Khamstvo (USSR, Russia) - Revision history

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	''Khamstvo'' manifested as emotional abuse in healthcare could be considered an emotional regime or an institutionalised behaviour. The vulnerability and dependence of patients together with the isolation of medical institutions help reproduce the superior status of staff. The institutionalization of'' khamstvo'' is indicative of the prevalence of the collective over the individual in Russia. This regime enables health care providers to neglect women’s emotional needs for care and subordinate these needs to the clinical, organizational and bureaucratic demands. ''Khamstvo'' in maternity wards used to be perceived as legitimate by both the healthcare providers and, to some extent, by the childbearing women.		''Khamstvo'' manifested as emotional abuse in healthcare could be considered an emotional regime or an institutionalised behaviour. The vulnerability and dependence of patients together with the isolation of medical institutions help reproduce the superior status of staff. The institutionalization of'' khamstvo'' is indicative of the prevalence of the collective over the individual in Russia. This regime enables health care providers to neglect women’s emotional needs for care and subordinate these needs to the clinical, organizational and bureaucratic demands. ''Khamstvo'' in maternity wards used to be perceived as legitimate by both the healthcare providers and, to some extent, by the childbearing women.

	''Khamstvo'' shapes the attitudes of all participants, including the clinicians themselves, who often claim feeling helpless within the paternalistic hierarchies of the state (Rivkin-Fish 2005). Doctors and midwives often feel in a subordinate and vulnerable position (Litvina, Temkina and Novkunskaya 2019). In this situation, they see familiarity and aggression as effective instruments to obey the women. Protagonists of such approach appeal to the necessity of controlling, manipulating and, in some cases, exercising power. Unlike in other medical settings, such as ''[[psikhushka]]'' (~~see~~ [[~~USSR\|~~Psikhushka (FSU)]] and [[~~Russia\|~~Psikhushka (Russia)]]), they do it verbally and emotionally, rather than physically. Women are labelled as ‘ignorant’ and ‘infantile’ and forced to cooperate and behave properly during the childbirth, purportedly for their own and their baby’s sake. Paternalistic aggression is used to generate shame to affect patient behaviour and to subordinate an individual to the ʻcorrectʼ way of behavior. Clinicians justify their way of communication as a preventive measure against ‘wrong or shameful’ behaviour from childbearing women and do not label it as ''khamstvo''. At the same time, they perceive the women’s tactics against ''khamstvo'', such as making complains or making videos of personnel’s communication with them as aggressive and respond to them with ''khamstvo''.		''Khamstvo'' shapes the attitudes of all participants, including the clinicians themselves, who often claim feeling helpless within the paternalistic hierarchies of the state (Rivkin-Fish 2005). Doctors and midwives often feel in a subordinate and vulnerable position (Litvina, Temkina and Novkunskaya 2019). In this situation, they see familiarity and aggression as effective instruments to obey the women. Protagonists of such approach appeal to the necessity of controlling, manipulating and, in some cases, exercising power. Unlike in other medical settings, such as ''[[psikhushka]]'' (in [[Psikhushka (FSU)\|USSR]] and [[Psikhushka (Russia)\|Russia]]), they do it verbally and emotionally, rather than physically. Women are labelled as ‘ignorant’ and ‘infantile’ and forced to cooperate and behave properly during the childbirth, purportedly for their own and their baby’s sake. Paternalistic aggression is used to generate shame to affect patient behaviour and to subordinate an individual to the ʻcorrectʼ way of behavior. Clinicians justify their way of communication as a preventive measure against ‘wrong or shameful’ behaviour from childbearing women and do not label it as ''khamstvo''. At the same time, they perceive the women’s tactics against ''khamstvo'', such as making complains or making videos of personnel’s communication with them as aggressive and respond to them with ''khamstvo''.

	Late Soviet era state medical services were characterized by overregulation, rigidity of medical hierarchies and shortages of resources. ''Khamstvo'' in maternity wards generated a power style and a code of rudeness that sought to discipline women and subject them to both the impersonal rules and the clinicians’ discretion in interpreting them. Because women were completely dependent on the medical staff, they had to accept these rules and codes as inevitable, beyond women’s control, and impossible to challenge (Temkina 2016). To feel bound by fate is considered as a constitutive element of the emotional regime of ''khamstvo'' and can be considered its intrinsic vehicle, reproduced in institutions at the organizational level (Temkina, Novkunskaya and Litvina forthcoming). Patients, who had no choice but to use state medical facilities, employed bottom-up strategies of personalization to counter ''khamstvo'', a top-down strategy of the staff. Some structural prerequisites and communication characteristics of ''khamstvo'' were transferred onto Russian contemporary medical institutions and are still typical for certain medical specialists and settings (Temkina, Novkunskaya, Litvina forthcoming).		Late Soviet era state medical services were characterized by overregulation, rigidity of medical hierarchies and shortages of resources. ''Khamstvo'' in maternity wards generated a power style and a code of rudeness that sought to discipline women and subject them to both the impersonal rules and the clinicians’ discretion in interpreting them. Because women were completely dependent on the medical staff, they had to accept these rules and codes as inevitable, beyond women’s control, and impossible to challenge (Temkina 2016). To feel bound by fate is considered as a constitutive element of the emotional regime of ''khamstvo'' and can be considered its intrinsic vehicle, reproduced in institutions at the organizational level (Temkina, Novkunskaya and Litvina forthcoming). Patients, who had no choice but to use state medical facilities, employed bottom-up strategies of personalization to counter ''khamstvo'', a top-down strategy of the staff. Some structural prerequisites and communication characteristics of ''khamstvo'' were transferred onto Russian contemporary medical institutions and are still typical for certain medical specialists and settings (Temkina, Novkunskaya, Litvina forthcoming).

Editor2018 at 16:09, 28 November 2020

2020-11-28T16:09:39Z

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	\| authorofpiece = Anastasia Novkunskaya, Daria Litvina and Anna Temkina		\| authorofpiece = Anastasia Novkunskaya, Daria Litvina and Anna Temkina
	\| authorinstitution = European University at Saint-Petersburg, Russia		\| authorinstitution = European University at Saint-Petersburg, Russia
	~~\| authorwebsite = null~~
	}}		}}
	<big>'''By Anastasia Novkunskaya, Daria Litvina and Anna Temkina, European University at Saint-Petersburg, Russia'''</big>		<big>'''By Anastasia Novkunskaya, Daria Litvina and Anna Temkina, European University at Saint-Petersburg, Russia'''</big>
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	‘Yes, they are boors. They yell, damn it, but they don’t just yell, they discipline’ (mother, 30 years old)’. </blockquote>		‘Yes, they are boors. They yell, damn it, but they don’t just yell, they discipline’ (mother, 30 years old)’. </blockquote>

	'Khamstvo'' manifested as emotional abuse in healthcare could be considered an emotional regime or an institutionalised behaviour. The vulnerability and dependence of patients together with the isolation of medical institutions help reproduce the superior status of staff. The institutionalization of'' khamstvo'' is indicative of the prevalence of the collective over the individual in Russia. This regime enables health care providers to neglect women’s emotional needs for care and subordinate these needs to the clinical, organizational and bureaucratic demands. ''Khamstvo'' in maternity wards used to be perceived as legitimate by both the healthcare providers and, to some extent, by the childbearing women.		''Khamstvo'' manifested as emotional abuse in healthcare could be considered an emotional regime or an institutionalised behaviour. The vulnerability and dependence of patients together with the isolation of medical institutions help reproduce the superior status of staff. The institutionalization of'' khamstvo'' is indicative of the prevalence of the collective over the individual in Russia. This regime enables health care providers to neglect women’s emotional needs for care and subordinate these needs to the clinical, organizational and bureaucratic demands. ''Khamstvo'' in maternity wards used to be perceived as legitimate by both the healthcare providers and, to some extent, by the childbearing women.

	''Khamstvo'' shapes the attitudes of all participants, including the clinicians themselves, who often claim feeling helpless within the paternalistic hierarchies of the state (Rivkin-Fish 2005). Doctors and midwives often feel in a subordinate and vulnerable position (Litvina, Temkina and Novkunskaya 2019). In this situation, they see familiarity and aggression as effective instruments to obey the women. Protagonists of such approach appeal to the necessity of controlling, manipulating and, in some cases, exercising power. Unlike in other medical settings, such as ''[[psikhushka]]'' (see [[USSR\|Psikhushka (FSU)]] and [[Russia\|Psikhushka (Russia)]]), they do it verbally and emotionally, rather than physically. Women are labelled as ‘ignorant’ and ‘infantile’ and forced to cooperate and behave properly during the childbirth, purportedly for their own and their baby’s sake. Paternalistic aggression is used to generate shame to affect patient behaviour and to subordinate an individual to the ʻcorrectʼ way of behavior. Clinicians justify their way of communication as a preventive measure against ‘wrong or shameful’ behaviour from childbearing women and do not label it as ''khamstvo''. At the same time, they perceive the women’s tactics against ''khamstvo'', such as making complains or making videos of personnel’s communication with them as aggressive and respond to them with ''khamstvo''.		''Khamstvo'' shapes the attitudes of all participants, including the clinicians themselves, who often claim feeling helpless within the paternalistic hierarchies of the state (Rivkin-Fish 2005). Doctors and midwives often feel in a subordinate and vulnerable position (Litvina, Temkina and Novkunskaya 2019). In this situation, they see familiarity and aggression as effective instruments to obey the women. Protagonists of such approach appeal to the necessity of controlling, manipulating and, in some cases, exercising power. Unlike in other medical settings, such as ''[[psikhushka]]'' (see [[USSR\|Psikhushka (FSU)]] and [[Russia\|Psikhushka (Russia)]]), they do it verbally and emotionally, rather than physically. Women are labelled as ‘ignorant’ and ‘infantile’ and forced to cooperate and behave properly during the childbirth, purportedly for their own and their baby’s sake. Paternalistic aggression is used to generate shame to affect patient behaviour and to subordinate an individual to the ʻcorrectʼ way of behavior. Clinicians justify their way of communication as a preventive measure against ‘wrong or shameful’ behaviour from childbearing women and do not label it as ''khamstvo''. At the same time, they perceive the women’s tactics against ''khamstvo'', such as making complains or making videos of personnel’s communication with them as aggressive and respond to them with ''khamstvo''.

	Late Soviet era state medical services were characterized by overregulation, rigidity of medical hierarchies and shortages of resources. ''Khamstvo'' in maternity wards generated a power style and a code of rudeness that sought to discipline women and subject them to both the impersonal rules and the clinicians’ discretion in interpreting them. Because women were completely dependent on the medical staff, they had to accept these rules and codes as inevitable, beyond women’s control, and impossible to challenge (Temkina 2016). To feel bound by fate is considered as a constitutive element of the emotional regime of ''khamstvo'' and can be considered its intrinsic vehicle, reproduced in institutions at the organizational level (Temkina, Novkunskaya and Litvina forthcoming). Patients, who had no choice but to use state medical facilities, employed bottom-up strategies of personalization to counter ''khamstvo'', a top-down strategy of the staff. Some structural prerequisites and communication characteristics of ''khamstvo'' were transferred onto Russian contemporary medical institutions and are still typical for certain medical specialists and settings (Temkina, Novkunskaya, Litvina forthcoming).		Late Soviet era state medical services were characterized by overregulation, rigidity of medical hierarchies and shortages of resources. ''Khamstvo'' in maternity wards generated a power style and a code of rudeness that sought to discipline women and subject them to both the impersonal rules and the clinicians’ discretion in interpreting them. Because women were completely dependent on the medical staff, they had to accept these rules and codes as inevitable, beyond women’s control, and impossible to challenge (Temkina 2016). To feel bound by fate is considered as a constitutive element of the emotional regime of ''khamstvo'' and can be considered its intrinsic vehicle, reproduced in institutions at the organizational level (Temkina, Novkunskaya and Litvina forthcoming). Patients, who had no choice but to use state medical facilities, employed bottom-up strategies of personalization to counter ''khamstvo'', a top-down strategy of the staff. Some structural prerequisites and communication characteristics of ''khamstvo'' were transferred onto Russian contemporary medical institutions and are still typical for certain medical specialists and settings (Temkina, Novkunskaya, Litvina forthcoming).


	==Entries in the online encyclopaedia linking to ''khamstvo''==		==Entries in the online encyclopaedia linking to ''khamstvo''==

Admin at 09:55, 27 November 2020

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	\| imagemap = Russia map.png		\| imagemap = Russia map.png
	\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]		\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]
	\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: ~~Intermediary~~\| ~~Intermediary~~]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]		\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: Intermediation\| Intermediation]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]
	\| authorofpiece = Anastasia Novkunskaya, Daria Litvina and Anna Temkina		\| authorofpiece = Anastasia Novkunskaya, Daria Litvina and Anna Temkina
	\| authorinstitution = European University at Saint-Petersburg, Russia		\| authorinstitution = European University at Saint-Petersburg, Russia

Editor2018 at 06:08, 23 November 2020

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	\| definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service provision		\| definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service provision
	\| location = USSR, Russia		\| location = USSR, Russia
	\| imagemap = ~~USSR~~ Russia map.png		\| imagemap = Russia map.png
	\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]		\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]
	\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: Intermediary\| Intermediary]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]		\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: Intermediary\| Intermediary]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]

Editor2018 at 06:07, 23 November 2020

2020-11-23T06:07:49Z

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	\| definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service provision		\| definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service provision
	\| location = USSR, Russia		\| location = USSR, Russia
	\| imagemap = USSR, Russia map.png		\| imagemap = USSR Russia map.png
	\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]		\| clusters = [[:Category: Domination\|Domination]] – [[:Category: Control\| Control]] – [[:Category: Intermediation\| Intermediation]]
	\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: Intermediary\| Intermediary]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]		\| categories = [[:Category: Russia\|Russia]] – [[:Category: FSU\| FSU]] – [[:Category: Healthcare\| Healthcare]] – [[:Category: Payment\| Payment]] – [[:Category: Intermediary\| Intermediary]] – [[:Category: Women\| Women]] – [[:Category: Gender\| Gender]] – [[:Category: Etiquette\| Etiquette]] – [[:Category: Norms\| Norms]] – [[:Category: Status\| Status]] – [[:Category: Emotions\| Emotions]] – [[:Category: Personal connections\| Personal connections]]

Editor2018: Created page with " {{infobox | nameofpractice = Khamstvo | flagemoji = 🇷🇺 | definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service..."

2020-11-22T10:34:39Z

Created page with " {{infobox | nameofpractice = Khamstvo | flagemoji = 🇷🇺 | definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service..."

New page

{{infobox
| nameofpractice = Khamstvo
| flagemoji = 🇷🇺
| definition = Rude, impudent and abusive way to communicate, used especially in the Soviet public sector service provision
| location = USSR, Russia
| imagemap = USSR, Russia map.png
| clusters = [[:Category: Domination|Domination]] – [[:Category: Control| Control]] – [[:Category: Intermediation| Intermediation]]
| categories = [[:Category: Russia|Russia]] – [[:Category: FSU| FSU]] – [[:Category: Healthcare| Healthcare]] – [[:Category: Payment| Payment]] – [[:Category: Intermediary| Intermediary]] – [[:Category: Women| Women]] – [[:Category: Gender| Gender]] – [[:Category: Etiquette| Etiquette]] – [[:Category: Norms| Norms]] – [[:Category: Status| Status]] – [[:Category: Emotions| Emotions]] – [[:Category: Personal connections| Personal connections]]
| authorofpiece = Anastasia Novkunskaya, Daria Litvina and Anna Temkina
| authorinstitution = European University at Saint-Petersburg, Russia
| authorwebsite = null
}}
<big>'''By Anastasia Novkunskaya, Daria Litvina and Anna Temkina, European University at Saint-Petersburg, Russia'''</big>
[[Category: Domination]]
[[Category: Control]]
[[Category: Intermediation]]
[[Category: Russia]]
[[Category: FSU]]
[[Category: Healthcare]]
[[Category: Payment]]
[[Category: Intermediary]]
[[Category: Women]]
[[Category: Gender]]
[[Category: Etiquette]]
[[Category: Norms]]
[[Category: Status]]
[[Category: Emotions]]
[[Category: Personal connections]]
[[Category: Entry]]
[[Category: 2020 entry]]

{| class="wikitable"
|-
|style="font-size:1.1em;"| ''Khamstvo'' – a communicative code of rudeness – signifies emotional and verbal abuse, which had been widely distributed in public sector services in the Soviet Union. Some examples of ''khamstvo'' can also be found in contemporary encounters. ''Khamstvo'' normally characterizes communicative situations when members of social groups, which lack status and authority, perform their situational dominance in a rude manner. ''Khamstvo'' was typical for the proletariat and professional groups that had exclusive access to scarce resources, such as sales clerks, medical personnel, accountants, and staff for communal and housing services (Koenker 2019).
|}

''Khamstvo'' was embedded in the fabric of Soviet everyday life. Multiple examples of ''khamstvo'' can be found in literary descriptions of early Soviet times – in Tolstoy’s Road to Calvary that covers the period 1914-1919 and Bulgakov’s Dog’s Heart that depicts the aftermath of the early twentieth century revolutions in Russia. The snap redistribution of power in that period and further economic, political and social changes provided institutionally favourable conditions for the spread of ''khamstvo''. ''Khamstvo'' can either be employed occasionally or become a habitual mode of behaviour, routinely performed in public: on transport, in queues, on the streets. It is more likely to be widespread in authoritarian and top-down regulated regimes, where the rigidity of rules is combined with poor services.

The Soviet planned economy resulted in a constant deficit of goods and services (even essential ones), unavailable even for a higher price (see [[blat]]). This made service workers the de facto gatekeepers of centrally-distributed, scarce resources. Their situational authority, giving them power to make decisions about the welfare of others made them eligible to perform ''khamstvo'' – to assert this authority by a rude manner. These gatekeepers could facilitate or limit access to goods or services and such examples were widespread in the late socialist fiction. One of the best-known attempts to formulate the essence of mature Soviet ''khamstvo'' is contained in an essay This untranslatable word – ''khamstvo'' by Sergei Dovlatov (2005):

<blockquote>‘''Khamstvo'' – so real, wallowing in itself, deliberately unpunished – is almost absent in New York. Here you can get robbed, but no one will slam the door right in front of your face, and this is not unimportant. […] [In Leningrad] I enter a grocery store, wait for my turn in the queue and then something strange happens to me […] something akin to the falsetto of a young beggar appears in my voice […]. I say to the saleswoman, who is in her sixties: “Dear lady, darling, could you be so kind to weight for me about hundred gramsies of butterling and also sausageling, you know, low-fatty, about two hundred gramsies…” And I pronounce all those diminutive suffixes trying my best to please this lady […], and so I bend in front of her in anticipation of ''khamstvo'', because she has a sausage and I do not yet […] I talked my entire life just as obsequiously […] to everyone whom we call the ʻservice sectorʼ. There were, of course, nice and polite people among them, but just in case, I pre-emptively mobilized all the diminutive suffixes, because these people could do something big, good, important for me, like give me two hundred grams of sausage, or, on the contrary, they could refuse, and it would be completely natural, normal and unpunishable’.</blockquote>

''Khamstvo'' continues to operate in the post-Soviet economy and culture in Russia, especially in the areas where basic services are sparse and provided at discretion of the public official, who acts as a gatekeeper to public welfare. We illustrate this practice with cases from maternity care – where childbearing women feel themselves particularly vulnerable and helpless.

Soviet maternity wards were physically closed to any visitors and could be characterized as quasi total institutions, harbouring opaque rules and practices resistant to challenges from the outside (see Goffman 1961, Davies 1989). Consequently, they were secure spaces for healthcare practitioners to exercise direct power and control over women and subordinate them to uniform medical procedures, disregarding patients’ feelings (Rivkin-Fish 2005). Maternity wards have since changed, yet ''khamstvo'' (even though reduced and lost status of normality in interactions) remains an important tool to control women and place them under clinicians’ authority.

The rigidity of the centralised socialist healthcare system was somewhat alleviated by a system of informal and paid care (Rivkin-Fish 2005, Stepurko et al. 2013, Cook 2015). In order to avoid the uniform over-medicalisation during childbearing and the emotionally traumatic experience of birth in Soviet hospitals (including ''khamstvo'' of personnel), women mobilised their families and networks and resorted to informal practices. These included personal introductions and referrals ([[blat]]), informal agreements arranged through the social networks and informal payments. The contacts were used to find a doctor that could offer a personal care, thus reducing negative experience and stress during the childbirth, in exchange for an out-of-pocket payment. While blat could not change the doctors’ emotional pressure on patients, or reduce manifestations of ''khamstvo'' overall, personal referrals could boost the competitive advantage of patients and ensure doctors’ attention, sincere concern and forgo ''khamstvo''. The system of out-of-pocket payments helped further improve the provider-patient relationship, by making emotional support part of the deal. Thus, ''khamstvo'' captured a complex emotional regime. On the one hand, it was on display in both bureaucratic and non-bureaucratic medical settings, but never openly admitted by the Soviet doctors, who positioned themselves as experts ‘teaching’ women proper behaviour. On the other hand, the trade of emotional support through informal channels was also widely known, albeit as an ‘open secret’.

Dominant in Soviet paternalistic maternity care, ''khamstvo'' remains present despite the significant changes in maternity care after the Soviet Union’s collapse. In in-depth interviews conducted by the authors for the research project ‘Choice, control and trust in childbirth’ in 2017, women shared examples of ''khamsky'' communication they had faced in maternity wards:

<blockquote>‘The midwives were so angry, so conniving and insolent... I asked her, “Well, what about the test results?”. She snapped at me: “How would I know, it's none of my business”, and so on (mother, 25 years old).’
‘Yes, they are boors. They yell, damn it, but they don’t just yell, they discipline’ (mother, 30 years old)’. </blockquote>

'Khamstvo'' manifested as emotional abuse in healthcare could be considered an emotional regime or an institutionalised behaviour. The vulnerability and dependence of patients together with the isolation of medical institutions help reproduce the superior status of staff. The institutionalization of'' khamstvo'' is indicative of the prevalence of the collective over the individual in Russia. This regime enables health care providers to neglect women’s emotional needs for care and subordinate these needs to the clinical, organizational and bureaucratic demands. ''Khamstvo'' in maternity wards used to be perceived as legitimate by both the healthcare providers and, to some extent, by the childbearing women.

''Khamstvo'' shapes the attitudes of all participants, including the clinicians themselves, who often claim feeling helpless within the paternalistic hierarchies of the state (Rivkin-Fish 2005). Doctors and midwives often feel in a subordinate and vulnerable position (Litvina, Temkina and Novkunskaya 2019). In this situation, they see familiarity and aggression as effective instruments to obey the women. Protagonists of such approach appeal to the necessity of controlling, manipulating and, in some cases, exercising power. Unlike in other medical settings, such as ''[[psikhushka]]'' (see [[USSR|Psikhushka (FSU)]] and [[Russia|Psikhushka (Russia)]]), they do it verbally and emotionally, rather than physically. Women are labelled as ‘ignorant’ and ‘infantile’ and forced to cooperate and behave properly during the childbirth, purportedly for their own and their baby’s sake. Paternalistic aggression is used to generate shame to affect patient behaviour and to subordinate an individual to the ʻcorrectʼ way of behavior. Clinicians justify their way of communication as a preventive measure against ‘wrong or shameful’ behaviour from childbearing women and do not label it as ''khamstvo''. At the same time, they perceive the women’s tactics against ''khamstvo'', such as making complains or making videos of personnel’s communication with them as aggressive and respond to them with ''khamstvo''.

Late Soviet era state medical services were characterized by overregulation, rigidity of medical hierarchies and shortages of resources. ''Khamstvo'' in maternity wards generated a power style and a code of rudeness that sought to discipline women and subject them to both the impersonal rules and the clinicians’ discretion in interpreting them. Because women were completely dependent on the medical staff, they had to accept these rules and codes as inevitable, beyond women’s control, and impossible to challenge (Temkina 2016). To feel bound by fate is considered as a constitutive element of the emotional regime of ''khamstvo'' and can be considered its intrinsic vehicle, reproduced in institutions at the organizational level (Temkina, Novkunskaya and Litvina forthcoming). Patients, who had no choice but to use state medical facilities, employed bottom-up strategies of personalization to counter ''khamstvo'', a top-down strategy of the staff. Some structural prerequisites and communication characteristics of ''khamstvo'' were transferred onto Russian contemporary medical institutions and are still typical for certain medical specialists and settings (Temkina, Novkunskaya, Litvina forthcoming).

==Entries in the online encyclopaedia linking to ''khamstvo''==
<div style="column-count:3;-moz-column-count:3;-webkit-column-count:3">
{{Special:Whatlinkshere/Khamstvo}}
</div>

==References==

Cook, L. 2015. ‘Constraints on Universal Health Care in the Russian Federation: Inequality, Informality, and the Failures of Mandatory Medical Insurance Reforms’, Journal of Self-Governance and Management Economics, 3(4): 37-60

Davies, C. 1989. Goffman's Concept of the Total Institution: Criticisms and Revisions. Human Studies, 12(1/2): 77-95

Dovlatov, S. 2005. ‘Eto neperevodimoe slovo – “khamstvo”’, in Sobranie sochineniy v 4-h tomah, Saint Petersburg: Azbuka-klassika. 323-327

Goffman, E. 1961. Asylums: essays on the social situation of mental patients and other inmates, New York: Anchor

Koenker, D. 2019. ‘The Smile behind the Sales Counter: Soviet Shop Assistants on the Road to Full Communism,’ Journal of Social History, 30 December 2019.

Litvina, D., Temkina A., Novkunskaya A. 2019. ‘Multiple Vulnerabilities in Medical Settings: Invisible Suffering of Doctors’, Societies, 10(1): 5

Rivkin-Fish, M. 2005. Women’s health in post-Soviet Russia: The politics of intervention, Bloomington: Indiana University Press

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