In the Soviet Union today, Marxist and psychiatric ideologues work together efficiently, even smoothly. This is a fairly recent development. During the power struggles of the 1920s and the mass purges of the 1930s, there was no need for the Kremlin’s self-proclaimed Marxists to summon assistance from psychiatrists. In Stalin’s time, his enemies, real or imaginary, were subjected to mock trials, then shot or locked up for good; there was no inclination to call them crazy. The Soviet ideological system had its convenient designations of “bourgeois” or “capitalist” or “reactionary,” which were quite enough. The NKVD ran its own psychiatric hospital in the 1940s, but a substantial number of those confined in it were political prisoners who were obviously in bad shape psychologically—plagued by hallucinations, delusions, etc. The Russian poet Naum Korzhavin told Sidney Bloch, a psychiatrist, and Peter Reddaway, a political scientist, both English and co-authors of Psychiatric Terror, that up until “1948 at least, the practice of placing healthy people in mental hospitals was not malicious in intent but benevolent.”
Korzhavin should know. He was arrested that year and thrown in a Soviet “forensic psychiatry” hospital for writing “anti-Soviet” poems. He believes he was shielded there by members of the staff, who knew only too well that the alternative for him was Stalin’s labor camps. Eventually he was deprived of his psychiatric sanctuary and sent to Siberia. Indeed, in the late 1940s, elements of Stalin’s bureaucracy were worried that psychiatrists were letting a few “renegades” or “traitors” off too easily—pampering them in hospitals when they belonged in labor camps. A new group of sterner psychiatrists was given power whose task it was to emphasize the difference between mental and political deviance and, in the event of any uncertainty or blurring, to favor the latter.
To be sure, in the early 1950s, before Stalin died in 1953, there were isolated instances of psychiatric abuse of a political nature—the confinement to a mental hospital of a person who had offended the state authorities. But doctors were not ordered to deal systematically with political dissidents—to call them crazy. Nor did they suggest or demand confession and recantation as part of a cure. Dissenters were not pressured to say: yes, I was out of my mind when I (allegedly, needless to say) said this or did that. Stalin, who believed various doctors were conspiring to be rid of him, was not about to entrust his major obsession, the liquidation of various “enemies,” to a group of psychiatrists.
On May 24, 1959, Pravda carried some remarks by Khrushchev on the communist world of the future. What would it be like when the “permanent revolution” had, at last, achieved its central objectives? Would there be a new kind of human being, living a radically different kind of personal and social life? Khrushchev was not an unqualified optimist, and he had a degree of candor that may have been responsible for his abrupt demise. There might still be trouble, he admitted, in the fully realized communist society. He spelled out one kind: “A crime is a deviation from the generally recognized standards of behavior, frequently caused by mental disorder.” There would always be, alas, what he went on to call “disease” and “nervous disorders.” And those so afflicted would, inevitably, do things that are unwarranted and deserve rebuke or worse. They would commit “offenses which are characteristic of people with abnormal minds.” Some of those people would, of course, turn on the world around them, try to criticize it, when in fact they are themselves in trouble, but are unable, or unwilling, to appreciate that such is the case. The Soviet leader was both philosophically resigned and admonishing:
To those who might in the future start calling for opposition to Communism on this “basis,” we can say that now, too, there are people who fight against Communism…but clearly the mental state of such people is not normal.
During the 1960s, and up to the present moment, the Soviet government has done its best to deal with the sad anomaly—mental anguish in the midst of a developing utopia—which Chairman Khrushchev indicated to be a continuing trial for communism. By 1971 the West had begun to learn rather a lot about the willingness of Russia’s bureaucrats and psychiatrists to fight social deviance head on, so to speak, along the lines suggested by the outspoken Khrushchev. Ward 7, an autobiographical book by Valery Tarsis (1965), could perhaps be dismissed as a somewhat overwrought account. Written in vivid, emotional prose, the book was the first full-length account of psychiatric punishment. Tarsis was a short story writer, a translator, a prolific essayist. Perhaps he was a cranky, all too articulate intellectual who, even if he wasn’t actually insane, had made a nuisance of himself in various ways—and so been locked up.
The authors of Psychiatric Terror say that Tarsis may well have made “some emotionally based exaggerations.” He was, however, to be proved a rather sober participant-observer. His description of the way psychiatrists work on political prisoners in an effort to get them to change their opinions has been echoed repeatedly by others, including Soviet psychiatrists themselves. One of them, Dr. Marina Voikhanskaya, now lives in England, and another, Dr. Semyon Gluzman, has himself been arrested and sent to prison, after having refused to work in a “special” mental hospital where, he knew, people not by any means insane were locked up because of their political views.
In 1971, at the World Congress of Psychiatry held in Mexico City, an effort was made by a number of Western psychiatrists, especially British and Canadian ones, to bring the matter before their colleagues, in the hope of obtaining a strong condemnation of Soviet political psychiatry, the nature of which by then had been amply documented. Case after case of persecution of dissidents in psychiatric hospitals was reported through personal statements, court proceedings, official records, carefully worded appeals by Russian citizens active in the human rights movement. I.F. Stone, in these pages (February 10, 1972), told what came of such efforts: nothing. The Russians were outraged and threatened to walk out of the Mexico City conference. They had strong allies in the leadership of the Congress—Western psychiatrists who had their own reasons to look the other way or stand fast in the defense of each nation’s obligation to mind its own business. This was the time of so-called “détente,” and English and American professional men and women had just begun visiting and receiving visits from their counterparts in the Soviet Union.
Since then the West has received from Russia one report after another of psychiatric abuse in the interests of political control. Valery Chalidze, a Moscow-born physicist, published in 1975 To Defend These Rights, a thorough survey of the various ways dissent is curbed in Eastern Europe, including medical and psychiatric punishment: enforced hospitalization, the use of drugs, electro-convulsive “therapy,” insulin shock, the gamut of other “interventions” doctors have at their disposal. In England, where psychiatrists have been notably outspoken about the behavior of their Russian colleagues, a Working Group on the Internment of Dissenters in Mental Hospitals has been established, and periodic news bulletins or reports are issued. A Committee of French Psychiatrists Against the Political Uses of Psychiatry has done likewise: it publishes lists of prisoners, with information about their lives, their current situations. Certain American psychiatrists, too, have made strong protests in local medical and psychiatric societies and through the American Psychiatric Association, which in recent months has faced up unequivocally to Soviet practices. The Association has condemned psychiatric punishment outright, and urged an international committee of inspection, aimed at uncovering the use of psychiatry anywhere for political repression.
The book Psychiatric Terror, published just before the sixth World Congress was to meet this past August in Honolulu, made it especially difficult for doctors from all over the world to look the other way. They could no longer claim, for example: we are scientists, and ought not to be involved in sticky matters of international politics; or we are physicians, and require extensive interviews with those hospitalized—clinical evidence, not hearsay stories or propaganda. (No Westerners, needless to say, have been able to obtain free access to the hospitals where dissidents are confined.)
Reddaway and Bloch supply plenty of evidence. Their book is introduced by Vladimir Bukovsky, who has in his relatively short life spent eleven years in Soviet psychiatric hospitals and prison camps—and, recently, an hour or two in the White House, conversing with Vice President Mondale. Bukovsky gets to the heart of the matter quickly. He wonders whether anyone in the West can really understand what it means to live (never mind speak up critically) in a world where a given ideology has control of a totalitarian political apparatus. “Theories and conclusions,” he points out, don’t “develop out of the raw material of life, but, on the contrary, the raw material of everyday life is created to fit in with the ruling theory.”
The “ruling theory” Bukovsky refers to can exert dominion over “life” itself—crush differing viewpoints, insinuate its assumptions into schools, offices, factories, courtrooms, and, of course, hospitals. Life, in Bukovsky’s tersely penetrating phrase, “does not develop freely, but is ‘interpreted’ by the party”: the reigning millenarian ideologues who have the final say on what constitutes “reality,” what constitutes deviance. But is not such a judgment, in concrete everyday clinical instances, the doctor’s? Bukovsky’s answer is: “The Soviet psychiatrist is a part of the Soviet system. He cannot say, ‘I find no symptoms of illness in this person.’ He cannot reach his conclusions inductively, he must follow the prescribed deductive method.”
The authors of Psychiatric Terror provide ten appendices, including a description of a Soviet mental hospital by a psychiatrist, a verbatim record of two psychiatric interrogations of political dissenters, and a fifty-page “register” of dozens of people who have been confined to mental hospitals because they have said or written words deemed “anti-Soviet.” The register offers personal information about each man or woman, and a brief summary of the “case.”
But the book contains more than a series of life histories suddenly and arbitrarily turned into case histories. Bloch and Reddaway are aware that psychiatry generally lends itself readily to political abuse. At the very start of their book, and without reference to the Soviet Union, they remark that “the nature of psychiatry is such that the potential for its improper use is greater than in any other field of medicine.” They draw on well-known psychiatric critics, such as Thomas Szasz and R.D. Laing, without going as far as those two in connecting psychiatric diagnostic categories with conventional social judgments. They give a brief history of Soviet psychiatry, showing how it has been strongly influenced by Pavlov’s experimental work in conditioning and research on learning.
For the most part, however, they describe Soviet psychiatric abuse, the justification for which does not follow from the theories of Pavlov or any other psychiatrists whose principles deserve respect. They explain how the procedures of civil commitment to mental institutions are devised to accommodate the desires of bureaucrats or the police rather than those of families, neighbors, or friends. The criminal commitment procedures are similarly bent, if not completely twisted. In the hospitals, frightened, intimidated, humiliated men and women struggle for long stretches against the effects of various drugs or electricity. Always near at hand are psychiatrists who act as judges, accusers, and sometimes tormentors. A useful historical description at the end of the book offers a little hope; we are reminded that an increasingly strong opposition to psychiatric abuse, among other repressive activities of the Soviet state, has developed both within Russia and in the West. The Russians, ever sensitive to their reputation abroad, seem willing to reduce at least some repressive activities that lead to worldwide censure. It remains true that if all psychiatric abuses were ended tomorrow, the labor camps would still be around. Knowing that, the authors concentrate on a specific task—to lay before Western readers the elements of a particular kind of “terror.”
Especially instructive are their accounts of the ways psychiatrists in an “advanced,” technologically “developed,” so-called civilized nation deal with their fellow human beings, who are called their patients. Soviet psychiatrists like other Soviet doctors take an oath Hippocrates would find incomprehensible: “I will in all my actions be guided by the principles of communist morality, ever to bear in mind the high calling of the Soviet physician and my responsibility to the people and the Soviet State.” Conviction, no doubt, prompts many psychiatrists, having been so sworn, to respond to the requirements of “communist morality” and “the Soviet State” by providing psychiatric labels—pejorative in implication, punitive in effect—for those who have earned the disfavor of various apparatchiks or bureaucrats.
None of the Soviet dissenters confined to mental hospitals has sought out psychiatric help; nor have members of their families, friends, or neighbors complained to anyone about their strange or unusual behavior. Rather they are subject to sudden surprise visits by the police, arrests on charges of “anti-state” activity, and referral to psychiatrists who have consistently demonstrated an astonishing willingness to oblige the secret police. Those arrested have dared to criticize the present political state of affairs. Some are disappointed communists, who feel that idealistic dreams have turned into a sour, mean-spirited reality. Some look westward enviously to democratic societies. Some have the nerve to proclaim religious faith openly and without apology.
If there is anything that characterizes those people sent by the secret police to psychiatrists, it is ideological aberrancy. They include not only members of the intelligentsia but also working people who have experienced statist authoritarianism, rigidity, narrowness, and felt impelled to speak up, however discreetly. Among them are Baptists, Catholics, Jews, Ukrainians, Georgians—people loyal to a religious creed, a cultural or racial tradition, hence immediately suspect, considered dangerous to those bent upon enforcing the hegemony of a given political doctrine.
It remains unclear precisely why some political dissenters are locked up for years in labor camps, while others are sent to mental hospitals. The ratio, Bloch and Reddaway estimate, is one to four in favor of the camps, but interestingly, “the hospital has beyond doubt been the fate of many of the most determined, resilient and respected of the dissenters,” including those who could be expected to defend themselves most stubbornly and boldly in court. How tempting it is for various bureaucrats and police officials to call upon the truly extraordinary definitions of schizophrenia that have come from Soviet psychiatry in recent years. A common way of attributing madness to political prisoners is to apply to them the phrase “sluggish schizophrenia,” a catch-all category into which nearly anyone could be fitted. A man or woman may be charged with “grandiose ideas of reforming the world.” One leading Russian psychiatrist makes a distinction between the “theoretical” and “clinical” presence of schizophrenia. He can thereby diagnose as “really” quite “sick” those who appear to be without psychosis, indeed without any observable mental symptoms. In a recent letter a group of prominent Russian psychiatrists mention “the seeming normality of such sick persons when they commit socially dangerous actions.” It is those people, the doctors insist, who are being used in the West for “anti-Soviet propaganda” and for “slanderous contention.”
At the recent World Congress of Psychiatry it was no longer possible to table the issue of political psychiatry, especially after “human rights” had become so prominent a subject. Still, there was formidable opposition to an effort made by Western psychiatrists (English, Canadian, Australian, American, French) to align the Congress firmly against the use of psychiatry for political purposes anywhere in the world, and specifically in the Soviet Union, the one nation where such a practice has been repeatedly and carefully documented.
The Russians could count on international politics for support: the reluctance of delegations from various countries to offend them, whether for reasons of fear, or because of ideological or military loyalty. They could also count, as at the previous Congress, on the wish of many psychiatrists to avoid taking sides on a controversial matter which they were anxious to consider not the business of doctors, scientists, or other professionals. And most unfortunate, they could count on the smug and perverse anti-Americanism that one finds in countries such as Sweden, whose delegates insistently refused to criticize their Soviet colleagues. Had the issue been Vietnam, there might have been quite another degree of moral concern.
Exiled Soviet psychiatrists were in Honolulu to describe what they had seen, heard, experienced. Amnesty International was there with case histories, statistics, reports. A number of victims came to confront their former accusers. The vote against the political use of psychiatry was a narrow 90 to 88, and had the Polish delegation shown up (no one there knows why it suddenly decided not to come), the strongly worded and sometimes eloquent speeches of certain Western psychiatrists, and the resolution they were upholding, would have been to no avail. As it is, the Soviets were specifically condemned, and a commission established to investigate complaints from any part of the world. The Soviets refused to attend a crucial open debate, and of course no one could assume that any investigatory body set up by such a Congress would be granted permission to do its work effectively. The Westerners could only hope that they were putting the pressure of “world opinion” on colleagues who seemed as anxious as their government to earn approval throughout the world.
The Russian mind-doctors I saw and talked to were an intriguing group. Most of the other delegates came prepared to succumb to the various blandishments and corruptions of Hawaiian tourism. Psychiatrists could be seen wearing leis, jogging and then eating large meals, cautiously testing the surf, picking and choosing among the glut of junk that is sold to be shown off back home. The convention was held at a new swank hotel, while many stayed at equally fancy places nearby, each full of gaudy shops or weird architectural features (water running through the lobby) meant to persuade the visitor that anything goes—or comes to those with a lot of cash.
The Russians—there were about two dozen of them—had a lot of cash; they peeled out hundred dollar bills when they registered, but they chose to stay at the relatively sedate Holiday Inn. One could always spot the Soviets, long before the Russian words became audible: the men in ties and jackets, the women in dowdy dresses. A Hawaiian told me: “I haven’t seen people looking like that since I was stationed in Rhode Island during the Second World War, and went to church in Newport.”
The Soviets kept away from the others, and walked in small groups. The height of the supposed “confrontation” took place on Tuesday evening, August 30, when “ethical issues”—more precisely, the question of political psychiatry in the USSR—were discussed during a long, emotional evening, at a meeting held in the largest room available, which was filled. The Soviet members stayed away, prompting some to feel that they were being taken advantage of. No one, of course, tried to keep them away. The meeting was a public one, to which all delegates were invited.
Still, in talking to the delegates I sensed that some of them, priding themselves on being fair and open-minded, felt a touch of concern and sympathy for the Russians. Perhaps there was a case to be heard from the members of a group that kept to themselves, acted differently, declared themselves to be fighters for the world’s poor and oppressed, and yet faced the prospect of censure throughout the convention. Perhaps delegates with a shared Western ideology—no less protective of capitalist interests and values for being less explicit about them—were attempting to intimidate those who subscribe to quite another way of regarding the world.
I managed to obtain an interview with Edward Babayan, a member of the Soviet Presidium of the All-Union Society of Neurologists and Psychiatrists. He had, in the course of a scientific session on Monday, August 29, denied emphatically the allegations which have been made year after year in various parts of the world, and which, as he surely knew, would be made the next evening. We talked on Wednesday, after the narrow vote of rebuke had carried. The next day I talked with Maya Germanovna Shchirina-Eyngori, another member of the Soviet delegation, a woman whose English was excellent, and again with Dr. Babayan. The two conversations were unsettling but quite helpful. I heard, repeatedly, arguments brought up elsewhere—and not only by comrades of those two psychiatrists but by many who consider themselves, for want of a better descriptive phrase, “Western liberals.”
For two hours a series of questions was asked of me. Why was the Soviet Union being singled out? What about Chile, Argentina, South Africa—countries where thousands have been imprisoned by “reactionary” governments which are “good friends” to the “Western countries”? How about psychiatry in the United States itself: the “injustices” Thomas Szasz has repeatedly pointed out, such as the use of psychiatry as a means of “social repression” and of moral coercion, whereby a society criticizes or if need be locks up those who don’t say or do the “right” things? What about Daniel Ellsberg’s psychiatrist, whose records were stolen by the government? What about the CIA and its various experiments in “thought control”? What about the deplorable state of many American state-run psychiatric hospitals, in which patients are drugged heavily, even lobotomized? Who goes to those hospitals—who but the poor, the socially and economically marginal and vulnerable? Isn’t it a fact that the rich can buy the time of Western psychiatrists, who then turn around and call poor or working-class people “untreatable”?
“My dear doctor,” I was told, “critics of Soviet psychiatry say we have ‘loose’ diagnostic criteria, which we bend to suit the state’s purposes. Your own American colleagues Fredrick Redlich and August Hollingshead have written Social Class and Mental Illness, which tells how psychiatrists in the United States use different diagnoses when talking about the rich from those they use when they talk about the workers. When a man’s family loses its money, and a person from the family has been in treatment, the psychiatrist soon discharges the patient, and changes the prognosis, too. Is that ethical? Why don’t the capitalist countries sponsor ethical discussions along those lines, instead of trying to make our Soviet psychiatrists appear to be compromised? Who has ‘human rights’ in the West? The poor people, the workers? In a capitalist society, the professional man keeps his eye on the rich and powerful people; he treats them, and becomes rich himself, and he watches what he says or does, so that he won’t offend them, and if he’s a psychiatrist, he’s on their side, not the workers’ side. When does he ever see workers? The authors of Social Class and Mental Illness say: not very often, and when the time does come, the doctor is prejudiced against the worker, and calls him psychiatric ‘names’ he wouldn’t use with a rich patient!”
The psychiatrists I talked to were both of vigorous temperament and strong opinions; and they knew the West—their West. The central issue soon enough became one of values, not to mention logic. I kept pointing out that Chile and Argentina, for all their awful crimes, do not use psychiatrists as adjuncts of the secret police or the state’s system of political repression. I spoke of my own experience in South Africa where apartheid is buttressed by an ideology in no need of psychiatrists: Calvin and original sin and predestination, certainly—but not Freud, and not Pavlov.
As for the very real social and racial inequalities in the West, or for that matter the cultural oppressions sharply criticized by Szasz and Laing, or the various misdeeds of our government, none of these in any way eliminates the need for a profession to condemn a quite special wrong: the organized and recurrent use by a government of psychiatric diagnosis and so-called therapy (hospitalization, drugs, electric shock) in the service of political punishment. American psychiatrists and American psychiatric hospitals have many defects, but they are not under orders of the FBI, nor has the FBI or the CIA rounded up members of any political opposition so that they can be sent to St. Elizabeth’s Hospital in Washington, pronounced “insane,” and kept there indefinitely. “My dear colleague,” they kept telling me, “you are young enough to see all that and more happen.” The remark was made with complete assurance—with no possibility admitted that history might be unpredictable.
Bloch and Reddaway, helped by the dissidents Gluzman and Bukovsky, classify Soviet psychiatrists rather vividly: they write first of the “novice,” eager to flex his diagnostic muscles and therefore prepared to call almost anyone a little “sick.” The pompous “academic” is anxious to keep away from political matters, and so is unlikely “to dirty his hands.” The “writer of dissertations” can sometimes be counted upon for scientific justification if it be required—in the event, say, that a given definition of mental illness is not flexible enough to permit the state to have its way with political dissenters. The “Voltairean” is clever, worldly, and keeps his distance from controversial matters out of boredom or detachment rather than self-importance. The “Philistine” is regarded, for obvious reasons, as “dangerous” to dissidents because he is intent on survival and a comfortable life at all costs. Finally, there is the “professional hangman,” a servile instrument of the powers that be, no matter the nature of their requests.
It is a devastating picture, not unlike some of the polemical satire Kierkegaard directed at nineteenth-century bourgeois Copenhagen. To be fair, it is entirely applicable in some respects to some of the West’s psychiatrists, among other professional people. But I think Bloch and Reddaway underestimate the impact of a half a century of ideological indoctrination. The two doctors I talked with were not schemers, not mere cynical opportunists. They had their moments of eloquence as well as dry, mordant wit; they believed what they said, and found my counterassertions pitiably inadequate and self-serving. Palov’s emphasis on the importance of the social environment as decisively affecting human behavior has become for them a reminder of what they had long before, as children, learned quite well. To them the mind is a mirror of a nation’s economic system. One of the doctors, in an ironic nod to Freud’s view of childhood as critically significant in everyone’s life, insisted that “we think as adults what we were allowed to discover about society as children by the nation we belong to.”
There was no doubt in the two doctors’ minds that one nation, the Soviet Union, has been for sixty years in possession of the truth, as they see it, “about society,” and that eventually other nations will fall in line. At times, after listening in Honolulu to sad, outrageous reports of human indignity and professional debasement, or reading similar accounts in Psychiatric Terror, some of the delegates said they thought at once of Kafka’s The Trial. But the analogy is inappropriate. The Soviet dissidents are not at all like Joseph K. They know exactly what they abhor and what they crave. And the Soviet state is not hard to fathom, not an elusive “power” whose purposes and justifying rationale are beyond anyone’s comprehension.
Flannery O’Connor, of all “provincial” writers, is a better guide to the problem at hand—that of a moral confrontation between stumbling, vulnerable, prideful, partially blind, but basically decent people and the fierce willfulness of those who, promising various rewards, know precisely what they want and how they must at all (awful) costs get it, as ordained by the very nature of things. It’s not such a long step from her “Good Country People” to the Kremlin, where Christianity is thought an opiate, but a messianic political apparatus exerts its authority not only upon individuals but professions and their comparatively small-fry dogmatists: genus Remora, sticking hard and fast to the shark.
October 27, 1977