Pyotr Gannushkin

Pyotr Borisovich Gannushkin (Пётр Бори́сович Га́ннушкин) (March 8, 1875, Ryazan Governorate – February 23, 1933, Moscow) 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 - the combination of methods of individual clinical analysis with sociological research and generalization.

Biography






Early life and education
Pyotr Borisovich Gannushkin was born in 1875, in the countryside Novosyolki of the Pronsk District of the Ryazan Governorate (present-day Ryazan Oblast) in the Russian Empire. His father, a responsive and punctual man, was a physician. His mother, née Mozharova, was of Russian impoverished squireens. She was well-bred and properly educated, fluent in both French and German languages, interested in philosophy, fond of music, poetry, and art. Furthermore, she was a gregarious and kind-hearted woman.

In his early years, Gannushkin was educated by his mother. After a while, his family moved to Ryazan, where his father started working in the men's high school. Gannushkin entered that school soon after he had turned 9 years-old. An excellent student, he always was a sociable, honest, and ironically inclined person who disliked severe discipline. During his school years, Gannushkin was involved in the editing of his own home journal.

His sister, Maria Borisovna, noted in her memoirs that her brother never told anyone which profession he wanted to choose, but when he turned 13 years-old, his keen interest in "personology" and human mentality became apparent. At the same time Gannushkin read Sechenov's monograph "Brain Reflexes," which was a successful attempt to describe physiological mechanisms of psychic activity.

University years
In 1893 Gannushkin had graduated from the high school with the gold medal and entered the department of medicine of the Moscow State University. When he was a third-year student, he finally decided to become a psychiatrist 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. He explained that "mental patients should not be regarded as soulless things; instead, they should be considered personalities familiar to everyone who is somehow related to them."

Except for visiting lectures and recitations during his university years, Gannushkin was an orderly who carried out responsibilities of the junior medical staff.

Academic career
Gannushkin graduated from the university in October 1898. He turned down a proposal to become a permanent resident physician, because at that moment it included superintendent's responsibilities. During the period of four years, up to 1902, he had been a non resident of the psychiatric hospital. He spent those years in the outpatient clinic and wrote a variety of scholarly works. For example, in 1901 in the French journal "Medico Psychological Annals" (Annales médico-psychologiques) he published a monograph subsequently banned in Russia. It was called "Voluptuousness, cruelty and religion" (La volupté, la cruauté et la religion). In this work, Gannushkin emphasized the fact that religiosity, sexuality, and cruelty were closely related to each other. He illustrated it with the example of Ivan the Terrible. According to Gannushkin, in many cases religious fanatics demonstrated cruelty, and vice versa, i.e. many cruel people were religious.

In 1902, at the suggestion of Sukhanov, Serbsky, and Rossolimo, Gannushkin became a full-fledged member of the Moscow Society of Neuropathologists and Psychiatrists (Московское общество невропатологов и психиатров). At the same time he was elected a supernumerary assistant of the psychiatric hospital headed by Serbsky, after Korsakoff's death caused by heart failure.

Sergei Sukhanov, Korsakoff's assistant, was willing to help young physicians by 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. Due to his penchant for synthesis, Sukhanov noted both scientific and social importance of this problem. He managed to make Gannushkin interested in this issue.

In collaboration with Sukhanov, Gannushkin has published six research papers. 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 transforming into schizophrenia.

In 1904 Gannushkin presented his thesis "Paranoia acuta" or "Acute paranoia" (Острая паранойя), which consisted of an historical sketch of development of the theory of paranoia. The issue description starts off with researches performed by Vincenzo Chiarugi and Jean-Étienne Dominique Esquirol. Then focus of a thesis switches to works by Wilhelm Griesinger, Bénédict Morel, and Carl Friedrich Otto Westphal. Subsequently represented are observations made by Sergei Korsakoff, Vladimir Serbsky, Emil Kraepelin, and Eugen Bleuler. Finally Gannushkin brilliantly describes his own findings related to paranoia.

After the presentation of his thesis, Gannushkin became a privatdocent (i.e. freelance university lecturer) 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" (Учение о патологических характерах).

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 (Hôpital Sainte-Anne) 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.

In 1911 university autonomy became a breach issue in Russia; it resulted in repressions performed by a Tsar's protégé, education minister, Lev Kasso. In 1911 Gannushkin left the university together with other progressive scientists in protest of the repressions. Before being drafted in the army, namely from 1906 to 1914, he worked as a resident physician in the Moscow Alexeev Psychiatric Hospital (Московская Алексеевская психиатрическая больница), which is known nowadays as Kashenko Mental Hospital (больница имени П. П. Кащенко). He was one of the founders of the front-rank scientific journal called "Korsakoff's Journal of Neuropathology and Psychiatry" (Журнал невропатологии и психиатрии имени Корсакова).

In 1917, after army discharge due to illness, Gannushkin returned in the Moscow Alexeev Psychiatric Hospital. Since 1918 he was a professor in the Department of Psychiatry of the Moscow State University (from 1930 - I.M. Sechenov First Moscow State Medical University) and director at the University Psychiatric Hospital, currently known as S.S. Korsakov Clinic of Psychiatry of I.M. Sechenov Moscow Medical Academy (Клиника имени С. С. Корсакова АМН России имени И. М. Сеченова).

Gannushkin was one of the first psychiatrists to talk about the schizoid reaction type, somatogenic and psychogenic reactions of schizoids. Moreover, in 1927 he discovered the so-called 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. maliciousness 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 was also involved in experimental research of hypnosis. He criticized Lombroso's theory of crime. Furthermore, Gannushkin was interested in psychoanalytic ideas, and experimentally used psychoanalytic therapy. His stance on psychoanalysis is outlined in his work called "On Psychotherapy and Psychoanalis" (О психотерапии и психоанализе). Although not a real proponent of Freud's theory, Gannushkin did believe that under certain conditions psychoanalytic methods could be used during the treatment process.

Gannushkin considered both war and revolution as a "traumatic epidemy" of all the population. He used to emphasize that there was a reciprocal influence between population mentality and social life.

As a new form of medical care for people with mental disorders, the system of psychoneurological dispensaries was created under Gannushkin's direction. Moreover, it was he who initiated the development of extramural psychiatric care in Russia. He helped organize a system of nonhospital psychiatric assistance in the USSR and worked out questions dealing with teaching in psychiatry and prevention of mental illness.





Marriage and children
Pyotr Borisovich Gannushkin married Sofia Vladimirovna Gannuskina (née Klumova). They had a son, Alexey Petrovich Gannushkin (1920 - 1974), an aircraft design engineer, USSR State Prize Laureate. Gannushkin's granddaughter, Svetlana Gannushkina (born 1943), 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 characteristics and views on psychiatry
Gannushkin was characterized by modesty and diffidence. He disliked public speaking. When visiting psychiatric conferences, he preferred to stay in the background. Gannushkin was able to open his mind only among his scientific fellows and while lecturing his senior students. He showed himself as an experienced clinician, a proponent of natural science method who considered himself as an enemy of pompous and meretricious declamation.

Gannushkin's power of observation was enhanced by his erudition and capability of distinguishing the most useful points in the different monographs and articles. He recorded each new thought and accurately gathered all required materials. His lectures and clinical vignettes were indicative of the fact that he carefully scrutinized and systematized all the research data he was working with.

L.A. Prozorov pointed out that "Gannushkin was able to interest young people in research, even if it was rough, search for people, and select research scientists." While remembering her husband, Sofia Gannushkina said, "Once he decided to do something, he grew fearless."

Throughout his life, Gannushkin did believe that psychiatry is closely connected with social life. From his point of view, a psychiatrist is primarily a community worker. Maybe that is why he made psychopathies his main research subject. "'We, our generation, do not limit ourselves by psychiatric hospitals. Using the same approach, we are coming into life, coming to schools, barracks, prisons. We are not looking for the demented who need to be hospitalized, but for half-normal people, borderline types, 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
When Gannushkin was finishing his seminal work called "Manifestations of psychopathies: statics, dynamics, systematic aspects" (Клиника психопатий, их статика, динамика, систематика), his health quickly deteriorated. After long hesitation he agreed the proposed surgery. The best Russian physicians tried to help him, however they did not succeed. Pyotr Borisovich Gannushkin died on February 23, 1933. He managed to read and sign his monograph after proofreading. The book was published after his death.

Research papers written by Gannushkin and his followers represent a landmark in the development of the theory of psychopathies in Russia. Finally it ought to be remarked that among Russian psychiatrists it was Gannushkin who defined psychopathies (personality disorders) most accurately.

Gannushkin had a lot of followers. It is possible to distinguish three generations of his disciples. The first generation was represented mostly by Gannushkin's 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 consisted 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. The third generation included Gannushkin's junior students: A.P. Alexandrova, A.M. Dubinin, O.V. Kerbikov, S.V. Krayts, A.Y. Levinson, D.E. Melekhov, V.M. Morozov, A.I. Ponomoryov, B.A. Famin, P.D. Fridman, Y.D. Shulman. Gannushkin's followers contributed significantly to development of psychiatry in Russia.

In 1933 the Scientific-Research Institute of Neuropsychiatric Prophylaxis of People's Commissariat of Health Care (Narkomzdrav) established an annual award n.a. Pyotr Borisovich Gannushkin. In 1936 Moscow Psychiatric Hospital no.4 was named after Gannushkin (Психиатрическая клиническая больница № 4 им. П.Б. Ганнушкина). After a while, his memorial museum was created inside this hospital. Furthermore, a river embankment in Moscow was also named in his honor.

It is interesting that Gannushkin became a prototype of Professor Titanushkin, a character from the famous satirical novel "The Little Golden Calf" written by two Soviet prose authors, Ilf and Petrov.

The theory of psychopathies
Pyotr Borisovich Gannushkin preferred to break down psychiatry into two main categories: major psychiatry (schizophrenia, bipolar disorder, etc.) and minor psychiatry (psychopathies or personality disorders). The theory of psychopathies or the so-called pathological characters is considered to be his main contribution to psychiatry.

In his book "Manifestations of psychopathies: statics, dynamics, systematic aspects," Gannushkin distinguished two types of pathological development - constitutional and situational. In case of situational type, the development of psychopathy is obviously caused by trauma or distress. Its onset is always marked by some serious mental change, after which everything becomes more or less static. Gannushkin pointed out that while statics of psychopathies means actual substance of the subject, dynamics of psychopathies implies types, laws, and development schemes of psychopathies.

It should be mentioned that Gannushkin did not consider psychopathies to be progredient mental states by opposing them to serious mental disorders causing mental retardation. Gannushkin placed special emphasis on the fact that borderline psychiatry includes a wide range of different transitional steps, transient mental states. He acknowledged that psychopaths (i.e. those with personality disorders) substantially contributed to science, art, and literature.

Gannushkin delineated the three main signs of behavioral pathology underlying psychopathies:


 * maladaptation


 * ubiquity


 * stability.

Some elements of Gannushkin's typology were later incorporated into the theory developed by another Russian psychiatrist, Andrey Yevgenyevich Lichko, who was also interested in personality disorders along with their milder forms, the so-called accentuations of character (акцентуации характера).