Periodic Reporting for period 3 - LEVIATHAN (Taming the European Leviathan: The Legacy of Post-War Medicine and the Common Good)
Reporting period: 2023-10-01 to 2025-03-31
Summary of the context and overall objectives of the project
The goal of the Leviathan project is to develop a balanced and multidisciplinary historiography of post-war Europe through the lens of medicine by studying forms of interaction through a comprehensive European framework. We achieve this by focussing our research on the following areas: ‘Body’, ‘Reproduction,’ ‘Risk,’ and ‘Utopia’. Leviathan takes a multidisciplinary approach: neither economics nor politics nor ideology nor everyday life, but an integration of these perspectives makes it possible to understand the pursuit of the European common good. Our first work package, ‘Body’, addresses the politics of public health and medicine across post-war Europe. Our second area, ‘Reproduction’, explores the frontiers of life, encompassing beginnings, aging and end-of life decisions. Our third work package, ‘Risk’, explores the negotiations and management of risk in medical research and development. Our fourth area focusses on ‘Utopia’. We analyse the ‘making of Utopia’ via the development of behavioural sciences and the use of health communication and propaganda.
Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far
Body: By focusing on the development of high-tech medicine, we show that the trans-European network of transplantation was driven by scientific constraints and civil society. A study on balneosanatoria investigates the development of medical facilities, infrastructure and technology. In addition to studying the ‘Semashko’ medical model and medical migration, we explored key political figures and cooperation within international organizations and among experts to highlight cooperation across the systemic divide. We analysed normative aspects of biopolitics and studied transnational collaboration of population geneticists via organisations in Europe. Another example looks at the development of policies regarding homes for children with disabilities. We studied public debates on biosocial concepts in a transnational context and how these were implemented. We also explored health laws in different states - both socialist and capitalist - to uncover the connections between law and socio-economic realities.
Research has also explored post-war developments in human genetics and population policies in Europe, including historical studies of eugenics, psychiatric epidemiology, and the history of institutions for children and youth. Comparative studies are addressing end-of-life decisions, international perspectives on death and dying, and bioethical issues such as the commodification of the human body and societal ideals influencing surgical bodily enhancements. Investigations are also being undertaken into the migration of medical professionals during the socialist era, the development of medical infrastructure, and the evolution of medical ethics and bioethics.
Reproduction: We engage with R&D, marketing and distribution, and the (mis)use of drugs in the field, for example via a study of the clinical trials of the abortion pill Mifepristone and the debates on women’s reproductive rights. By analysing the R&D of (sex) hormones, we show how socialist states participated in and benefited from medical advances. These studies show the close connections of drug research and the use of new substances in both permissible (contraception) and non-permissible contexts (abortion, doping) across the systemic divide. We also address the normative perspective of social inequities, exclusion and discrimination by comparing abortion and reproductive rights across various states. Another aspect looks at research about the social inequalities via a study of the history of Bulgarian gerontology. A comparative case study on aging focusses on care homes and home care in Albania and Italy. Comparing discussions of end-of-life decisions across Europe, for example in the Dutch context, assists in outlining the key concepts and dimensions of the “autonomy” debate.
Work within this work package has also continued to examine reproductive policies in post-war Europe, including family planning, contraception, and the medicalisation of the female body. Studies highlight changing abortion laws, pro-natalist policies, and the institutionalisation of elderly care. Research has been extended to reproductive rights, gerontology, and the prevention of sexually transmitted infections, including UN/WHO initiatives addressing endemic syphilis. The history of contraception in Yugoslavia and genetic counselling in Hungary are also being explored.
Risk: We demonstrate how the legacy of the Holocaust made the medical profession more reflective about issues related to medical ethics within European societies. We can also show the extent to which codified medical deontology — rather than the Nuremberg Code — served as a central reference point within different national and cultural contexts. A key area of analysis is shaped by the post-war legacy of eugenics. We trace debates about disability and definitions of work capacity in both Eastern and Western European countries. In doing so, we can better understand how post-war welfare and health policies were shaped by medically-based productivism. The example of the prevention and control of poliomyelitis shows the consequences of certain health policies. The politics of risk are also analysed via the development of European ethno-psychiatry in the context of global mental health policy. This case study examines cross-cultural projects focused on mental disorders undertaken by the World Health Organisation to analyse the dialogue between psychiatrists from different states across western, central and eastern Europe and beyond.
The study of risk reasoning in healthcare policies under capitalist and socialist regimes has been a central theme. Studies undertaken by Leviathan teams are examining risk communication, particularly for tuberculosis and poliomyelitis, alongside issues like epidemiological practices, health risks in socialist workforces, and debates on disability and labour capacity. Research also covers medical ethics, focusing on malpractice, consent, surgical practices, and the history of deontology in Central and Eastern Europe. Additional work investigates cross-system collaborations in medical fields, including psychopharmaceutical experiments and anaesthetic practices. The research further explores the intersection of risk, medicine, and the management of violent behavior under state socialism. It examines how quantification, forecasting methods, and computational technology were utilized as governance strategies in state socialist care and control policies.
Utopia: The history of chemical enhancement explores the shared methodologies and beliefs among European psychopharmacists who aimed to enhance the behavioural choices, intelligence, physical performance, and moral character of trial participants. We examine the cooperation of national organizations, both at state level and within the public sphere, within the field of TB prevention. We also analyse the dissemination of healthcare propaganda to promote socialist and state-managed healthcare and a further study examines the “invisibility” of people with special needs via an exploration of visual archives in Bulgaria. This work package also considers the potential consequences of ‘utopian dreams’. Using the example of uranium mining on both sides of the Ore Mountains under Soviet occupation, we examine how such a project (more than 10,000 cancer deaths) could be carried out, and how civil society involvement was articulated in the GDR. The rise of suggestology and unorthodox research fields (e.g. psychotronics) opens another perspective on educational efforts and scientific visions in Europe and beyond.
Research undertaken by Leviathan teams continues to challenge Western-centric narratives by exploring international medical law and the right to health, especially within socialist states. Themes include pharmaceutical regulation, the political roles of medical experts, and utopian visions of health technologies like organ replacement. Studies are examining health propaganda, scientific knowledge transfer, and portrayals of psychiatric facilities and disabilities in media. Further research explores bioscientific cooperation, including efforts to prevent WMD proliferation, advancements in brain research, and the intersections of psychological disciplines across Europe.
Research has also explored post-war developments in human genetics and population policies in Europe, including historical studies of eugenics, psychiatric epidemiology, and the history of institutions for children and youth. Comparative studies are addressing end-of-life decisions, international perspectives on death and dying, and bioethical issues such as the commodification of the human body and societal ideals influencing surgical bodily enhancements. Investigations are also being undertaken into the migration of medical professionals during the socialist era, the development of medical infrastructure, and the evolution of medical ethics and bioethics.
Reproduction: We engage with R&D, marketing and distribution, and the (mis)use of drugs in the field, for example via a study of the clinical trials of the abortion pill Mifepristone and the debates on women’s reproductive rights. By analysing the R&D of (sex) hormones, we show how socialist states participated in and benefited from medical advances. These studies show the close connections of drug research and the use of new substances in both permissible (contraception) and non-permissible contexts (abortion, doping) across the systemic divide. We also address the normative perspective of social inequities, exclusion and discrimination by comparing abortion and reproductive rights across various states. Another aspect looks at research about the social inequalities via a study of the history of Bulgarian gerontology. A comparative case study on aging focusses on care homes and home care in Albania and Italy. Comparing discussions of end-of-life decisions across Europe, for example in the Dutch context, assists in outlining the key concepts and dimensions of the “autonomy” debate.
Work within this work package has also continued to examine reproductive policies in post-war Europe, including family planning, contraception, and the medicalisation of the female body. Studies highlight changing abortion laws, pro-natalist policies, and the institutionalisation of elderly care. Research has been extended to reproductive rights, gerontology, and the prevention of sexually transmitted infections, including UN/WHO initiatives addressing endemic syphilis. The history of contraception in Yugoslavia and genetic counselling in Hungary are also being explored.
Risk: We demonstrate how the legacy of the Holocaust made the medical profession more reflective about issues related to medical ethics within European societies. We can also show the extent to which codified medical deontology — rather than the Nuremberg Code — served as a central reference point within different national and cultural contexts. A key area of analysis is shaped by the post-war legacy of eugenics. We trace debates about disability and definitions of work capacity in both Eastern and Western European countries. In doing so, we can better understand how post-war welfare and health policies were shaped by medically-based productivism. The example of the prevention and control of poliomyelitis shows the consequences of certain health policies. The politics of risk are also analysed via the development of European ethno-psychiatry in the context of global mental health policy. This case study examines cross-cultural projects focused on mental disorders undertaken by the World Health Organisation to analyse the dialogue between psychiatrists from different states across western, central and eastern Europe and beyond.
The study of risk reasoning in healthcare policies under capitalist and socialist regimes has been a central theme. Studies undertaken by Leviathan teams are examining risk communication, particularly for tuberculosis and poliomyelitis, alongside issues like epidemiological practices, health risks in socialist workforces, and debates on disability and labour capacity. Research also covers medical ethics, focusing on malpractice, consent, surgical practices, and the history of deontology in Central and Eastern Europe. Additional work investigates cross-system collaborations in medical fields, including psychopharmaceutical experiments and anaesthetic practices. The research further explores the intersection of risk, medicine, and the management of violent behavior under state socialism. It examines how quantification, forecasting methods, and computational technology were utilized as governance strategies in state socialist care and control policies.
Utopia: The history of chemical enhancement explores the shared methodologies and beliefs among European psychopharmacists who aimed to enhance the behavioural choices, intelligence, physical performance, and moral character of trial participants. We examine the cooperation of national organizations, both at state level and within the public sphere, within the field of TB prevention. We also analyse the dissemination of healthcare propaganda to promote socialist and state-managed healthcare and a further study examines the “invisibility” of people with special needs via an exploration of visual archives in Bulgaria. This work package also considers the potential consequences of ‘utopian dreams’. Using the example of uranium mining on both sides of the Ore Mountains under Soviet occupation, we examine how such a project (more than 10,000 cancer deaths) could be carried out, and how civil society involvement was articulated in the GDR. The rise of suggestology and unorthodox research fields (e.g. psychotronics) opens another perspective on educational efforts and scientific visions in Europe and beyond.
Research undertaken by Leviathan teams continues to challenge Western-centric narratives by exploring international medical law and the right to health, especially within socialist states. Themes include pharmaceutical regulation, the political roles of medical experts, and utopian visions of health technologies like organ replacement. Studies are examining health propaganda, scientific knowledge transfer, and portrayals of psychiatric facilities and disabilities in media. Further research explores bioscientific cooperation, including efforts to prevent WMD proliferation, advancements in brain research, and the intersections of psychological disciplines across Europe.
Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)
The ethical, historical, and legal aspects of public health policy making have been analysed, for instance, in two jointly written papers which focus on the “Vaccination Cold War” and “Autonomy and Social Responsibility”. Public engagement and research dissemination has been achieved via a public symposium on Medicine and Politics, and multiple interdisciplinary seminar series including one on medical anthropology, in Bulgaria.
Research on health laws and the public health regulations of the period has proven to be novel, as has research on the post-war European development of medical deontology and ethical codes, developments in pharmaceutical trials across Europe, and different levels of collaboration regarding health communications across Europe.
Interdisciplinary collaboration is a key aspect of our synergy team. What we have found to be most beneficial and intellectually stimulating has been the effect of methodological pluralism on our research processes. Advances beyond the state of the art are expected as a result of the integration of previously unknown sources (such as the personal archives of important figures in the history of medicine), and new transnational approaches highlighting the intellectual alliances on both sides of the systemic divide.
The Leviathan project continues to challenge deeply held assumptions about post-war European societies, which have recently become even more politically sensitive. We believe this approach will greatly benefit scholarly research and significantly impact the public and social spheres. Studying public health regulations from that period has proven to be a significant innovation, as has research on the post-war evolution of medical ethics and ethical codes, progress in pharmaceutical trials across Europe, and the level of cooperation in health communications across the continent.
The approach of an integrative historiography led to innovative methodological considerations. Among these we emphasise the approach of a "socialist governmentality": Evaluating Foucault’s governmentality concept for health care in state-socialist societies opens up new horizons of discussion.
A further conceptual development beyond the state of art is the transfer of the concept of psychologisation to analyse socialist societies, as this concept has so far mainly been applied to neoliberal governmental techniques. We anticipate significant progress beyond the current state of knowledge through integrating previously less known sources, such as the personal archives of crucial figures in the history of medicine, institutional archives (e.g. “Mother & Child” Homes; Homes for children with disabilities; Gerontology and Geriatrics institutions, sciences of the human brain and neurosciences etc.), and through transnational approaches that emphasise the intellectual collaborations on both sides of the Iron Curtain and beyond it.
Research into the history of medical ethics and law is revealing a previously unknown complexity in the development of legal codes across Europe during the post-war period. In addition, work undertaken on the development of emerging medical technologies is providing significant new insight into the involvement of eastern European states in what was previously considered in some areas to be a domain largely dominated by western companies. Research on the history of human genetics has revealed hitherto unexplored similarities in the integration of demographic and hereditary data into population health research in both east and west Europe. Moreover, work on international relations and reproductive health has demonstrated the cross-border efforts of individual doctors to promote access to birth control technologies and methods across ideological and religious divides. Further work has demonstrated the influential role of physicians in promoting ‘social responsibility’ across the ideological divides of the period, revealing the underexamined personal risks such dissent often took.
While previous research has shown how political and expert discourses shaped abortion policies and gender roles in state socialist societies, the paternalistic tendencies within medical systems and their impact on reproductive control have not yet been thoroughly examined. By analyzing concrete examples, we highlight the constraints and opportunities for women to assert their interests and needs, as well as the role gynecologists played in either facilitating or obstructing women’s reproductive decisions at the local level of socialist society.
Research on health laws and the public health regulations of the period has proven to be novel, as has research on the post-war European development of medical deontology and ethical codes, developments in pharmaceutical trials across Europe, and different levels of collaboration regarding health communications across Europe.
Interdisciplinary collaboration is a key aspect of our synergy team. What we have found to be most beneficial and intellectually stimulating has been the effect of methodological pluralism on our research processes. Advances beyond the state of the art are expected as a result of the integration of previously unknown sources (such as the personal archives of important figures in the history of medicine), and new transnational approaches highlighting the intellectual alliances on both sides of the systemic divide.
The Leviathan project continues to challenge deeply held assumptions about post-war European societies, which have recently become even more politically sensitive. We believe this approach will greatly benefit scholarly research and significantly impact the public and social spheres. Studying public health regulations from that period has proven to be a significant innovation, as has research on the post-war evolution of medical ethics and ethical codes, progress in pharmaceutical trials across Europe, and the level of cooperation in health communications across the continent.
The approach of an integrative historiography led to innovative methodological considerations. Among these we emphasise the approach of a "socialist governmentality": Evaluating Foucault’s governmentality concept for health care in state-socialist societies opens up new horizons of discussion.
A further conceptual development beyond the state of art is the transfer of the concept of psychologisation to analyse socialist societies, as this concept has so far mainly been applied to neoliberal governmental techniques. We anticipate significant progress beyond the current state of knowledge through integrating previously less known sources, such as the personal archives of crucial figures in the history of medicine, institutional archives (e.g. “Mother & Child” Homes; Homes for children with disabilities; Gerontology and Geriatrics institutions, sciences of the human brain and neurosciences etc.), and through transnational approaches that emphasise the intellectual collaborations on both sides of the Iron Curtain and beyond it.
Research into the history of medical ethics and law is revealing a previously unknown complexity in the development of legal codes across Europe during the post-war period. In addition, work undertaken on the development of emerging medical technologies is providing significant new insight into the involvement of eastern European states in what was previously considered in some areas to be a domain largely dominated by western companies. Research on the history of human genetics has revealed hitherto unexplored similarities in the integration of demographic and hereditary data into population health research in both east and west Europe. Moreover, work on international relations and reproductive health has demonstrated the cross-border efforts of individual doctors to promote access to birth control technologies and methods across ideological and religious divides. Further work has demonstrated the influential role of physicians in promoting ‘social responsibility’ across the ideological divides of the period, revealing the underexamined personal risks such dissent often took.
While previous research has shown how political and expert discourses shaped abortion policies and gender roles in state socialist societies, the paternalistic tendencies within medical systems and their impact on reproductive control have not yet been thoroughly examined. By analyzing concrete examples, we highlight the constraints and opportunities for women to assert their interests and needs, as well as the role gynecologists played in either facilitating or obstructing women’s reproductive decisions at the local level of socialist society.