Institute of Fools: Notes from the Serbsky
The practice of “political psychiatry” has so far been limited mainly to the USSR and, to a lesser extent, Eastern Europe, but it could well spread to any country under authoritarian rule. Essentially it is a secret police tool to intimidate, suppress, or terrorize into recantation through drug treatment the open critics of a regime. In Russia it has roots so deep in the practices of both the KGB and their medical collaborators that even if the Kremlin oligarchy wanted to end the bad publicity it causes abroad, the task of stamping it out would not be easy. Not that there is any clear sign that the current KGB boss Yuri Andropov, a powerful member of the Politburo, is concerned to stop it, rather than just conceal it.
But the domestic opposition to this distinctively twentieth-century perversion of medicine has also been tenacious—in the face of repeated official attempts to destroy it. The books under review are part of a steady flow of documents that record the constant dramas of an inevitably protracted contest and illuminate the subtle grays among the moral blacks and whites. Extra color is added by the rich, often eccentric personalities of some of those among whom the victims of political psychiatry are forced to exist in a variety of mental institutions—genuine lunatics and inspired simulators, brilliant crooks and harmless cranks.
Alexander Podrabinek began investigating political psychiatry in 1973 at the age of twenty. He had already been barred from being a doctor because he was critical of the regime, but he managed to qualify as a medical assistant or feldsher. This put him in an excellent position to gather evidence. Working in the Moscow ambulance service, he saw political dissenters being forced into hospitals. He started to question former victims of such actions, and interviewed current victims and their doctors. He made his own intensive study of official legal and psychiatric literature. He listened to the lectures of leading practitioners of political psychiatry at a Moscow conference.
The book Podrabinek compiled, Punitive Medicine, began to circulate in samizdat in 1977. The next year he was sentenced to five years of exile in Siberia because he had “slandered the Soviet system.” His trial, which became a one day farce, was especially embarrassing to the authorities when a key prosecution witness suddenly confirmed the truth of what he had written. Now he is being held in the coldest inhabited part of the USSR, 5,000 miles from home.
During the years when Podrabinek was secretly working on Punitive Medicine, Sidney Bloch and I were independently researching the same broad topic. Much of our material was the same, and the conclusions we reached were remarkably similar.1 Podrabinek’s book, however, adds much to our own work, particularly in its account of the early history of Soviet political psychiatry, beginning with Lenin’s insistent attribution of mental illness to his foreign minister Chicherin because of the views he held. “We will be fools,” Lenin said, “unless we immediately and forcibly send him to a sanitorium!” Podrabinek argues persuasively that this episode may have provided a basis for the later justifications of pseudo-scientific political psychiatry as ideologically sound. The pseudo science itself has been supplied, as he shows, mainly by two professors, Andrei Snezhnevsky and Daniil Lunts, who concocted the theory that opposition to the state and its purposes is a symptom of mental illness.
Podrabinek also provides more detail than any previous writer has done on the hypocrisy and fallibility of the laws which supposedly govern the actions of police and doctors. Notably hypocritical is the official view that in criminal cases the defense has no need for psychiatric witnesses of its own, because “there is no reason to doubt the impartiality of the psychiatrists assigned by the Ministry of Health.” And while the legal code states categorically that no one can be deprived of liberty except by a court, the authorities issue directives providing for forcible psychiatric internment without reference to a court, either before or after the event. Podrabinek quotes Dr. Georgy Morozov, the head of the Serbsky Institute of Forensic Psychiatry, as saying in a rash moment, “What do we need political trials for if we have psychiatric hospitals?” Morozov is a friend of Andropov and combines being president of the Soviet psychiatric society with running his famous institute.
Podrabinek has assembled evidence to show that most of the doctors on whom the KGB relies are fully aware that they are involved in dirty practices but do not mind much because they have been so manipulated and corrupted by the system, which has convinced them it will protect them. The case of Dr. Felix Vartanyan is especially chilling. In recent years he has worked at the World Health Organization in Geneva, holding a prominent job to which he was nominated by the USSR. In 1968, however, when he worked with Snezhnevsky, he gave the actor Vladimir Gusarov “destructive ‘treatment’ with tranquilizers and neuroleptics for many days.” Gusarov had been hospitalized on KGB orders and told that he would not be released until he informed them where to find the materials Solzhenitsyn had collected to write his Gulag Archipelago.
In fact Gusarov knew nothing about the location of Solzhenitsyn’s archives, but no one would believe him. Eventually, to end the torture, he pretended he did know, and was promptly released. The same day, according to Podrabinek’s informants, a colleague asked Vartanyan: “What’s happening here? Gusarov came in healthy, and now we’re discharging him as a complete wreck.” Vartanyan was annoyed. “These forensic patients,” he said, “are a pain in the neck.”
Podrabinek writes of political patients who showed great bravery. One had the courage to tell the psychiatrist who was administering “destructive treatment” to him: “Look, when there’s a Moscow trial like the Nuremberg one, with Snezhnevsky, Lunts, and Landau on trial, you’ll be tried with them.” He replied: “That isn’t going to happen so soon…. [Anyway] I’m too small a potato. There won’t be enough room for me.”
Harvey Fireside’s Soviet Psychoprisons includes memoirs not only by Gusarov but also by a worker Mikhail Kukobaka and a chemical engineer Oleg Solovyov about their experiences of political psychiatry. These give us detailed accounts of life in the special psychiatric hospitals of Kazan, Chernyakhovsk, Oryol, and Sychyovka, as well as in some ordinary mental institutions. The least barbaric and terrifying conditions were those found by Gusarov in Kazan in 1953-1954. At this time the inmates were not usually treated with drugs. As Gusarov says in the title of his essay, “It was better under Stalin.”
Fireside in his analysis traces the changes and increasing sophistication of political psychiatry between the 1950s and 1979. My only major disagreement with him concerns his view that readers should not direct their outrage “at a medical rogues’ gallery,” on the grounds that Soviet doctors are “merely complying with a nexus of formidable institutional pressures and a public opinion out of sympathy for dissenters.” The available evidence about Soviet public opinion toward dissidents strikes me as contradictory and far from conclusive. Certainly it would be wrong if readers concluded from Fireside’s book that Soviet dissenters held in mental hospitals have been put there with the connivance of their relatives, friends, and colleagues. The opposite is in fact true. With very few exceptions, the three hundred or so victims of political psychiatry whose cases are now well documented had, before their internment, been effective people at home and at work, and were regarded as sane by those around them. In most cases, moreover, their friends and relatives have had the courage to oppose their internment before, during, and after the event.
How responsible are the doctors? I would myself agree with Podrabinek and with Victor Nekipelov, in Institute of Fools, that while institutional pressures on them are strong, and the politicians and “the system” have much to answer for, the doctors who break the Hippocratic Oath are not in fact forced to do so. Many cases are on record of psychiatrists who have been able to avoid taking part in political psychiatry without harmful consequence to themselves, and a low but rising number have practiced open or semi-open resistance to political abuse.
One of the best witnesses we have on the question of the responsibility of Soviet doctors is Nekipelov, a middle-aged poet and pharmacist who was arrested in 1973 for circulating writing in samizdat. Since an investigation of his activities revealed little for the KGB to work on, he was sent for psychiatric assessment to the Serbsky. Here he spent two months before being ruled sane—a result, he believes, of strong Western protests at the time against KGB psychiatry. Nekipelov’s penetrating account of the Serbsky Institute—the headquarters of political psychiatry—is offered as appropriate evidence for the prosecution at a future trial of doctors. As a man of unusual compassion he would like such a trial to be more educational than vengeful. But the banality of evil does not, he believes, wipe out the responsibility for it, however widely diffused this may be.
Nekipelov not only describes vividly the Serbsky’s procedures and personnel but gives affectionate sketches of his fellow inmates (only a few of whom were political), and a frank record of his own reflections and moods. His quiet wit and lightness of touch, the natural honesty with which he reveals his personal weaknesses, give unusual force to his occasional moral judgments. In his calm observation of the telling detail, the revealing moment, he writes in the tradition of Chekhov.
Institute of Fools has a useful introduction by the editors and also some essays by Nekipelov as appendices. One of these describes the seven police searches of his home between 1972 and 1977. In 1978 he joined the Moscow “Helsinki Watch Group.” I was reading his book in November when his account of being searched for the eighth time arrived in London. This he accurately saw as the start of a new KGB assault on the Helsinki group and dissenters in general. He commented: “Here’s how the Soviet state steps into Olympic year!” Since he wrote this the campaign to harass and arrest dozens of dissidents has become increasingly vicious, involving inter alia his own arrest in December and the deportation of Sakharov to Gorky on January 22. Nekipelov’s book will, one hopes, serve as a rallying point for writers, psychiatrists, and defenders of human rights to campaign for his release.
However severe the current assault proves to be, the resistance to political psychiatry will continue in some form. During the last three years it has been led by a Moscow “Working Commission” affiliated to the Helsinki group, and support for its work has grown steadily, coming not only from the friends and relatives of victims, but from human rights activists and, most significantly, dissenting doctors and others in the mental institutions.
Medical and humanitarian groups abroad now also seem more concerned than they were only a few years ago. Recently, for example, the well-known dissenter General Pyotr Grigorenko, now living in New York, was given a thorough examination by a team of psychiatrists and psychologists including Dr. Alan Stone, the President of the American Psychiatric Association. Twice Grigorenko had been ruled a paranoid by Serbsky psychiatrists, and had spent six years in Soviet institutions. The American team concluded: “In reviewing our tests, interviews and other examinations, we could find no evidence of mental illness in Grigorenko…. Nor could we find evidence in Grigorenko’s history consistent with mental illness in the past.” When this conclusion was communicated to Moscow’s Professor Snezhnevsky, he could only reply that Americans were unfamiliar with some aspects of Soviet life and that there were as many forms of paranoia as there were persons suffering from it.
Dr. Alexander Voloshanovich, chief psychiatric consultant to the Working Commission, is, however, familiar with Soviet life, and so far none of the thirty-six dissenters whom he has examined at their own request has, in his view, been in need of hospitalization. His reports, copies of which are available in the West, are their main insurance against internment. The high quality of the reports and the strong support Voloshanovich has received from Western colleagues are his main insurance against a jail sentence.2
Vyacheslav Bakhmin, a leading figure in the Working Commission who is now threatened with arrest, recently wrote in the American paper Psychiatric News: “The experience of our commission shows that ‘punitive psychiatry’ in the Soviet Union fears publicity above all.” The books of Podrabinek, Nekipelov, and Fireside should do something to intensify these fears, and they come at a time when Soviet dissenters will need all the support they can get against a rampant KGB.
Sidney Bloch and Peter Reddaway, Psychiatric Terror (Basic Books, 1977).↩
On February 7, Dr. Voloshanovich emigrated from the USSR. He hopes to settle in Britain.↩