psychiatric institutions – and notably that of hospitals – in order to transform these into proper health care structures. Those responsible for the psychiatric administration, who were gambling their recently-acquired legitimacy, claimed that the organisation of hospitals and medical production had been improved. In reality, however, the latter were unable to overcome several problems. The first of these was financial: those in charge of health care institutions did not have the funding patients and staff required. The second of these problems was linked to the diversity of the patients themselves, whose heterogeneity called for every more numerous measures which overwhelmed those procedures and methods which had been designed to care for mental disorders. The third problem was the overcrowding of hospitals, which led to competition among those interned for equipment, medicine and staff attention. The final destabilising factor was the shortage of nurses and carers, who were largely inadequetly trained for the tasks they were supposed to undertake. In the end, the level of organisation of hospitals was determined by the capacity of those in charge to deal with these problems locally so as to develop medical production to the extent that this was possible.