Pyotr Gannushkin


Pyotr Borisovich Gannushkin was a Russian psychiatrist who developed one of the first theories of psychopathies known today as personality disorders. He was a student of Sergei Korsakoff and Vladimir Serbsky. Not only did he manage to delineate certain organizational tasks of social psychiatry, but he also clearly formulated the main methodological aim of social psychiatrists, to combine methods of individual clinical analysis with sociological research and generalization.

Biography

Early life and education

Pyotr Borisovich Gannushkin was born in the Russian Empire in 1875 in the village of Novosyolki in the Pronsk district of the Ryazan Governorate. His father Boris was a physician, a compassionate and precise man. His mother Olga came of an impoverished Russian landed family. Well-bred and educated, she was fluent in French and German, interested in philosophy, and fond of music, poetry and art. She was, moreover, a gregarious and kind-hearted woman.
In his early years, Pyotr was educated by his mother. After a while, the family moved to Ryazan, the regional capital, where his father started teaching at a high school for boys. Soon after his 9th birthday, the young Gannushkin enrolled at the same school. An excellent student, Pyotr was always sociable, honest, and inclined to irony; he nursed a dislike for severe discipline. During his school years, he edited his own home journal.
Gannushkin's sister Maria noted in her memoirs that Pyotr never told anyone which profession he intended to pursue. When he turned 13, however, Gannushkin's keen interest in "personology" and human mentality became apparent. It was then that he read Sechenov's monograph "Brain Reflexes", a successful attempt to describe the physiological mechanisms of mental activity.

University years

In 1893 Gannushkin graduated from the high school with a gold medal, the highest award, and entered the department of medicine at Moscow State University. In his third year of studies, he finally decided to become a psychiatrist after being influenced by such university professors as Aleksei Kozhevnikov and Sergei Korsakoff.
All the students, including Gannushkin, were fascinated by the way Korsakoff interacted with the mentally disabled. As Korsakoff explained, "mental patients should not be regarded as soulless creatures: they should be considered personalities familiar to everyone who is somehow related to them."
In addition to attending lectures and //recitations during his university years, Gannushkin served as an orderly with the responsibilities of a junior medical staff member.

Academic career

Gannushkin graduated from Moscow University in October 1898. He turned down a proposal to become a permanent resident physician, because it then included superintendent's responsibilities. During the next years, up to 1902, he was a non-resident of the psychiatric hospital. He worked in the outpatient clinic and wrote a variety of scholarly works.
In 1901, for example the French journal Medico Psychological Annals he published a monograph called "Voluptuousness, cruelty and religion", which was subsequently banned in Russia. In it Gannushkin emphasized the close relation between religiosity, sexuality, and cruelty, using the example of Ivan the Terrible as an illustration. In many cases religious fanatics demonstrated cruelty, wrote Gannushkin, and vice versa, i.e. many cruel people were religious.
In 1902, at the suggestion of Sukhanov, Serbsky, and Rossolimo, Gannushkin was made a full member of the Moscow Society of Neuropathologists and Psychiatrists. At the same time, he was elected a supernumerary assistant at the psychiatric hospital headed by Serbsky, after Korsakoff's early death from heart failure.

The role of Sergei Sukhanov

Korsakoff's assistant Sergei Sukhanov was willing to help young physicians, fostering them in word and in deed.
Sukhanov and Gannushkin formed friendly relations. Sukhanov was a proponent of nosological approach. A remarkable power of observation was a peculiarity of his nature. Borderline psychiatry, especially psychopathies and psychogenies, was among his main research interests. Thanks to his inclination towards synthesis, Sukhanov noted both the scientific and social importance of this problem. He managed to stir Gannushkin's interest in this issue.
Gannushkin published [|six research papers] together with Sukhanov. They preferred to study particular mental disorders taken by themselves rather than their mixed types, because they thought that it would contribute to the study of acknowledged diseases, discovery of new mental disorders, and development of psychiatric classification. Sukhanov and Gannushkin distinguished an especial form of obsessions and were the first to show the process when, at least in some cases, obsessions were transformed into schizophrenia.

''Acute paranoia'' (1904)

In 1904, Gannushkin presented his thesis "Acute paranoia", an historical sketch of the historical development of the theory of that condition. It begins by describing the research of Vincenzo Chiarugi and Jean-Étienne Dominique Esquirol. The focus then shifts to works by Wilhelm Griesinger, Bénédict Morel, and Carl Friedrich Otto Westphal. Next he presents the observations made by Sergei Korsakoff, Vladimir Serbsky, Emil Kraepelin, and Eugen Bleuler. Finally Gannushkin gives a brilliant exposition of his own findings about paranoia.
After the presentation of his thesis, Gannushkin became a privatdocent of the Department of Mental Disorders in the Moscow State University. It was the moment he started lecturing his course called "The Theory of Pathological Characters".
In 1905 Gannushkin visited postgraduate psychiatry courses at Kraepelin's clinic in Munich. After that he became a proponent of Kraepelin's theory. In 1906 Gannushkin visited St. Anne's Psychiatric Hospital in Paris, where he familiarized himself with the work of an influential figure in French psychiatry, Valentin Magnan. In 1908 and 1911 Gannushkin repeatedly visited postgraduate psychiatry courses at Kraepelin's clinic.

Resignation (1911) and post-Revolutionary career

In 1911 university autonomy became a crucial issue in Russia, leading to repressive measures by the Tsar's protégé Lev Kasso, the education minister. In 1911, together with other progressive scholars and scientists, Gannushkin left the university in protest. From 1906 until to 1914, when he was drafted into the army, he worked as a resident physician at the Moscow Alexeyev Psychiatric Hospital, known today as the Kashchenko Mental Hospital. During this period Gannushkin and othere set up a first-class research journal, The Korsakoff Journal of Neuropathology and Psychiatry.
In 1917, after being discharged from the army for health reasons,Gannushkin returned in the Moscow Alexeyev Psychiatric Hospital. From 1918 onwards he was a professor in the Department of Psychiatry at the Moscow State University and director at the University Psychiatric Hospital: today this is known as the Korsakov Clinic of Psychiatry at the Sechenov Moscow Medical Academy.

His work

Gannushkin was one of the first psychiatrists to talk about the schizoid reaction type, the somatogenic and psychogenic reactions of schizoids.
In 1927, he identified the "epileptoid reaction type", which is usually characterized by repeated temporary reactions caused by the influence of psychogenic factors and unfavorable situations. This reaction type is expressed by symptoms of dysphoria, i.e. malicious actions combined with anger, anguish, and fear. In many ways, this reaction type is akin to the behavior pattern typical for borderline personality disorder. As a psychotic episode, such reactions could happen during epidemic encephalitis, cerebral atherosclerosis, and brain injury.
Gannushkin also took part in the experimental study of hypnosis. He criticized Lombroso's theory of crime.
Gannushkin was interested in psychoanalytical ideas, and made experimental use of psychoanalytic therapy. His stance on psychoanalysis is outlined in his "On Psychotherapy and Psychoanalysis". Not a committed proponent of Freud's theory, Gannushkin did believe that under certain conditions psychoanalytical methods could be used as part of the process of treatment.
Gannushkin regarded war and revolution as a "traumatic epidemic" affecting the entire population. There is a reciprocal influence, he used to say, between the mentality of the population and its life in society.
Under Gannushkin's direction a new form of medical care for people with mental disorders was created in Russia. He helped to organise a network of psychoneurological out-patient clinics in the USSR. He worked on issues linked to the teaching of psychiatry and the prevention of mental illness.
is a mathematician and human rights activist said to have been a serious contender for the 2010 Nobel Peace Prize.

Marriage and children

Pyotr Borisovich Gannushkin married Sofia Vladimirovna Gannuskina. They had a son, Alexey Petrovich Gannushkin, an aircraft design engineer, USSR State Prize Laureate. Gannushkin's granddaughter, Svetlana Gannushkina, is a mathematician and human rights activist who was reported to have been a serious contender for the 2010 Nobel Peace Prize. Svetlana Gannushkina worked for many years as a professor of mathematics at the Moscow State University. She is a member of the Council for the Development of Civil Society Institutions and Human Rights under the President of Russia.

Personality and views on psychiatry

Gannushkin was a modest and diffident man and he disliked public speaking. When attending psychiatric conferences, he preferred to stay in the background. Only among fellow scientists and when lecturing to his senior students was Gannushkin able to open his mind. An experienced clinician, he was a proponent of the natural science method who considered himself an enemy of pompous and meretricious declamation.
Gannushkin's power of observation was enhanced by his erudition and ability to discern the most useful points in a variety of different monographs and articles. He recorded each new thought and accurately gathered all required materials. His lectures and clinical vignettes show how carefully he scrutinized and systematized all the research data he was working with.
As L.A. Prozorov commented: "Gannushkin could stir the interest of young people in research, even if it was crude; he sought out and selected research scientists." Remembering her husband, Sophia Gannushkina said, "Once he decided to do something, he grew fearless."
Throughout his life, Gannushkin believed that psychiatry and our life in society are closely connected. To him a psychiatrist was primarily a community worker. That is why, perhaps, he made psychopathies his main research subject.
"Our generation does not limit itself to psychiatric hospitals. Using the same approach, we visit schools, barracks, and prisons. We are not looking for those who need to be hospitalized, but for the half-normal, borderline types, those who represent intermediate steps. Borderline psychiatry, minor psychiatry... - here is a motto for our times, an area to which our actions must be directed in the immediate future."

Death and influence

While Gannushkin was finishing his seminal work on the Manifestations of psychopathies: their statics, dynamics and systematic aspects, his health quickly deteriorated. After long hesitation he agreed to undergo the proposed operation. The best Russian surgeons and physicians tried to save him, but he died on 23 February 1933. Before his death he managed to read his monograph after proofreading and approve it for publication. The book appeared that year following his death.
Research papers written by Gannushkin and his followers represent a landmark in the theory of psychopathies in Russia. Among Russian psychiatrists, it was Gannushkin who developed the most accurate definition of various psychopathies. Gannushkin had many followers, among who it is possible to distinguish three generations.
The first generation of disciples was formed of colleagues who worked under his direction: D.A. Amenitsky, I.N. Vvedensky, T.A. Geyer, V.A. Grombakh, M.O. Gurevich, P.M. Zinovyev, E.K. Krasnushkin, L.A. Prozorov, L.M. Rezenstein, M.Y. Serieysky, T.I. Yudin. The second generation was made up of Gannushkin's senior students: B.A. Belousov, A.G. Galachyan, F.F. Detengor, S.G. Zhislin, A.N. Zalmanov, M.Z. Kaplinsky, R.E. Lusternik, N.S. Molodenkov, A.N. Molokhov, N.I. Ozeretsky, D.S. Ozeretskovsky, T.P. Simpson, Y.A. Florenskaya, B.D. Fridman, Y.P. Frumkin, A.O. Edelstein. A third generation included his junior students. Together, Gannushkin's followers made significant contributions to the development of psychiatry in Russia.
In 1933, the Health Care Commissariat's Research Institute of Neuropsychiatric Treatment established an annual Gannushkin award. In 1936, Moscow's Psychiatric Hospital No.4 was named after Gannushkin. Later a Gannushkin memorial museum was created inside the hospital. A river embankment in Moscow was also renamed in his honor.
Gannushkin was immortalised in fiction as Professor Titanushkin, a character in Ilf and Petrov's satirical novel The Little Golden Calf.

The theory of psychopathies

Pyotr Borisovich Gannushkin divided psychiatry into two principal categories: major psychiatric conditions, such as schizophrenia, bipolar disorder, etc., and minor psychiatric conditions. The theory of psychopathies or "pathological characters" is regarded as Gannushkin's main contribution to the discipline.
In Manifestations of psychopathies: statics, dynamics, systematic aspects, Gannushkin distinguished two types of pathological development: constitutional and situational. The situational development of psychopathy is evidently caused by trauma or distress: its onset is always marked by some serious mental change, after which everything becomes more or less static. While the statics of psychopathies refer to the actual substance of the subject, noted Gannushkin, the dynamics of psychopathies indioate the types, laws, and developmental schemes of psychopathies.
Gannushkin did not consider psychopathies to be progressive mental states and contrasted them with serious mental disorders that caused retardation. Borderline psychiatry, he was at pains to emphasise, includes a wide range of different transitional steps and transient mental states. He acknowledged that psychopaths have made substantial contributions to science, scholarship, art, and literature.
Gannushkin delineated the three main signs of behavioral pathology that underlie psychopathies:
Some elements of Gannushkin's typology were later incorporated into a theory developed by Andrey Yevgenyevich Lichko, another Russian psychiatrist interested in personality disorders together with their milder forms, the "accentuations of character".