• Email
  • Single Page
  • Print

Should World Psychiatry Readmit the Soviets?

1.

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.1 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 as domestic policy, the leading officials are still hanging on. The Foreign Ministry has been pressing for the reform of psychiatry because it has been working for nearly three years to improve the human rights image of the USSR in the West, and psychiatric abuse has been one of the ugliest blemishes on that image.

However, the psychiatric officials know that if they were to allow serious reform, it would soon sweep them away. They have long presided over a branch of medicine that, in addition to harboring violators of the most basic medical ethics, is also inefficient, scientifically backward and even obscurantist, expensive to the state, and, to judge by Soviet press reports, at least as corrupt as most of the rest of Soviet medicine.

For this reason, reform in Soviet psychiatry has so far been limited in its announced aims and even more limited in its practice. True, the most visible cases of abuse—cases known in the West of political dissidents who are forcibly kept in psychiatric hospitals—have now been largely removed by the convenient device of having them suddenly declared cured and releasing them. During the last two years, some one hundred have been sent home. But the system by which dissidents are persecuted by psychiatric means remains in place, and we also receive new information that some dissidents who were previously unknown abroad remain interned, and that new internments are sporadically occurring.

Just as important, if a repressive leader were to replace Gorbachev, and if a crackdown on reformers and dissidents of the type recently seen in China were to take place—developments that could occur during the next few years—then the system could start “processing” large numbers of victims without difficulty. The US delegation gained insight into this system because we were allowed to see many more patients, records, and institutions than have been accessible to other foreign visitors in the past. But this unprecedented opportunity will not necessarily be repeated and it has not stopped the system from functioning.

Since last summer a dozen or so articles have appeared in the Soviet press that have frankly discussed the use of psychiatry to silence political dissidents.2 On June 28, for example, a particularly revealing case was described in the government paper Izvestia. Nothing was previously known in the West about the victim, Yu. I. Sobolev, a former director of a timber yard in the Ulyanovsk region on the middle Volga who was critical of official policies, even though he has been confined in a hospital three times for political dissent, and has spent a total of a year and a half as, in effect, a political prisoner. Although a psychiatrist had diagnosed him as psychotic with a “depressive-paranoid syndrome” and ordered that he be confined, he was found by the hospital that admitted him after diagnosis, and by the reporter, to be normal. The circumstances of Sobolev’s third internment in March 1989 were described to the Izvestia reporter with unusual candor by a deputy police chief in the Ulyanovsk region. Three weeks before the elections to the Congress of People’s Deputies last March, he told the reporter,

I was phoned by the First Secretary of the Nikolayevka District Party Committee, V.A. Panasenko, who said that at a candidate’s election meeting Sobolev had been putting forward some sort of undesirable ideas. He said that Sobolev must be taken out of circulation. I phoned the psychiatrist V. Kamalov and explained the situation. He said he’d write an order for hospitalization.

Dr. Kamalov, the report continued, “admits that he consigned to compulsory treatment in a mental hospital a man who was not on the psychiatric register, and whom he had never even set eyes on.” Kamalov’s self-serving comment was: “What is one to do, if one is given an order?”

The answer to this question is that many Soviet psychiatrists faced with the same situation have, without doing anything heroic, found ways of avoiding complicity in a professional and juridical crime.

The most significant aspect of the case, however, is the casual, routine way in which compulsory confinement was arranged—at a time when officials of the Ministries of Health and Foreign Affairs had long been telling foreigners in private that such practices had stopped. Such assurances were designed to back up public statements that legislation passed in 1988 had radically improved the protection of patients from possible abuses, and that the new law would allow patients with grievances to have their cases reviewed and to engage legal counsel to defend them against unjust hospitalization. But it was already clear that the assurances by the Soviet ministries that the compulsory confinement of healthy dissidents had stopped were not true, because news of a score of new political internments during 1988 and 1989 had reached the West. However, the victims in these cases had not been sent to the hospital as a result of a criminal prosecution but were put there, as Sobolev was, by an administrative order signed by a doctor; and they were soon discharged. It was therefore possible to believe that these cases of confinement might be local aberrations that would soon come to an end.

The Sobolev case, along with other evidence, tends to confirm my suspicion that secret instructions have probably been issued by officials in Moscow to local authorities telling them (a) to avoid criminal commitments in political cases, and (b) if news of a local case of civil or administrative commitment leaks out, to have the person released. In other words, such instructions—and we can so far only speculate about them—are probably not intended to eliminate political abuse altogether, but to prevent the continuing, more infrequent, use of psychiatric repression from causing problems for the USSR’s foreign policy.

A somewhat similar case is that of the Ukrainian dissident Anatoly Ilchenko, whom members of the US delegation examined in March. He showed no symptoms that would have justified putting him in a hospital, and he was immediately released. In this case the local authorities in the Ukraine had been more careless. They had overlooked the fact that Ilchenko’s name, though not well known, had in fact been reported earlier in the West in connection with a previous internment in a psychiatric hospital for dissident activities.

Another article in the Soviet press, by the journalist Leonid Zagalsky,3 is notable for being the first to call for the resignation of three longstanding top executives of the system of political abuse of psychiatry—Dr. Georgy Morozov, Dr. Marat Vartanyan, and Dr. Alexander Churkin. Dr. Churkin, the chief psychiatrist of the Ministry of Health, played a prominent part in arranging the visit of the US psychiatric delegation. Also, in May of this year he was invited, by a group of American psychiatrists who did not trouble to look into his credentials, to take part as an honored guest at the annual convention of the American Psychiatric Association (which, as an association, takes a strong position against Soviet psychiatric abuse). I shall have more to say about him and his colleagues below.

Zagalsky’s article begins by documenting the dirty and crowded conditions and demoralized atmosphere of Soviet mental hospitals. A hospital in Adzharia, for example, had no plumbing or toilets and stank so horribly that it was, he reported, “a rare bird” that dared to fly over it. He also tells how he accompanied an earlier American group to Moscow’s Serbsky Institute for General and Forensic Psychiatry, and how they were carefully kept away from the depressing sight of the wards—a sight which was “not suitable for weak-nerved Americans.” Only hardened Soviets could “endure such a spectacle.” This institute is the apex of the system of psychiatric abuse, and has labeled as insane hundreds of dissidents such as Vladimir Bukovsky and General Petro Grigorenko.

Zagalsky then discusses how Soviet psychiatry “started to serve politics” during the 1950s. Early on, as in the well-known case of the biologist Zhores Medvedev, who was confined to a mental hospital near Moscow in 1970, it was sometimes possible for established intellectuals to get a victim released quickly. But this soon became difficult since victims were locked up for “long years” and “those who interceded for them faced the threat of serious punishment.” Thus the foreign criticism that led in 1983 to the USSR’s resignation from the World Psychiatric Association (WPA) was, in Zagalsky’s view, fully justified. He appears to doubt whether the Soviet application to be readmitted will be approved at the WPA’s congress in Athens this October. Certainly his article strongly implies that Soviet psychiatry has not yet earned the right to readmission.

  1. 1

    See Report of the US Delegation to Assess Recent Changes in Soviet Psychiatry, to Assistant Secretary of State for Human Rights and Humanitarian Affairs, US Department of State (July 12, 1989), 117 pages. Issued simultaneously was a “Preliminary Soviet Response” to the report, consisting of seven pages of psychiatric comment by anonymous official psychiatrists and fourteen pages of commentary on legal problems in psychiatry by two lawyers.

  2. 2

    Among those not discussed here are articles in Literaturnaya gazeta (May 31, 1989), Znamya, No. 7 (1988), Uchitelskaya gazeta (November 19, 1988), Meditsinskaya gazeta (May 21, 1989), and Ogonek, No. 29 (July 15–22, 1989).

  3. 3

    Literaturnaya gazeta, June 28, 1989.

  • Email
  • Single Page
  • Print