Medicalizing Suffering: Postsocialist Reforms of the Mental Health System in Ukraine

This dissertation explores how mental health reforms in postsocialist Ukraine, specifically the push for privatized community mental health services, are playing out on the ground through provider and patient perspectives and are mediated by nongovernmental organizations (NGOs). I argue that the international agenda promoted in Ukraine that pushes for western neoliberal political and economic reforms has produced cultural and structural discrepancies and tensions which can be seen in the mental health field. As major reforms are promoted, including the shift from state hospitals to private “community-based” services as part of a transition from socialized to privatized or insurance-based care, and as providers adopt the U.S. – modeled International Classification of Diseases [ICD-10] to diagnose and treat mental health disorders, the cultural meanings of socialism and capitalism collide and coalesce around questions such as where (or with whom) the responsibility for health lies, the proper relationship between psychiatrists and patients, and the prioritization of the individual vs. the collective, and the implications of these. Amid these cultural and structural changes, moreover, the neoliberal agenda forces Ukrainians to replace deeply rooted cultural tenants shaped by socialism with those of U.S. dominated corporate capitalism. Human rights discourse has been adopted by some NGOs as a way to mediate and critique these processes of cultural change induced by transformations in political economy. I use psychiatry and mental health as a window into this struggle.