The current situation in Soviet psychiatry needs a surrealist to describe it. On the one hand, an increasing number of Soviet journals have been forthrightly saying what Soviet dissidents and Western observers have said for almost twenty years. This is that abuses of psychiatry for political reasons—including the confinement of political dissidents in psychiatric institutions—have taken place in the USSR on a large scale for decades, violating the Hippocratic oath and causing enormous human suffering. Many of the confined dissidents, for example, were gratuitously injected with the drug Sulphazine, which, without having any medical benefits, induces a high fever and also excruciating pain in the area of the injection. Second, some of these journals point out that abuses, though much reduced in scale, continue to occur.
On the other hand, the leading officials of Soviet psychiatry and also, on occasion, the politicians who employ them, put forward a completely different picture. They say, or at least imply, that no such abuses have ever occurred, or—a slight variant—that a few mistakes occurred in the past as a result of psychiatrists being overcautious and producing “hyperdiagnoses,” but that now such mistakes cannot occur, thanks to new legislation and administrative reforms. The officials who are in charge of Soviet psychiatry also continue three long-established practices: they continue to try to manipulate foreign psychiatric organizations and delegations; they put obstacles in the way of those victims of abuse who seek psychiatric “rehabilitation” or justice through the courts; and they try to discredit critics of these abuses in the Soviet Union.
The two worlds occupied by the critical journals and the Soviet officials are radically different. The US psychiatric delegation that visited the USSR earlier this year, of which I was a member, was made aware of the difference when it moved back and forth between them, and the contrast is reflected in our report. In the first world, which includes liberal journalists, psychiatrists outside the bureaucracy, and dissidents, our talks about psychiatric abuses were useful and uninhibited. But when we stepped through the looking glass into the second world, which had organized our official program and made sure that it included only approved doctors, dialogue was either impossible or so tortuous as to be exhausting and most of the time unproductive. Since the Soviet side could not acknowledge the basic facts, our talks lacked a common language and could often proceed only through circumlocutions and hints.
Why does such a dualistic situation exist? The answer is simple: since early 1987, the officials who have for many years been in charge of psychiatry have been fighting to preserve their power during the period of perestroika. Perestroika is a comprehensive program which aims to bring efficiency and integrity to the economy, society, and politics in the USSR. In most fields, reform is well underway, and many of the old leaders have been retired, disgraced, or even jailed. In psychiatry, even though perestroika has been needed for reasons of foreign as well …