During the last years, among Northern American historians specialising in Russian and Soviet studies a discussion has appeared and developed about the qualification of the USSR as an empire, more or less ‘typical’, or rather as a political entity and period of its own, a possible way for getting rid with imperial legacy and building up a contemporary, modernised society. The present book by P. A. Michaels, an Assistant Professor of the University of Iowa, belongs to this series of studies. In this case, however, Soviet history is looked at ‘from Kazakhstan’, and in the sphere of medical policy.
It comes out of the introduction (1-13) and the conclusion (177-82) that the author espouses the latter thesis, and has written her work in the framework of a global conception identifying the Soviet Union as a Russian version of Western European imperialism, propagating on its territory new types of institutions, practices and discourses for the exclusive goal of submitting “others” and exploiting them. These conclusions are based on an analysis of the biomedical policy implemented by the soviet power in Kazakhstan. The author has been particularly interested in the following aspects: the reinforcement of the state’s influence through the creation of a system of health care; the role played by the language of implementation of this policy in the Russians’ and Moscow’s domination; the Kazakhs’ resistance against this domination. The book’s three chapters are built on a scrupulous study by the author of an impressive mass of archive and literary data.
In the chapters on “Kazakh Medicine and Russian Colonialism (1861-1928)” [21-45] and on “Medical Propaganda and Cultural Revolution” [46-70, both in a first part entitled “Discourse”], P.A.M. offers a description of traditional “ethno-medical” practices among the Kazakhs. She characterises the way Russian Oriental studies have dealt with Kazakh medicine in the nineteenth and early twentieth centuries, shortly evokes the implementation of the Soviet bio-policy till 1928 and the turn towards a new bio-policy, through the methods and rhetorical frames of medical propaganda, the formation of the archetype of the “hero-doctor (doctor-geroi),” etc. Here, P.A.M. writes the difficulties and limitations this policy had to cope with in Kazakhstan during the 1930s. She stresses in particular the interest showed by Russian and Oriental ethnography, then of the soviet medical propaganda in the living conditions, the customs and hygiene as the main threats for public health. PA.M. qualifies this interest as a discursive means through which the power enhanced its own representation on the “backwardness” and inferiority of Kazakh culture and of Kazakh society, requiring decisive reforms on a Russian and European (universal?) scheme.
In the chapters on “Medical Education and the Formation of a New Elite” [73-102] and “Constructing Socialism: Medical Cadres in the Field” [103-26, both chapters constituting the second part on “The Construction of Institutions”], P.A.M. reconstructs at length the history of the development of biomedical education in Kazakhstan, notably through the archive created in 1931 by the Kazakh Medical Institute. She pictures the formation, in the framework of this education, of Soviet-type loyalty, pride, and patriotism, and describes the study of Russian language by the Kazakhs—giving a specific attention to the efforts put by the Kazakhs into their training, the evolution of the proportion of Kazakh students in the Medical Institute, the changing relationship between different students from ethnic groups, the existence of forms of discontent and repression. Then P.A.M. reconstructs the diffusion of medical institutions throughout Stalin’s Kazakhstan, the Soviet power’s national and gender policy, remembering the difficulties and obstacles with which these processes had to cope—lack of equipment, low qualification, absence of life conditions for medical personal, etc. On this basis, she assesses the effects of the biomedical policy implemented in Stalin’s time, underlying its successes as well as its failures.
The chapters on “The Policy of Women’s Health Care” [129-52] and on “Medical and Public Health Policy toward the Kazakh Nomads” [153-75, both chapters composing the third part on “Practices”] are devoted to the reception of this policy, and to the role of Kazakh women in the Soviet programme of transformation, in the successes and difficulties of the policy of “defence of maternity and early childhood.” The author recalls in detail the Bolsheviks’ vision of the nomadic way of life, and the “Red Yurts” policy through which the medical and other kinds of power managed to reach Kazakh nomads. The also remembers collectivisation and the nomads’ settling process, in which medical executives played a part in their capacities as civil servants.
The book is distinguished by numerous unquestionable qualities (like the cautious study of archive materials, the author’s attempt at looking at the history of the Soviet society from a local and regional viewpoint, her effort for basing her work on a discussion of the postcolonial theory, etc.). At the same time, one must remark that the author did not give concluding answers to all the questions arising from the conceptual frameworks of her choice. Though it is uneasy to enter in a detailed discussion of this dimension in a necessarily short review, I would like to draw the Reader’s attention to some particular problems.
For instance, the question would have deserved to been asked as to why the discussion on the Soviet regime that lasted from 1917 to 1991 must focus on Stalin’s period, more particularly on the 1930s-1940s. Why this particular period is to significant, instead of the 1920s, or the Khrushchev or Brezhnev periods? In these years too a Soviet society did exist, sensitively different from Stalin’s. Dealing with more attention with those periods would have driven the author, with us, to observe that the Kazakhs (and generally speaking all the “colonised” peoples of the USSR) were actively involved in the project/process of the Soviet modernisation, and contributed to their implementation in their own interests. We would remark among these Kazakhs the same strong and efficient Soviet identity backed by habits, practices, habitus formed in the course of the Soviet period. Isn’t Paula A. Michaels’ concentration on the 1930s-40s explainable by the fact that these other periods of time do not easily conform to the notion of “empire”, and provide on the contrary much more material for questioning the imperial nature of the USSR?
At the same time on Stalin’s time itself one should not satisfy him/herself with unequivocal assessments. Despite the cruel repression of dissidence, the policy implemented in the 1930s-40s may be described not only in terms of repression and conflict, but also in terms of compromise and agreement between different groups of the elite and of the masses. This multifaceted, generally silent and not always equal agreement relied on the understanding and desire of reforms and change, a desire made out of the innumerable trajectories of group and individual biographies of policy makers and ordinary citizens. Getting back to medicine, we can ask ourselves and the author: Wasn’t there in the Kazakh society any desire of rationalisation of medical practices? Weren’t there among the Kazakhs enthusiastic supporters of such a king of change? Even if modern medicine did reach the Kazakhs coming from Russia, there were there already rudiments of “modern” representations; there was an inner need for them. Demonstrating its efficiency, modern medicine became a component of Kazakh culture and an instrument of self-consciousness as well. Without answering to such questions, how can we assert that the sole fact of the Russian “trace” in the process of the formation of modern medicine (and modern knowledge in the widest meaning of this term) in Kazakhstan was an exclusive expression of Russia’s imperial essence? Such responses the reader will not find, unfortunately, in Paula A. Michaels’ remarkable book, despite its impressive statistics on the bio-political expansion. Notwithstanding all its qualities, this book lets opened a wide range of questions and drives us, its readers, to continue our reflection on the inner contradictions of the Soviet period, of the Soviet man, and of Soviet identity.