In Shock Therapy: Psychology, Precarity and Well-Being in Postsocialist Russia, Thomas Matza offers an ethnographic account that explores the rise of psychotherapy in post-socialist Russia. Through in-depth interviews and observations of psychotherapists working in different institutions across the country, Matza not only probes deeply into their practice and perspectives, but also gives a human face to Russian experiences of flux and transition, writes Michael Warren.

Shock Therapy: Psychology, Precarity and Well-Being in Postsocialist Russia. Tomas Matza. Duke University Press. 2018.

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Since Russia’s tumultuous transition from communism to capitalism in the early 1990s, the country has grappled with economic, political and cultural challenges, which have frequently been the focus of academic studies. Tomas Matza’s examination of psychotherapy in Russia offers a novel vantage point from which to understand the stories of individual Russians who have faced these challenges. The book’s title, Shock Therapy, is a play on the neoliberal reforms that have happened in that transition, in which, as Alena V. Ledeneva put it, there was ‘too much shock, and too little therapy’.

In the 1990s, Russia experienced a psychology boom, which gave rise to a proliferation of treatment options and increased demand from Russians. A broad range of people became involved in providing psychotherapy and, as Matza puts it, their work offers a means to understand what Russians thought of ‘the self, the other, emotions, disorder, healing, and potential’ at a time of transformation. Matza’s ethnographic study brings a nuanced lens to view post-socialist Russia, showing that the ‘neoliberal governmentality’ is not the only factor in the rise of psychotherapy. Instead, there are other rationales and aims which should be taken into account, such as the humanisation of doctor-patient relations, the de-medicalisation of care and a shift from ‘patient’ to ‘client’, amongst other goals.

Matza, Assistant Professor of Anthropology at the University of Pittsburgh, conducted fieldwork with psychotherapists on and off between 2005 and 2013 in St Petersburg. Matza undertook fieldwork through varied means: observing psychotherapy sessions, listening to psychotherapy radio phone-ins and reversing roles with practitioners, thereby giving them a seat to discuss their lives. Fieldwork took place in a variety of settings too, creating striking contrasts for readers, such as that between the commercial psychological camps (given the alias ‘ReGeneration’ in the book) for affluent children learning self-management techniques and state services (Psycho-Pedagogical Medico-Social centres, or PPMS), overwhelmed by demand from children whose families were often troubled by issues relating to alcoholism, suicide, divorce and abuse. The approaches to the children of the centres are starkly opposed: ReGeneration using psychology as a positive means for helping children reach their potential, with PPMS approaching the child ‘as a kind of machine in crisis whose function must be improved’. The reader feels like there is a tale of two Russias here.

Image Credit: St Petersburg, Russia (kishjar? CC BY 2.0)

First encountering Russia in 1994, Matza’s long relationship with the country is clear, with personal experiences infused throughout the book. These experiences and the vivid case studies give balance to a text that is heavily anchored in the theories of the likes of Michel Foucault, Jacques Rancière as well as other powerhouses. The peppering of these in the book helps position Matza’s ideas and gives the foundations for him to build his own unique understanding of the subject matter, though it does reduce accessibility for lay readers.

Matza’s study is heavily situated in the perspectives of the psychotherapy practitioners he interviews. These interviews enable him to probe deeply into their motivations. Matza explains that one psychotherapist joined the profession in response to the ‘unravelling’ of the world around them in the 1990s, with psychotherapy offering ‘mooring, and eventually, a professional identity’. On the other hand, there are some psychotherapists who are ‘uninterested in anything but earning more money through therapy’, according to one of Matza’s interviewees. Meanwhile, psychologists working in the ReGeneration camps with the children of elites viewed themselves as social reformers. Their ‘civilising concern’ (Matza’s description) comes from their view that if they can alter the behaviour of the young elite clientele for the better through lessons of emotional interdependence, empathy, civility and personal responsibility, then Russia as a country can benefit. The more the reader learns about the entrenched problems of Russia, however, the more this civilising mission can feel quixotic. Matza also points out that the ReGeneration psychologists’ intended values for their clients was defined in a subtractive way: clear what they are against (a version of the Soviet past and the style of the current Russian elites), but not what they were for.

When thinking about the care of a client, most would picture there to be only one vulnerable person in the practitioner/client relationship. In Matza’s concept of ‘precarious care’, both practitioner and client are vulnerable. In the PPMS centres visited by the author, practitioners were in fragile positions as they were working with meagre financial support, snowed under by burdensome administration and anxious about harsh inspections. A major reason for the latter two is the audit culture instigated by the reforms of Vladimir Putin, which can be roughly distilled to audits, standardisation and systemisation. These manifest themselves in measurability, an overly bureaucratic culture and the treatment of citizens as consumers. One example of the overly bureaucratic culture recounted by Matza is that if staff of the PPMS centre go beyond their legally mandated duty to protect children, they face reprimand from senior management, for whom the PPMS centre’s work was primarily ‘a matter of results and protocols’. Admirably, this does not deter PPMS staff from finding ways to work around this: for example, the development of a collaboration with a ‘sister organisation’ affiliated with local police to meet on a monthly basis in order to share data of clients the PPMS centre first encounters, thus enabling the sister organisation to make best use of its limited time with those clients. However, these positive stories from the PPMS centre are rare and the audit culture, coupled with the jottings of Matza’s observations of cases, make for melancholy reading:

Case: Eight-year old boy. Fears. Bad self-image. Screams at school and can’t be restrained. Parent advice sought. Practitioner was unable to help. Dispatched to another school.

Not all of Matza’s material came from on-site interviews. A radio show hosted by a psychologist provides fertile ground for further understanding issues in contemporary Russia. One particularly striking debate mediated by the host, Mikhail Labkovsky, focused on inter-generational relations. Public transport is an arena for clashes between generations, where older people called the show to vent their fury that younger riders refuse to give up seats on the metro. Younger callers responded over the air by insisting that they were entitled to a seat as they had paid for it and were irked by the rudeness of their elders. This debate displays a telling clash of conceptions of citizenship: social custom versus consumer models.

This debate took place in the shadow of neoliberal reforms to replace elderly benefits such as free metro rides with meagre cash payments. One elderly caller linked the ‘boorish behaviour’ of youths on transport to alterations to benefits and the attitudes of the upper echelons of government: ‘attitudes to the elderly are administered from the top, that’s why we have this atmosphere in society’. The chapter on the radio show is a particularly insightful one in comparison to the rest of the book, as due to the democratic nature of the radio phone-in, Matza has unbridled access to the views of those seeking psychotherapeutic help more so than in other areas of his fieldwork.

Shock Therapy dissembles the many layers of psychotherapists’ personalities and practice with rigour, making poignant and nuanced observations about the state of contemporary Russia. The book could benefit from more coverage of the perspective of clients, who for most of the book are passive and often voiceless. Matza nonetheless acknowledges that there are limitations to his access to such perspectives, particularly of those in PPMS care.  Given the time span of the fieldwork and theoretical literature surveyed, Shock Therapy is an achievement of conciseness. The role reversal of putting psychotherapists on the couch means that Matza is not only able to probe deep into the phenomena of psychotherapy, but also give a human face to the flux of post-socialist Russia.

Michael Warren completed an MSc in Empires, Colonialism and Globalisation at the LSE in 2012, and graduated from the University of Sheffield (studying on exchange at the University of Waterloo, Ontario) with a BA in Modern History in 2011. He researched on an open data project for Deloitte and the Open Data Institute, and worked for the All-Party Parliamentary Health Group and as a Management Consultant in Health and Public Service at Accenture. He is a Policy Adviser at the Professional Standards Authority.

Note: This review gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics.

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