Soviet Psychiatric Abuse

The Shadow Over World Psychiatry

Sidney Bloch, Peter Reddaway

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781000312676
• Edition: 1
• Topic: Historia
• Subtopic: Historia del mundo

This book provides an account of contemporary historical assessment of the response to psychiatric abuse in the Soviet Union. It discusses all the major activities against Soviet psychiatry that took place in the West between the Honolulu and Vienna world psychiatric congress.

Chapter One

Political Abuse: What is it?

The Vulnerability of Psychiatry

BECAUSE OF ITS particular nature, the profession of psychiatry has to wrestle constantly with a wide range of ethical questions. Although many of these are shared with medicine in general, the practice of psychiatry involves some exceptional quandaries. Consider, for example, the question of compulsory hospitalization.¹ The psychiatrist, uniquely, has the awesome authority, invested in him by society, to place a person in a psychiatric hospital without his consent. Although granted legal sanctions to fulfil this role, the relevant statutes are frequently ambiguous and ill-defined. Even when the law is more explicit, its translation into practical guidelines is exceedingly complex. A person posing a danger to himself or to others is the usual reason for commitment—on the face of it, reasonable enough—but the psychiatrist’s predicament lies in the lack of objective criteria to predict dangerous behaviour. His best efforts to arrive at a clinically-scientific judgement are inevitably influenced by pressures from several sources including his own tendency to play safe in the face of doubt.

The slender scientific basis for a judgement about dangerousness also applies elsewhere in psychiatry. In contrast to other spheres of medical work, objective criteria to establish whether a psychiatric condition is present or not are unavailable in many cases. Even more problematic is the whole question of what is mental illness. An influential body of opinion—Thomas Szasz² is its most vocal representative—holds that psychiatry does not deal with ill people at all but rather with their problems in living. Thus, to label a young married mother’s unhappiness as “morbid depression” constitutes a camouflage of the real issue: namely, that she feels harried and overwhelmed by her responsibilities and consequently has difficulty in coping. The picture is all the more complex since the diagnostic process is closely intertwined with social factors; this is evidenced by the sometimes considerable differences among various cultures and in the same culture from one epoch to another in the clinical approach to such patterns of behaviour as homosexuality and the use of alcohol and other drugs. The relationship is patently illustrated by the decision of the American Psychiatric Association some years ago to alter radically its view of homosexuality by declaring that the term did not in itself signify a clinical condition.³

In this new view American psychiatry echoed society’s profound shift in attitude towards homosexuality during the 1960s. This example reveals another feature of psychiatry universally—the tendency to align itself with the status quo. Not unexpected, therefore, is the concept of “adjustment to society” as a commonly used criterion of mental health. A person is adjudged well if he adapts to the customs and conventions of the culture wherein he functions. The argument is advanced, most cogently by the American psychiatrist Seymour Halleck,⁴ that the psychiatrist, whether he realizes it or not, assumes a political role when he attempts to modify a person’s “maladaptive behaviour” in order that he may resume his membership of society.

All three above issues—compulsory hospitalization, the question of what is mental illness, and the widely-supported link between mental health and social adjustment—are made the more involved by psychiatry’s vague boundaries. The optimal extent of its role and responsibility is subject to heated debate. The position is trenchantly held at one extreme that psychiatrists would do well to limit sharply their sphere of activity to the treatment of patients who can be confidently diagnosed as suffering from a recognized clinical illness. The opposite camp avers that as most illnesses are attributable to social factors—unemployment, racism, lack of opportunity, and divorce, for example—a rational approach entails an active political role for the psychiatrist so that he may contribute to an amelioration of undesirable conditions in his society.

The special character of psychiatry—to which the aforementioned ethical issues point—constitutes an Achilles heel of considerable danger for its practitioners, because they may harness their professional skills, intentionally or unwittingly, to purposes in such a way that their patients lose paramountcy. The vulnerability of psychiatry to misuse, for non-medical reasons, is always present. Periodically, though happily this is rare, an individual psychiatrist perpetrates an abuse. This is inevitable in a profession made up of ordinary men and women who share the same foibles and weaknesses as any other group of people. While statutory regulations, review by peers, and codes of ethical practice contribute to the safeguarding of proper ethical standards, occasional infringements are bound to occur. More sinister is a pattern of abuse which involves an entire professional system and relies on the active connivance of its representatives with non-medical forces of influence.

It is to this form of unethical conduct that we now turn as we provide an outline of the misuse of psychiatry for political purposes in the Soviet Union. In so doing, we will follow a similar format to that used in our earlier book;⁵ anyone wishing to obtain a comprehensive picture is advised to read this basic volume. We feel a summary of what we covered there is appropriate now, serving as it does as a mise-en-scène for the material we shall deal with in the chapters that follow.

We highlighted earlier the unavoidable relationship between the psychiatrist and his society, and the problems this generates. The association could not be better exemplified than in the Soviet Union where an exceptionally authoritarian State is coupled with the espousal of a doctrinal ideology. Both the particular structure of government and the central place given to ideology facilitate an intimate bond between Soviet society and its psychiatric profession.

The supremacy of ideology in all fields was a feature of the early revolution period and has remained solidly intact throughout the Soviet era. Stalin’s call for political awareness in the professional work of scientists specifically—psychiatrists are included here together with all fellow scientists—is obvious from the following quotation:

… there is one branch of science which Bolsheviks in all branches of science are duty-bound to know, and that is the Marxist-Leninist science of society … a Leninist cannot be just a specialist in his favourite science; he must also be a political and social worker, keenly interested in the destinies of his country, acquainted with the laws of social development, capable of applying these laws and striving to be an active participant in the political guidance of the country.⁶

For Stalin political qualifications were of greater relevance than professional ability and experience, and entailed the professional’s commitment to Communist principles, reflected chiefly in his loyalty to the Communist Party. The Party then played a dominant role in all professional matters, as indeed it still does.

History of the Abuse

The first recorded case in Russia of the suppression of dissent by means of psychiatry occurred in 1836 when the philosopher, Pyotr Chaadayev (1793–1856), was labelled by Tsar Nicholas the First as suffering from “derangement and insanity”. Ostensibly benevolent—“… the Government in its solicitude and fatherly concern for its subject …”—Nicholas had in one neat stroke punished Chaadayev for publishing an article critical of his regime, and at the same time discredited the ideas expressed therein by declaring that they were those of a sick mind. This episode was, however, localized and in no way constituted a State policy.

The advent of the Bolshevik Government saw no basic change, in that the psychiatric repression of dissent continued to be sporadic and ad hoc. The most noteworthy case, in the very early days of the new regime, was the prominent political figure Maria Spiridonova. 1918 saw the collapse of the alliance of the Bolsheviks and the Socialist Revolutionary Party. Spiridonova and her Socialist Revolutionary colleagues posed a marked threat to the fledgling Government, and were energetically suppressed. Undeterred by a prison sentence, Spiridonova mustered her party’s forces and launched a vehement attack on the Bolsheviks. Her growing power and influence had to be curbed, but rearrest and a second prison sentence would have proved embarrassing and risky to the Government; Spiridonova was by then too popular and celebrated a figure. The dilemma was soon resolved in a judgement by the Moscow Revolutionary Tribunal: in the interests of her health Spiridonova was to be “banished for one year from political and social life and isolated in a ‘sanatorium’—there she would have the opportunity of healthy physical and mental work”.⁷ While in detention Spiridonova had predicted such an outcome, presumably in the knowledge that a declaration of insanity would discredit her political ideas as well as deprive her of the opportunity to continue her campaign. In the event, she escaped and the tribunal’s scheme never materialized.

The Bolsheviks resorted to a similar device a year later in an effort to check another persistent critic, Angelica Balabanoff. In 1920 she attacked the leadership, including Lenin, pointing out the errors she believed they had committed. Again, the quandary faced the Government of what to do with a prominent political figure. The plan devised for Spiridonova was revived, albeit in modified form: Balabanoff was ordered to enter a sanatorium for the sake of her health although her “mental condition” was only hinted at. As in the case of the tough-minded Spiridonova, the plan was foiled by an uncooperative and unswerving critic. An alternative scheme was then concocted to dispose of Balabanoff, and before long she was bound for distant Turkestan at the command of a propaganda train.

During the Stalin period, the picture of psychiatric abuse is rather obscure but it does seem as if an embryonic policy to detain political dissenters in mental hospitals evolved in the late 1930s. Evidence comes from a psychiatrist who worked on the staff of a psychiatric hospital in Kazan during the second world war (he remained silent following his move to the United States, but in 1970, when allegations of current Soviet abuses were first made in the West, he reported vividly on his experiences in Kazan).⁸ The institution, under the direction of the NKVD (the secret police), catered for the treatment of politicals from throughout the USSR. Most patients were in fact ill, the content of their disturbed minds being political in nature. A small proportion, however, were mentally healthy and detained there only on the grounds of their political convictions. The case of a Moscow factory worker exemplifies this second group. Following his persistent refusal to contribute to the war effort, then a “voluntary” State requirement for all workers, he was arrested, diagnosed as schizophrenic, and transferred to Kazan. His psychiatrist could not detect any mental illness but obviously felt under considerable pressure to collude with the police authorities; not to do so would have spelt personal danger for the psychiatrist himself. A humanitarian motive also operated—the hospital ward was undoubtedly less punitive than a prison or labour camp; at the least, he would remain alive!

This humanitarian motive on the part of psychiatrists is understandable in the face of the inhumanity of Stalin’s penal policy. We obtained reliable corroboration of its existence from the poet Naum Korzhavin, when he provided us with an account of his experiences of 1948 in the Serbsky Institute for Forensic Psychiatry. (We discuss the Serbsky later in this chapter.) Following his arrest for writing “anti-Soviet” poems, he was examined by the Serbsky staff. Although finally declared sane and thus responsible before the law—he was sent into Siberian exile for several years as a result—he gained the distinct impression that the motive for psychiatric detention of healthy “politicals” was benevolent, not punitive. The staff, he suspected, were hoping to pin a diagnostic label on him in order to prevent his dispatch to a labour camp, with all its attendant horrors.

Korzhavin’s testimony is buttressed by that of Ilya Yarkov, another victim of the thoroughly arbitrary legal procedures that typified the Stalin period. In his vivid autobiography he paints a similar picture of the practice of psychiatric abuse as he witnessed it in three different mental hospitals—in Gorky, Kazan and Chistopol. As in Korzhavin’s experience, Yarkov never received any treatment, most doctors were kind and cordial, and conditions in the hospital were reasonably pleasant. No matter how humanitarian the motive of psychiatrists was, despite their benevolent management of the healthy dissenter their profession was obviously being manipulated during the 1940s and early 1950s to serve nonmedical interests—as a tool to repress dissent.

It was Sergei Pisarev, a long-standing Party member, who first campaigned for the abolition of this political misuse of psychiatry. He himself had suffered from it between 1953 and 1955 following his open criticism of the secret police for fabricating the notorious “Doctors’ Plot”. His arrest, a spell in the Serbsky Institute, and then some eighteen months’ detention in the Leningrad Prison Psychiatric Hospital enabled him to witness numerous cases—among them writers, artists and Party workers—in which misdiagnoses had been intentionally made. On his release he pressed the Party’s Central Committee to rid psychiatry of this evil. The resultant commission of enquiry inspected the Serbsky, Leningrad and Kazan Hospitals, but its findings were completely ignored by the Party.

Were the revelations too embarrassing to allow their dissemination? Were there influential figures in the committee or in the secret police who wished to retain a useful option in the battle against political deviation? Stalin had by this time been succeeded by Khrushchev who was keen to cleanse the tarnished image of the USSR and to convey to the West that the ruthless methods of Stalin had ceased and the country no longer held political prisoners. The advantages inherent in psychiatrically-based repression, especially the discreet silencing of dissenters without recourse to a major trial or blatantly trumped-up charges probably appealed to Khrushchev as he tried to project a new image of the Soviet regime.

The actual reasons for sweeping the report under the carpet were, in the event, of little consequence—political psychiatry evidently continued unabated; in 1970, with the development of a human rights movement, Pisarev felt compelled to resume his protest. On this occasion he wrote to the Academy of Medical Sciences (the Government’s most senior and prestigious advisory body in medicine) expressing his bitter disappointment that no substantial changes had taken place since the Central Committee’s investigation. Indeed, if anything, matters had worsened, with an “increase in the illegal political repressions facilitated by the Serbsky Institute …”⁹ (the foremost Soviet centre for forensic psychiatry which also doubles as the apex of psychiatric abuse). Although there is no way of corroborating Pisarev’s statement about an escalation in political psychiatry, sufficient cases were learned about—Yarkov and Pisarev have already been mentioned but others that came to light were the mathematician Alexander Volpin, the artist Mikhail Naritsa, the geophysicist Nikolai Samsonov and the pensioner Fyodor Shults—to suggest that during the 1950s and early 1960s a proportion of dissenters were charged with a political offence, diagnosed as mentally ill, and detained in a psychiatric hospital for indefinite treatment.

Hitherto, only flimsy details that something was amiss in Soviet psychiatry had percolated to the West. Then, in 1965, two events brought the matter into much sharper focus. The first was the British publication of Ward 7 by Valery Tarsis.¹⁰ Although in novel form, it was obviously an account of the author’s own personal experience in a Moscow psychiatric hospital. Party officials had engineered his forcible admission there when they learned that Tarsis planned to publish in the West The Blue-Bottle, an account of the constraints imposed on intellectuals under Khrushchev. This “anti-Soviet” behaviour required nipping in the bud, and what better deterrent than an indefinite stay in a mental hospital? The second event, in 1965, which attracted Western attention concerned Evgeny Belov, a student interpreter. The discovery of his politically-based psychiatric internment was entirely fortuitous. A year earlier a group of British students had met him whilst on a tour of the Soviet Union and during a follow-up visit they learned of his psychiatric confinement. On their return to Britain they immediately launched a campaign on his behalf which attracted widespread support from the media, public and Amnesty International.

It soon emerged that Belov had, in the period between the British students’ two visits, become dissatisfied with certain features of the Communist Party of which he was a member and had voiced his criticism openly, his discontent culminating in his dispatch of proposals for change to the Soviet leadership. Although beyond verification, and despite an article in Izvestia which dubbed the British campaign on behalf of Belov as a “filthy soap bubble” and “yet another anti-Soviet forgery”, all the evidence pointed to his detention as another example of political psychiatry.

Finally, in this brief sketch of the history of psychiatric misuse, we focus on Alexander Volpin. Forcibly hospitalized on no less than five occasions between 1949 and 1968, his case illuminates clearly the practice of political psychiatry during this period. His poetry, regarded by the authorities as anti-Soviet, led to his arrest, a diagnosis of schizophrenia and a year in a prison psychiatric hospital. All subsequent admissions were clearly associated with political factors. The fifth episode, for example, followed his application for a visa to visit the United States where he had been invited to attend a scientific conference. On this occasion and for the very first time in the USSR in the context of psychiatric abuse, a large-scale protest ensued—99 of Volpin’s colleagues petitioned the authorities for his immediate release. Several paid a high price for this action—demotion or dismissal from their posts. One signatory, Yuri Shikhanovich, would himself later share Volpin’s fate. One of the authors (SB) interviewed both Volpin and Shikhanovich and failed to detect any evidence to warrant a diagnosis of mental illness.

Nineteen sixty-eight also saw the first generalized protest in the Soviet Union when a dozen human rights activists appealed to a conference of Communist Parties to react to the suppression of human rights including “the most shocking form of reprisal—forcible confinement in a mental hospital”.¹¹ This act heralded two notable and interrelated developments: the emergence of a regular samizdat (underground, non-official publ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• LIST OF ILLUSTRATIONS
• Preface
• Chapter 1. Political Abuse: What Is It?
• Chapter 2. The Honolulu Congress: The First Great Clash
• Chapter 3. Resistance at Home: Growth and Suppression
• Chapter 4. The Review Committee: An Attempt to Investigate
• Chapter 5. Honolulu to Vienna: The Opposition Intensifies
• Chapter 6. Dialogue or Confrontation—The Movement to Expel
• Chapter 7. The Resignation: The Russians Retreat
• Chapter 8. Vienna and Beyond
• Appendices
• Notes and References
• Index