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To be a Healer: Life Histories and Conceptions of Medical Relationships in Russia

This collaborative project between UNC-Chapel Hill-based anthropologist Michele Rivkin-Fish and Russian psychotherapist Viktor Samokhvalov, MD, is an educational intervention intended to raise discussions about the politics and ethics of clinical relations in Russian medical training. It is comprised of two parts: 1) the production of a film on Samokhvalov's life history as a doctor and the psychotherapeutic concept of selfhood known as lichnost'; 2) the development of a curricular program for using the film and life history exercises in classroom settings as a means of introducing innovative approaches to the politics of the self and interrelations in health encounters. This project brings together Rivkin-Fish's ethnographic insights as an anthropologist with Samokhvalov's clinical experience in order to better patient care in Russia.

In both producing the film and developing the educational program, the project views life history as a genre that asks the speaker to author him/herself for particular purposes, rather than as a transparent or objective window onto the past. The film tells the story of how for Dr. Samokhvalov, the concept of the self that is lichnost' offered a personally empowering and politically challenging model for being a psychotherapist. Rivkin-Fish and Samokhvalov ask the viewer to compare lichnost' with other modes of conceptualizing the self that medical professionals deploy -- both in their daily lives and with patients in the clinic. As this film will be presented in medical training programs, it is intended as an intervention in the training of medical providers in Russia.

Rivkin-Fish and Samokhvalov, the collaborators on the project, plan to produce and use this film in Russian health education programs, in order to inspire innovative thinking about the ethics of practicing medicine in the post-socialist context. Rather than imposing a model of patient rights based on visions of individualism, they strive to use the Russian notion of lichnost' to initiate discussion on modes of selfhood and relationality in the healing encounter. Screening "To be a doctor is to be a lichnost' " could be incorporated in an exercise inviting students to compose their own life histories, and to reflect on their decisions to become a healer at this particular moment in Russian history. By explicitly discussing how life histories are stylized accounts, shaped by the context of elicitation and the expected future uses of the narrative, we can insert a deliberative reflection on the malleability and construction of selfhood as a jumping off point for group discussions about the social roles, responsibilities, and constraints of practicing medicine. The questions that they address include the following: What does being a doctor mean to you? In considering the obstacles created by the current socio-economic crisis, and the new circumstances of market-based medicine: what does it mean to enter into/practice medicine at this time in Russia? How do these circumstances transform the role of the doctor, and the expectations of doctors and patients towards each other? In what ways is a doctor/ are you able to alleviate patients' suffering?

This intervention is timely as the ethics and character of doctor-patient relations represent a newly contentious arena of debate in Russia, where market-based health care services are emerging as alternatives to the underfunded state health care services. Since the breakdown of the Soviet Union in 1991, international organizations from the World Bank to the WHO have promoted restructuring RussiaÕs health care services, in the interest of both economic efficiency and democratic revival. In their globalizing recommendations, the need for acknowledging and respecting patient rights has been an important theme. Yet ethnographic insights of the daily negotiations between Russian doctors and patients in clinic settings have demonstrated that local understandings of healing responsibilities and morality in health care relations are not based on the concept of "individual rights." Current innovations in clinic relations, rather, draw on Russian relational concepts of interpersonal responsibility to revive standards of benevolent expertise. This experiment aims to use the culturally relevant concept of lichnost' framed within a film and exercise on life history in medicine, to stimulate new kinds of thinking and discussion on selfhood and relationality in health care.