CIA Archives: Psychiatry in Russia (1957)

Psychiatry in Russia during the 1950s was deeply influenced by the theories of Ivan Pavlov, who was a Russian physiologist and the founder of the famous Pavlovian theory of classical conditioning. This theory proposed that behavior and psychological responses could be altered through conditioning and reinforcement, and it had a significant impact on the practice of psychiatry in the Soviet Union during that time.

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In the 1950s, mental hospitals were the primary institutions for treating mental illness in Russia. These hospitals were often overcrowded, understaffed, and poorly equipped, with patients frequently being subjected to inhumane conditions, such as being restrained or confined to their beds for long periods. Treatment methods were also heavily influenced by Pavlovian theory, with psychiatrists attempting to condition patients through various means, such as aversive conditioning, in which negative stimuli were used to discourage undesirable behaviors.

One notable example of the use of Pavlovian theory in psychiatry during the 1950s was the treatment of schizophrenia. Soviet psychiatrists believed that schizophrenia was caused by faulty conditioning, and they used various methods to try and recondition patients. One approach involved exposing patients to a repeated series of sensory stimuli, such as loud noises or flashing lights, in an attempt to alter their behavior and reduce symptoms.

Another technique used in Soviet psychiatry during this period was the use of psychotropic drugs, such as chlorpromazine, which was first developed in the Soviet Union in the 1950s. These drugs were used to suppress symptoms of mental illness, but they were often administered in high doses and without proper monitoring, leading to serious side effects.

There was systematic political abuse of psychiatry in the Soviet Union,[1] based on the interpretation of political opposition or dissent as a psychiatric problem.[2] It was called "psychopathological mechanisms" of dissent.[3]

During the leadership of General Secretary Leonid Brezhnev, psychiatry was used to disable and remove from society political opponents ("dissidents") who openly expressed beliefs that contradicted the official dogma.[4][5] The term "philosophical intoxication", for instance, was widely applied to the mental disorders diagnosed when people disagreed with the country's Communist leaders and, by referring to the writings of the Founding Fathers of Marxism–Leninism—Karl Marx, Friedrich Engels, and Vladimir Lenin—made them the target of criticism.[6]

Article 58-10 of the Stalin-era Criminal Code, "Anti-Soviet agitation", was to a considerable degree preserved in the new 1958 RSFSR Criminal Code as Article 70 "Anti-Soviet agitation and propaganda". In 1967, a weaker law, Article 190-1 "Dissemination of fabrications known to be false, which defame the Soviet political and social system", was added to the RSFSR Criminal Code. These laws were frequently applied in conjunction with the system of diagnosis for mental illness, developed by academician Andrei Snezhnevsky. Together, they established a framework within which non-standard beliefs could easily be defined as a criminal offence and the basis, subsequently, for a psychiatric diagnosis.[7]
Applying the diagnosis

The "anti-Soviet" political behavior of some individuals – being outspoken in their opposition to the authorities, demonstrating for reform, and writing critical books – were defined simultaneously as criminal acts (e.g., a violation of Articles 70 or 190–1), symptoms of mental illness (e.g., "delusion of reformism"), and susceptible to a ready-made diagnosis (e.g., "sluggish schizophrenia").[8] Within the boundaries of the diagnostic category, the symptoms of pessimism, poor social adaptation and conflict with authorities were themselves sufficient for a formal diagnosis of "sluggish schizophrenia".[9]

The psychiatric incarceration of certain individuals was prompted by their attempts to emigrate, to distribute or possess prohibited documents or books, to participate in civil rights protests and demonstrations, and become involved in forbidden religious activities.[10] In accordance with the doctrine of state atheism, the religious beliefs of prisoners, including those of well-educated former atheists who had become adherents of a religious faith, was considered to be a form of mental illness that required treatment.[11][12] The KGB routinely sent dissenters to psychiatrists for diagnosis, in order to discredit dissidence as the product of unhealthy minds and to avoid the embarrassment caused by public trials.[13] Highly classified government documents that became available after the dissolution of the Soviet Union confirm that the authorities consciously used psychiatry as a tool to suppress dissent.[14]

According to the "Commentary" to the post-Soviet Russian Federation Law on Psychiatric Care, individuals forced to undergo treatment in Soviet psychiatric medical institutions were entitled to rehabilitation in accordance with the established procedure and could claim compensation. The Russian Federation acknowledged that before 1991 psychiatry had been used for political purposes and took responsibility for the victims of "political psychiatry."[15]

The political abuse of psychiatry in Russia has continued, nevertheless, since the fall of the Soviet Union,[16] and human rights activists may still face the threat of a psychiatric diagnosis for their legitimate civic and political activities.[17]
Background
Definitions
Mass repression
in the Soviet Union
Economic repression

Collectivization Dekulakization Soviet famine of 1930–1933
Ukraine Kazakhstan

Political repression

Red Terror Purges of the Communist Party Great Purge Gulag Punitive psychiatry

Ideological repression

Religion
1917–1921 1921–1928 1928–1941 1958–1964 1975–1987 Christianity Islam Judaism Legislation Science Censorship
Images

Ethnic repression

De-Cossackization National operations of the NKVD Population transfers

vte

Political abuse of psychiatry is the misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society.[18] It entails the exculpation and committal of citizens to psychiatric facilities based upon political rather than mental health-based criteria.[19] Many authors, including psychiatrists, also use the terms "Soviet political psychiatry"[20] or "punitive psychiatry" to refer to this phenomenon.[21]

In his book Punitive Medicine (1979) Alexander Podrabinek defined the term "punitive medicine", which is identified with "punitive psychiatry," as "a tool in the struggle against dissidents who cannot be punished by legal means."[22] Punitive psychiatry is neither a discrete subject nor a psychiatric specialty but, rather, it is an emergency arising within many applied sciences in totalitarian countries where members of a profession may feel themselves compelled to serve the diktats of power.[23] Psychiatric confinement of sane people is uniformly considered a particularly pernicious form of repression[24] and Soviet punitive psychiatry was one of the key weapons of both illegal and legal repression.[25]

As Vladimir Bukovsky and Semyon Gluzman wrote in their joint A Manual on Psychiatry for Dissenters, "the Soviet use of psychiatry as a punitive means is based upon the deliberate interpretation of dissent... as a psychiatric problem."[26]
An inherent capacity for abuse

The diagnosis of mental disease can give the state license to detain persons against their will and insist upon therapy both in the interest of the detainee and in the broader interests of society.[27] In addition, receiving a psychiatric diagnosis can itself be regarded as oppressive.[28] In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.[27]

In the period from the 1960s to 1986, the abuse of psychiatry for political purposes was reported to have been systematic in the Soviet Union and episodic in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.[29] The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.[30] Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.[31] As scholars have long argued, governmental and medical institutions have at times classified threats to authority during periods of political disturbance and instability as a form of mental disease.[32] In many countries, political prisoners are still sometimes confined and abused in mental institutions.[33]

In the Soviet Union, dissidents were often confined in psychiatric wards commonly called psikhushkas.[34] Psikhushka is the Russian ironic diminutive for "psychiatric hospital".[35] One of the first penal psikhushkas was the Psychiatric Prison Hospital in the city of Kazan.[36] In 1939, it was transferred to the control of the NKVD (the secret police and precursor of the KGB) on the orders of Lavrentiy Beria, the head of the NKVD.[37] International human rights defenders such as Walter Reich have long recorded the methods by which Soviet psychiatrists in Psikhushka hospitals diagnosed schizophrenia in political dissenters.[32] Western scholars examined no aspect of Soviet psychiatry as thoroughly as its involvement in the social control of political dissenters.[38]
Under Stalin, Khrushchev and Brezhnev

As early as 1948, the Soviet secret service took an interest in this area of medicine.[39] One of those with overall responsibility for the Soviet secret police, pre-war Procurator General and State Prosecutor, the deputy Minister of Foreign Affairs Andrey Vyshinsky, was the first to order the use of psychiatry as a tool of repression.[40] Russian psychiatrist Pyotr Gannushkin believed that in a class society, especially during the most severe class struggle, psychiatry was incapable of not being repressive.[41] A system of political abuse of psychiatry was developed at the end of Joseph Stalin's regime.[42]

Punitive psychiatry was not simply an inheritance from the Stalin era, however, according to Alexander Etkind. The Gulag, or Chief Administration for Corrective Labor Camps, was an effective instrument of political repression. There was no compelling requirement to develop an alternative and more expensive psychiatric substitute.[43] The abuse of psychiatry was a natural product of the later Soviet era.[43] From the mid-1970s to the 1990s, the structure of the USSR mental health service conformed to the double standard in society, being represented by two distinct systems which co-existed peacefully for the most part, despite periodic conflicts between them:

system one was that of punitive psychiatry. It directly served the authorities and those in power, and was headed by the Moscow Institute for Forensic Psychiatry named in honour of Vladimir Serbsky;
system two was made up of elite, psychotherapeutically oriented clinics. It was headed by the Leningrad Psychoneurological Institute named in memory of Vladimir Bekhterev.[43]

The hundreds of hospitals in the provinces combined elements of both systems.[43]

If someone was mentally ill then, they were sent to psychiatric hospitals and confined there until they died.[44] If his mental health was uncertain but he was not constantly unwell, he and his kharakteristika [testimonial from employers, the Party and other Soviet institutions] were sent to a labour camp or to be shot.[44] When allusions to socialist legality started to be made, it was decided to prosecute such people.[44] Soon it became apparent that putting people who gave anti-Soviet speeches on trial only made matters worse for the regime. Such individuals were no longer tried in court. Instead they were given a psychiatric examination and declared insane.[44]
The Joint Session, October 1951
Main article: Pavlovian session

In the 1950s, the psychiatrists of the Soviet Union turned themselves into the medical arm of the Gulag State.[45] A precursor of later abuses in psychiatry in the Soviet Union, the "Joint Session" of the USSR Academy of Medical Sciences and the Board of the All-Union Neurological and Psychiatric Association took place from 10 to 15 October 1951. The event was dedicated, supposedly, to the great Russian physiologist Ivan Pavlov, and alleged that several of the USSR's leading neuroscientists and psychiatrists of the time (among them Grunya Sukhareva, Vasily Gilyarovsky, Raisa Golant, Aleksandr Shmaryan, and Mikhail Gurevich) were guilty of practicing "anti-Pavlovian, anti-Marxist, idealistic [and] reactionary" science, and this was damaging to Soviet psychiatry.[46]

During the Joint Session, these eminent psychiatrists, motivated by fear, had to publicly admit that their scientific positions were erroneous and they also had to promise to conform to "Pavlovian" doctrines.[46] These public declarations of obedience proved insufficient. In the closing speech, Andrei Snezhnevsky, the lead author of the Session's policy report, stated that the accused psychiatrists "have not disarmed themselves and continue to remain in the old anti-Pavlovian positions", thereby causing "grave damage to the Soviet psychiatric research and practice". The vice president of the USSR Academy of Medical Sciences accused them of "diligently worshipping the dirty source of American pseudo-science".[47] Those who articulated these accusations at the Joint Session – among them Irina Strelchuk, Vasily Banshchikov, Oleg Kerbikov, and Snezhnevsky – were distinguished by their careerist ambition and fear for their own positions.[46] Not surprisingly, many of them were promoted and appointed to leadership posts shortly after the session.[46]

The Joint Session also had a negative impact on several leading Soviet academic neuroscientists, such as Pyotr Anokhin, Aleksey Speransky, Lina Stern, Ivan Beritashvili, and Leon Orbeli. They were labeled as anti-Pavlovians, anti-materialists and reactionaries and subsequently they were dismissed from their positions.[46] In addition to losing their laboratories some of these scientists were subjected to torture in prison.[46] The Moscow, Leningrad, Ukrainian, Georgian, and Armenian schools of neuroscience and neurophysiology were damaged for a period due to this loss of personnel.[46] The Joint Session ravaged productive research in neurosciences and psychiatry for years to come.[46] Pseudo-science took control.[46]

Following a previous joint session of the USSR Academy of Sciences and the USSR Academy of Medical Sciences (28 June–4 July 1950) and the 10-15 October 1951 joint session of the Presidium of the Academy of Medical Sciences and the Board of the All-Union Society of Neuropathologists and Psychiatrists, Snezhnevky's school was given the leading role.[48] The 1950 decision to give monopoly over psychiatry to the Pavlovian school of Snezhnevsky was one of the crucial factors in the rise of political psychiatry.[49] The Soviet doctors, under the incentive of Snezhnevsky, devised a "Pavlovian theory of schizophrenia" and increasingly applied this diagnostic category to political dissidents.[50]
"Sluggish schizophrenia"
Main article: Sluggish schizophrenia

The incarceration of free thinking healthy people in madhouses is spiritual murder, it is a variation of the gas chamber, even more cruel; the torture of the people being killed is more malicious and more prolonged. Like the gas chambers, these crimes will never be forgotten and those involved in them will be condemned for all time during their life and after their death."[51] (Alexander Solzhenitsyn)

Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.[52] It was the diagnosis of "sluggish schizophrenia" that was most prominently used in cases of dissidents.[53] Sluggish schizophrenia as one of the new diagnostic categories was created to facilitate the stifling of dissidents and was a root of self-deception among psychiatrists to placate their consciences when the doctors acted as a tool of oppression in the name of a political system.[54] According to the Global Initiative on Psychiatry chief executive Robert van Voren, the political abuse of psychiatry in the USSR arose from the conception that people who opposed the Soviet regime were mentally sick since there was no other logical rationale why one would oppose the sociopolitical system considered the best in the world.[55] The diagnosis "sluggish schizophrenia", a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Snezhnevsky, furnished a very handy framework for explaining this behavior.[55]

The weight of scholarly opinion holds that the psychiatrists who played the primary role in the development of this diagnostic concept were following directives from the Communist Party and the Soviet secret service, or KGB, and were well aware of the political uses to which it would be put. Nevertheless, for many Soviet psychiatrists "sluggish schizophrenia" appeared to be a logical explanation to apply to the behavior of critics of the regime who, in their opposition, seemed willing to jeopardize their happiness, family, and career for a reformist conviction or ideal that was so apparently divergent from the prevailing social and political orthodoxy.[55]

Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences, developed a novel classification of mental disorders postulating an original set of diagnostic criteria.[9] A carefully crafted description of sluggish schizophrenia established that psychotic symptoms were non-essential for the diagnosis, but symptoms of psychopathy, hypochondria, depersonalization or anxiety were central to it.[9] Symptoms referred to as part of the "negative axis" included pessimism, poor social adaptation, and conflict with authorities, and were themselves sufficient for a formal diagnosis of "sluggish schizophrenia with scanty symptoms".[9] According to Snezhnevsky, patients with sluggish schizophrenia could present as quasi sane yet manifest minimal but clinically relevant personality changes which could remain unnoticed to the untrained eye.[9] Thereby patients with non-psychotic mental disorders, or even persons who were not mentally sick, could be easily labelled with the diagnosis of sluggish schizophrenia.[9] Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters.[9] As per the theories of Snezhnevsky and his colleagues, schizophrenia was held to be much more prevalent than previously considered, for the illness might present with comparatively slight symptoms, and might only progress afterwards.[55] As a consequence, schizophrenia was diagnosed much more often in Moscow than in cities of other countries, as the World Health Organization Pilot Study on Schizophrenia reported in 1973.[55] The city with the highest prevalence of schizophrenia in the world was Moscow.[56] In particular, the scope was widened by sluggish schizophrenia because according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of functioning almost normally in the social sense.[55] Their symptoms could be like those of a neurosis or could assume a paranoid character.[55] The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society.[55] Thereby, sluggish schizophrenia could have such symptoms as "reform delusions", "perseverance", and "struggle for the truth".[55] As Viktor Styazhkin reported, Snezhnevsky diagnosed a reformation delusion for every case when a patient "develops a new principle of human knowledge, drafts an academy of human happiness, and many other projects for the benefit of mankind".[57]

In the 1960s and 1970s, theories, which contained ideas about reforming society and struggling for truth, and religious convictions were not referred to delusional paranoid disorders in practically all foreign classifications, but Soviet psychiatry, proceeding from ideological conceptions, referred critique of the political system and proposals to reform this system to the delusional construct.[58] Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union and several Eastern European countries.[59]

On the covert orders of the KGB, thousands of social and political reformers—Soviet "dissidents"—were incarcerated in mental hospitals after being labelled with diagnoses of "sluggish schizophrenia", a disease fabricated by Snezhnevsky and "Moscow school" of psychiatry.[60] American psychiatrist Alan A. Stone stated that Western criticism of Soviet psychiatry aimed at Snezhnevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia with a "sluggish type" manifestation by "reformerism" including other symptoms.[61] One can readily apply this diagnostic scheme to dissenters.[61] Snezhnevsky was long attacked in the West as an exemplar of psychiatric abuse in the USSR.[53] The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and this diagnosis to make political dissent into a mental disease.[62] He was charged with cynically developing a system of diagnosis which could be bent for political purposes, and he himself diagnosed or was involved in a series of famous dissident cases,[53] and, in dozens of cases, he personally signed a commission decision on legal insanity of mentally healthy dissidents including Vladimir Bukovsky, Natalya Gorbanevskaya, Leonid Plyushch, Mikola Plakhotnyuk,[63] and Pyotr Grigorenko.[64]
Beginning of the trend toward mass abuse
From Khrushchev to Andropov

The campaign to declare political opponents mentally sick and to commit dissenters to mental hospitals began in the late 1950s and early 1960s.[39] As Vladimir Bukovsky commented on the emergence of the political abuse of psychiatry,[65] Nikita Khrushchev reckoned that it was impossible for people in a socialist society to have an anti-socialist consciousness. Whenever manifestations of dissidence could not be justified as a provocation of world imperialism or a legacy of the past, they were self-evidently the product of mental disease.[39] In a speech published in the Pravda daily newspaper on 24 May 1959, Khrushchev said:

A crime is a deviation from generally recognized standards of behavior frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offences, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal.[39]

Yuri Andropov (1914–1984), a KGB Chairman and General Secretary of the CPSU

The now available evidence supports the conclusion that the system of political abuse of psychiatry was carefully designed by the KGB to rid the USSR of undesirable elements.[66] According to several available documents and a message by a former general of the Fifth (dissident) Directorate of the Ukrainian KGB to Robert van Voren, political abuse of psychiatry as a systematic method of repression was developed by Yuri Andropov along with a selected group of associates.[67]

Andropov was in charge of the wide-ranging deployment of psychiatric repression from the moment he was appointed to head the KGB.[68] He became KGB Chairman on 18 May 1967.[69] On 3 July 1967, he made a proposal to establish a Fifth Directorate (ideological counterintelligence) within the KGB to deal with internal political opposition to the Soviet regime.[70][71] The Directorate was set up at the end of July and took charge of KGB files on all Soviet dissidents, including Andrei Sakharov and Alexander Solzhenitsyn.[70] In 1968, KGB Chairman Andropov issued a departmental order "On the tasks of State security agencies in combating the ideological sabotage by the adversary", calling for the KGB to struggle against dissidents and their imperialist masters.[72] His aim was "the destruction of dissent in all its forms" and he insisted that the positions of the capitalist countries on human rights, and their criticisms of the Soviet Union and its own politics of human rights from these positions, was just one part of a wide-ranging imperialist plot to undermine the Soviet state's foundation.[72] Similar ideas can be found in the 1983 book Speeches and Writings by Andropov published when he had become General Secretary of the CPSU:[73]

[w]hen analyzing the main trend in present-day bourgeois criticism of [Soviet] human rights policies one is bound to draw the conclusion that although this criticism is camouflaged with "concern" for freedom, democracy, and human rights, it is directed in fact against the socialist essence of Soviet society...

Implementation and the legal framework

On 29 April 1969, Andropov submitted an elaborate plan to the Central Committee of the Communist Party of the Soviet Union to set up a network of mental hospitals that would defend the "Soviet Government and the socialist order" from dissenters.[74] To persuade his fellow Politburo members of the risk posed by the mentally ill, Andropov circulated a report from the Krasnodar Region.[75] A secret resolution of the USSR Council of Ministers was adopted.[76] Andropov's proposal to use psychiatry for struggle against dissenters was adopted and implemented.[77]

In 1929, the USSR had 70 psychiatric hospitals and 21,103 psychiatric beds. By 1935, this had increased to 102 psychiatric hospitals and 33,772 psychiatric beds, and by 1955 there were 200 psychiatric hospitals and 116,000 psychiatric beds in the Soviet Union.[78] The Soviet authorities built psychiatric hospitals at a rapid pace and increased the quantity of beds for patients with nervous and mental illnesses: between 1962 and 1974, the number of beds for psychiatric patients increased from 222,600 to 390,000.[79] Such an expansion in the number of psychiatric beds was expected to continue in the years up to 1980.[80] Throughout this period the dominant trend in Soviet psychiatry ran counter to the vigorous attempts in Western countries to treat as many as possible as out-patients rather than in-patients.[80]

On 15 May 1969, a Soviet Government decree (No. 345–209) was issued "On measures for preventing dangerous behavior (acts) on the part of mentally ill persons."[81] This decree confirmed the practice of having undesirables hauled into detention by psychiatrists.[81] Soviet psychiatrists were told whom they should examine and were assured that they might detain these individuals with the help of the police or entrap them into coming to the hospital.[81] The psychiatrists thereby doubled as interrogators and as arresting officers.[81] Doctors fabricated a diagnosis requiring detention and no court decision was required for subjecting the individual to indefinite confinement in a psychiatric institution.[81]

By the end of the 1950s, confinement to a psychiatric institution had become the most commonly used method of punishing leaders of the political opposition.[9] In the 1960s and 1970s, the trials of dissenters and their referral for "treatment" to the Special Psychiatric Hospitals under MVD control and oversight[82] came out into the open, and the world learned of a wave of "psychiatric terror" which was flatly denied by those in charge of the Serbsky Institute.[83] The bulk of psychiatric repression spans the period from the late 1960s to the early 1980s.[84] As CPSU General Secretary, from November 1982 to February 1984, Yury Andropov demonstrated little patience with domestic dissafection and continued the Brezhnev Era policy of confining dissenters in mental hospitals.[85]
Examination and hospitalization

Political dissidents were usually charged under Articles 70 (agitation and propaganda against the Soviet state) and 190-1 (dissemination of false fabrications defaming the Soviet state and social system) of the RSFSR Criminal Code.[9] Forensic psychiatrists were asked to examine offenders whose mental state was considered abnormal by the investigating officers.[9]

In almost every case, dissidents were examined at the Serbsky Central Research Institute for Forensic Psychiatry[86] in Moscow, where persons being prosecuted in court for committing political crimes were subjected to a forensic-psychiatric expert evaluation.[84] Once certified, the accused and convicted were sent for involuntary treatment to the Special Psychiatric Hospitals controlled by the Ministry of Internal Affairs (MVD) of the Russian Soviet Federative Socialist Republic.[84]

The accused had no right of appeal.[9] The right was given to their relatives or other interested persons but they were not allowed to nominate psychiatrists to take part in the evaluation, because all psychiatrists were considered fully independent and equally credible before the law.[9]

According to dissident poet Naum Korzhavin, the atmosphere at the Serbsky Institute in Moscow altered almost overnight when Daniil Lunts took over as head of the Fourth Department (otherwise known as the Political Department).[39] Previously, psychiatric departments were regarded as a 'refuge' against being dispatched to the Gulag. Now that policy altered.[39] The first reports of dissenters being hospitalized on non-medical grounds date from the early 1960s, not long after Georgy Morozov was appointed director of the Serbsky Institute.[39] Both Morozov and Lunts were personally involved in numerous well-known cases and were notorious abusers of psychiatry for political purposes.[39] Most prisoners, in Viktor Nekipelov's words, characterized Daniil Lunts as "no better than the criminal doctors who performed inhuman experiments on the prisoners in Nazi concentration camps."[87]

A well-documented practice was the use of psychiatric hospitals as temporary prisons during the two or three weeks around the 7 November (October Revolution) Day and May Day celebrations, to isolate "socially dangerous" persons who otherwise might protest in public or manifest other deviant behavior.[88]
Struggle against abuse
Main article: Struggle against political abuse of psychiatry in the Soviet Union

In the 1960s, a vigorous movement grew up protesting against abuse of psychiatry in the USSR.[89] Political abuse of psychiatry in the Soviet Union was denounced in the course of the Congresses of the World Psychiatric Association in Mexico City (1971), Hawaii (1977), Vienna (1983) and Athens (1989).[9] The campaign to terminate political abuse of psychiatry in the USSR was a key episode in the Cold War, inflicting irretrievable damage on the prestige of medicine in the Soviet Union.[60]
Classification of the victims
Main article: Cases of political abuse of psychiatry in the Soviet Union

Upon analysis of over 200 well-authenticated cases covering the period 1962–1976, Sidney Bloch and Peter Reddaway developed a classification of the victims of Soviet psychiatric abuse. They were classified as:[90]

advocates of human rights or democratization;
nationalists;
would-be emigrants;
religious believers;
citizens inconvenient to the authorities.

The advocates of human rights and democratization, according to Bloch and Reddaway, made up about half the dissidents repressed by means of psychiatry.[90] Nationalists made up about one-tenth of the dissident population dealt with psychiatrically.[91] Would-be emigrants constituted about one-fifth of dissidents victimized by means of psychiatry.[92] People detained only because of their religious activity made up about fifteen per cent of dissident-patients.[92] Citizens inconvenient to the authorities because of their "obdurate" complaints about bureaucratic excesses and abuses accounted for about five per cent of dissidents subject to psychiatric abuse.[93]
Incomplete figures

In 1985, Peter Reddaway and Sidney Bloch provided documented data on some five hundred cases in their book Soviet Psychiatric Abuse.[94]
True scale of repression

On basis of the available data and materials accumulated in the archives of the International Association on the Political Use of Psychiatry, one can confidently conclude that thousands of dissenters were hospitalized for political reasons.[55] From 1994 to 1995, an investigative commission of Moscow psychiatrists explored the records of five prison psychiatric hospitals in Russia and discovered about two thousand cases of political abuse of psychiatry in these hospitals alone.[55] In 2004, Anatoly Prokopenko said he was surprised at the facts obtained by him from the official classified top secret documents by the Central Committee of the CPSU, by the KGB, and MVD.[95] According to his calculations based on what he found in the documents, about 15,000 people were confined for political crimes in the psychiatric prison hospitals under the control of the MVD.[95] In 2005, referring to the Archives of the CPSU Central Committee and the records of the three Special Psychiatrial Hospitals — Sychyovskaya, Leningrad and Chernyakhovsk hospitals — to which human rights activists gained access in 1991, Prokopenko concluded that psychiatry had been used as punitive measure against about 20,000 people for purely political reasons.[96] This was only a small part of the total picture, Prokopenko said. The data on the total number of people who had been held in all sixteen prison hospitals and in the 1,500 "open" psychiatric hospitals remains unknown because parts of the archives of the prison psychiatric hospitals and hospitals in general are classified and inaccessible.[96] The figure of fifteen or twenty thousand political prisoners in psychiatric hospitals run by the Soviet Ministry of Internal Affairs was first put forward by Prokopenko in the 1997 book Mad Psychiatry ("Безумная психиатрия"),[97] which was republished in 2005.[98]

An indication of the extent of the political abuse of psychiatry in the USSR is provided by Semyon Gluzman's calculation that the percentage of "the mentally ill" among those accused of so-called anti-Soviet activities proved many times higher than among criminal offenders.[99][19] The attention paid to political prisoners by Soviet psychiatrists was more than 40 times greater than their attention to ordinary criminal offenders.[99] This derives from the following comparison: 1–2% of all the forensic psychiatric examinations carried out by the Serbsky Institute targeted those accused of anti-Soviet activities;[99][19] convicted dissidents in penal institutions made up 0.05% of the total number of convicts;[99][19] 1–2% is 40 times greater than 0.05%.[99][19]

According to Viktor Luneyev, the struggle against dissent operated on many more layers than those registered in court sentences. We do not know how many the secret services kept under surveillance, held criminally liable, arrested, sent to psychiatric hospitals, or who were sacked from their jobs, and restricted in all kinds of other ways in the exercise of their rights.[100] No objective assessment of the total number of repressed persons is possible without fundamental analysis of archival documents.[101] The difficulty is that the required data are very diverse and are not to be found in a single archive.[101] They are scattered between the State Archive of the Russian Federation, the archive of the Russian Federation State Statistical Committee (Goskomstat), the archives of the RF Ministry of Internal Affairs (MVD of Russia), the FSB of Russia, the RF General Prosecutor's Office, and the Russian Military and Historical Archive. Further documents are held in the archives of 83 constituent entities of the Russian Federation, in urban and regional archives, as well as in the archives of the former Soviet Republics, now the 11 independent countries of the Commonwealth of Independent States or the three Baltic States (Baltics).[101]
Concealment of the data

According to Russian psychiatrist Emmanuil Gushansky, the scale of psychiatric abuses in the past, the use of psychiatric doctrines by the totalitarian state have been thoroughly concealed.[102] The archives of the Soviet Ministries of Internal Affairs (MVD) and Health (USSR Health Ministry), and of the Serbsky Institute for Forensic Psychiatry, which between them hold evidence about the expansion of psychiatry and the regulations governing that expansion, remain totally closed to researchers, says Gushansky.[102] Dan Healey shares his opinion that the abuses of Soviet psychiatry under Stalin and, even more dramatically, in the 1960s to 1980s remain under-researched: the contents of the main archives are still classified and inaccessible.[103] Hundreds of files on people who underwent forensic psychiatric examinations at the Serbsky Institute during Stalin's time are on the shelves of the highly classified archive in its basement[104] where Gluzman saw them in 1989.[105] All are marked by numbers without names or surnames, and any biographical data they contain[104] is unresearched and inaccessible to researchers.[105]

Anatoly Sobchak, the former Mayor of Saint Petersburg, wrote:

The scale of the application of methods of repressive psychiatry in the USSR is testified by inexorable figures and facts. A commission of the top Party leadership headed by Alexei Kosygin reached a decision in 1978 to build 80 psychiatric hospitals and 8 special psychiatric institutions in addition to those already in existence. Their construction was to be completed by 1990. They were to be built in Krasnoyarsk, Khabarovsk, Kemerovo, Kuibyshev, Novosibirsk, and other parts of the Soviet Union. In the course of the changes that the country underwent in 1988, five prison hospitals were transferred from the MVD to the jurisdiction of the Ministry of Health, while another five were closed down. There was a hurried covering of tracks through the mass rehabilitation of patients, some of whom were mentally disabled (in one and the same year no less than 800,000 patients were removed from the psychiatric registry). In Leningrad alone 60,000 people with a diagnosis of mental illness were released and rehabilitated in 1991 and 1992. In 1978, 4.5 million people throughout the USSR were registered as psychiatric patients. This was equivalent to the population of many civilized countries.[106]

In Ukraine, a study of the origins of the political abuse of psychiatry was conducted for five years on the basis of the State archives.[107] A total of 60 people were again examined.[107] All were citizens of Ukraine, convicted of political crimes and hospitalized on the territory of Ukraine. Not one of them, it turned out, was in need of any psychiatric treatment.[107]
Alexander Yakovlev (1923–2005), the head of the Commission for Rehabilitation of the Victims of Political Repression

From 1993 to 1995, a presidential decree on measures to prevent future abuse of psychiatry was being drafted at the Commission for Rehabilitation of the Victims of Political Repression.[108] For this purpose, Anatoly Prokopenko selected suitable archival documents and, at the request of Vladimir Naumov, the head of research and publications at the commission, Emmanuil Gushansky drew up the report.[108] It correlated the archival data presented to Gushansky with materials received during his visits, conducted jointly with the commission of the Independent Psychiatric Association of Russia, to several strict-regime psychiatric hospitals (former Special Hospitals under MVD control).[108] When the materials for discussion in the Commission for Rehabilitation of the Victims of Political Repression were ready, however, the work came to a standstill.[108] The documents failed to reach the head of the Commission Alexander Yakovlev.[108]

The report on political abuse of psychiatry prepared at the request of the commission by Gushansky with the aid of Prokopenko lay unclaimed and even the Independent Psychiatric Journal (Nezavisimiy Psikhiatricheskiy Zhurnal)[102] would not publish it. The Moscow Research Center for Human Rights headed by Boris Altshuler and Alexey Smirnov and the Independent Psychiatric Association of Russia whose president is Yuri Savenko were asked by Gushansky to publish the materials and archival documents on punitive psychiatry but showed no interest in doing so.[108] Publishing such documents is dictated by present-day needs and by how far it is feared that psychiatry could again be abused for non-medical purposes.[109]

In its 2000 report, the Commission for Rehabilitation of the Victims of Political Repression included only the following four phrases about the political abuse of psychiatry:[110]

The Commission has also considered such a complex, socially relevant issue, as the use of psychiatry for political purposes. The collected documents and materials allow us to say that the extrajudicial procedure of admission to psychiatric hospitals was used for compulsory hospitalization of persons whose behavior was viewed by the authorities as "suspicious" from the political point of view. According to the incomplete data, hundreds of thousands of people have been illegally placed to psychiatric institutions of the country over the years of Soviet power. The rehabilitation of these people was limited, at best, to their removal from the registry of psychiatric patients and usually remains so today, due to gaps in the legislation.

In the 1988 and 1989, about two million people were removed from the psychiatric registry at the request of Western psychiatrists. It was one of their conditions for the re-admission of Soviet psychiatrists to the World Psychiatric Association.[111] Yury Savenko has provided different figures in different publications: about one million,[112] up to one and a half million,[113] about one and a half million people removed from the psychiatric registry.[114] Mikhail Buyanov provided the figure of over two million people removed from the psychiatric registry.[115]
Theoretical analysis

In 1990, Psychiatric Bulletin of the Royal College of Psychiatrists published the article "Compulsion in psychiatry: blessing or curse?" by Russian psychiatrist Anatoly Koryagin. It contains analysis of the abuse of psychiatry and eight arguments by which the existence of a system of political abuse of psychiatry in the USSR can easily be demonstrated. As Koryagin wrote, in a dictatorial State with a totalitarian regime, such as the USSR, the laws have at all times served not the purpose of self-regulation of the life of society but have been one of the major levers by which to manipulate the behavior of subjects. Every Soviet citizen has constantly been straight considered state property and been regarded not as the aim, but as a means to achieve the rulers' objectives. From the perspective of state pragmatism, a mentally sick person was regarded as a burden to society, using up the state's material means without recompense and not producing anything, and even potentially capable of inflicting harm. Therefore, the Soviet State never considered it reasonable to pass special legislative acts protecting the material and legal part of the patients' life. It was only instructions of the legal and medical departments that stipulated certain rules of handling the mentally sick and imposing different sanctions on them. A person with a mental disorder was automatically divested of all rights and depended entirely on the psychiatrists' will. Practically anybody could undergo psychiatric examination on the most senseless grounds and the issued diagnosis turned him into a person without rights. It was this lack of legal rights and guarantees that advantaged a system of repressive psychiatry in the country.[116]

According to American psychiatrist Oleg Lapshin, Russia until 1993 did not have any specific legislation in the field of mental health except uncoordinated instructions and articles of laws in criminal and administrative law, orders of the USSR Ministry of Health. In the Soviet Union, any psychiatric patient could be hospitalized by request of his headman, relatives or instructions of a district psychiatrist. In this case, patient's consent or dissent mattered not. The duration of treatment in a psychiatric hospital also depended entirely on the psychiatrist. All of that made the abuse of psychiatry possible to suppress those who opposed the political regime, and that created the vicious practice of ignoring the rights of the mentally ill.[117]

According to Yuri Savenko, the president of the Independent Psychiatric Association of Russia (the IPA), punitive psychiatry arises on the basis of the interference of three main factors:[118]

The ideologizing of science, its breakaway from the achievements of world psychiatry, the party orientation of Soviet forensic psychiatry.
The lack of legal basis.
The total nationalization of mental health service.

Their interaction system is principally sociological: the presence of the Penal Code article on slandering the state system inevitably results in sending a certain percentage of citizens to forensic psychiatric examination.[23] Thus, it is not psychiatry itself that is punitive, but the totalitarian state uses psychiatry for punitive purposes with ease.[23]

According to Larry Gostin, the root cause of the problem was the State itself.[119] The definition of danger was radically extended by the Soviet criminal system to cover "political" as well as customary physical types of "danger".[119] As Bloch and Reddaway note, there are no objective reliable criteria to determine whether the person's behavior will be dangerous, and approaches to the definition of dangerousness greatly differ among psychiatrists.[120]

Richard Bonnie, a professor of law and medicine at the University of Virginia School of Law, mentioned the deformed nature of the Soviet psychiatric profession as one of the explanations for why it was so easily bent toward the repressive objectives of the state, and pointed out the importance of a civil society and, in particular, independent professional organizations separate and apart from the state as one of the most substantial lessons from the period.[121]

According to Norman Sartorius, a former president of the World Psychiatric Association, political abuse of psychiatry in the former Soviet Union was facilitated by the fact that the national classification included categories that could be employed to label dissenters, who could then be forcibly incarcerated and kept in psychiatric hospitals for "treatment".[122] Darrel Regier, vice-chair of the DSM-5 task force, has a similar opinion that the political abuse of psychiatry in the USSR was sustained by the existence of a classification developed in the Soviet Union and used to organize psychiatric treatment and care.[123] In this classification, there were categories with diagnoses that could be given to political dissenters and led to the harmful involuntary medication.[123]

According to Moscow psychiatrist Alexander Danilin, the so-called "nosological" approach in the Moscow psychiatric school established by Snezhnevsky boils down to the ability to make the only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept "sluggish schizophrenia" introduced some time once by an academician Snezhnevsky, whom Danilin called a state criminal.[124]

St Petersburg academic psychiatrist professor Yuri Nuller notes that the concept of Snezhnevsky's school allowed psychiatrists to consider, for example, schizoid psychopathy and even schizoid character traits as early, delayed in their development, stages of the inevitable progredient process, rather than as personality traits inherent to the individual, the dynamics of which might depend on various external factors.[125] The same also applied to a number of other personality disorders.[125] It entailed the extremely broadened diagnostics of sluggish (neurosis-like, psychopathy-like) schizophrenia.[125] Despite a number of its controversial premises and in line with the traditions of then Soviet science, Snezhnevsky's hypothesis has immediately acquired the status of dogma which was later overcome in other disciplines but firmly stuck in psychiatry.[126] Snezhnevsky's concept, with its dogmatism, proved to be psychologically comfortable for many psychiatrists, relieving them from doubt when making a diagnosis.[126] That carried a great danger: any deviation from a norm evaluated by a doctor could be regarded as an early phase of schizophrenia, with all ensuing consequences.[126] It resulted in the broad opportunity for voluntary and involuntary abuses of psychiatry.[126] However, Snezhnevsky did not take civil and scientific courage to reconsider his concept which clearly reached a deadlock.[126]

According to American psychiatrist Walter Reich, the misdiagnoses of dissidents resulted from some characteristics of Soviet psychiatry that were distortions of standard psychiatric logic, theory, and practice.[53]

According to Semyon Gluzman, abuse of psychiatry to suppress dissent is based on condition of psychiatry in a totalitarian state.[19] Psychiatric paradigm of a totalitarian state is culpable for its expansion into spheres which are not initially those of psychiatric competence.[19] Psychiatry as a social institution, formed and functioning in the totalitarian state, is incapable of not being totalitarian.[19] Such psychiatry is forced to serve the two differently directed principles: care and treatment of mentally ill citizens, on the one hand, and psychiatric repression of people showing political or ideological dissent, on the other hand.[19] In the conditions of the totalitarian state, independent-minded psychiatrists appeared and may again appear, but these few people cannot change the situation in which thousands of others, who were brought up on incorrect pseudoscientific concepts and fear of the state, will sincerely believe that the uninhibited, free thinking of a citizen is a symptom of madness.[19] Gluzman specifies the following six premises for the unintentional participation of doctors in abuses:[19]

The specificity, in the totalitarian state, of the psychiatric paradigm tightly sealed from foreign influences.
The lack of legal conscience in most citizens including doctors.
Disregard for fundamental human rights on the part of the lawmaker and law enforcement agencies.
Declaratory nature or the absence of legislative acts that regulate providing psychiatric care in the country. The USSR, for example, adopted such an act only in 1988.
The absolute state paternalism of totalitarian regimes, which naturally gives rise to the dominance of the archaic paternalistic ethical concept in medical practice. Professional consciousness of the doctor is based on the almost absolute right to make decisions without the patient's consent (i.e. there is disregard for the principle of informed consent to treatment or withdrawal from it).
The fact, in psychiatric hospitals, of frustratingly bad conditions, which refer primarily to the poverty of health care and inevitably lead to the dehumanization of the personnel including doctors.

Gluzman says that there, of course, may be a different approach to the issue expressed by Michel Foucault.[127] According to Michael Perlin, Foucault in his book Madness and Civilization documented the history of using institutional psychiatry as a political tool, researched the expanded use of the public hospitals in the 17th century in France and came to the conclusion that "confinement [was an] answer to an economic crisis... reduction of wages, unemployment, scarcity of coin" and, by the 18th century, the psychiatric hospitals satisfied "the indissociably economic and moral demand for confinement."[128]

In 1977, British psychiatrist David Cooper asked Foucault the same question which Claude Bourdet had formerly asked Viktor Fainberg during a press conference given by Fainberg and Leonid Plyushch: when the USSR has the whole penitentiary and police apparatus, which could take charge of anybody, and which is perfect in itself, why do they use psychiatry? Foucault answered it was not a question of a distortion of the use of psychiatry but that was its fundamental project.[129] In the discussion Confinement, Psychiatry, Prison, Foucault states the cooperation of psychiatrists with the KGB in the Soviet Union was not abuse of medicine, but an evident case and "condensation" of psychiatry's "inheritance", an "intensification, the ossification of a kinship structure that has never ceased to function."[130] Foucault believed that the abuse of psychiatry in the USSR of the 1960s was a logical extension of the invasion of psychiatry into the legal system.[131] In the discussion with Jean Laplanche and Robert Badinter, Foucault says that criminologists of the 1880—1900s started speaking surprisingly modern language: "The crime cannot be, for the criminal, but an abnormal, disturbed behavior. If he upsets society, it's because he himself is upset".[132] This led to the twofold conclusions.[132] First, "the judicial apparatus is no longer useful." The judges, as men of law, understand such complex, alien legal issues, purely psychological matters no better than the criminal. So commissions of psychiatrists and physicians should be substituted for the judicial apparatus.[132] And in this vein, concrete projects were proposed.[132] Second, "We must certainly treat this individual who is dangerous only because he is sick. But, at the same time, we must protect society against him."[132] Hence comes the idea of mental isolation with a mixed function: therapeutic and prophylactic.[132] In the 1900s, these projects have given rise to very lively responses from European judicial and political bodies.[133] However, they found a wide field of applications when the Soviet Union became one of the most common but by no means exceptional cases.[133]

According to American psychiatrist Jonas Robitscher, psychiatry has been playing a part in controlling deviant behavior for three hundred years.[134] Vagrants, "originals," eccentrics, and homeless wanderers who did little harm but were vexatious to the society they lived in were, and sometimes still are, confined to psychiatric hospitals or deprived of their legal rights.[134] Some critics of psychiatry consider the practice as a political use of psychiatry and regard psychiatry as promoting timeserving.[134]

As Vladimir Bukovsky and Semyon Gluzman point out, it is difficult for the average Soviet psychiatrist to understand the dissident's poor adjustment to Soviet society.[135] This view of dissidence has nothing surprising about it—conformity reigned in Soviet consciousness; a public intolerance of non-conformist behavior always penetrated Soviet culture; and the threshold for deviance from custom was similarly low.[135]

An example of the low threshold is a point of Donetsk psychiatrist Valentine Pekhterev, who argues that psychiatrists speak of the necessity of adapting oneself to society, estimate the level of man's social functioning, his ability to adequately test the reality and so forth.[136] In Pekhterev's words, these speeches hit point-blank on the dissidents and revolutionaries, because all of them are poorly functioning in society, are hardly adapting to it either initially or after increasing requirements.[136] They turn their inability to adapt themselves to society into the view that the company breaks step and only they know how to help the company restructure itself.[136] The dissidents regard the cases of personal maladjustment as a proof of public ill-being.[136] The more such cases, the easier it is to present their personal ill-being as public one.[136] They bite the society's hand that feed them only because they are not given a right place in society.[136] Unlike the dissidents, the psychiatrists destroy the hardly formed defense attitude in the dissidents by regarding "public well-being" as personal one.[136] The psychiatrists extract teeth from the dissidents, stating that they should not bite the feeding hand of society only because the tiny group of the dissidents feel bad being at their place.[136] The psychiatrists claim the need to treat not society but the dissidents and seek to improve society by preserving and improving the mental health of its members.[136] After reading the book Institute of Fools by Viktor Nekipelov, Pekhterev concluded that allegations against the psychiatrists sounded from the lips of a negligible but vociferous part of inmates who when surfeiting themselves with cakes pretended to be sufferers.[136]

According to the response by Robert van Voren, Pekhterev in his article condescendingly argues that the Serbsky Institute was not so bad place and that Nekipelov exaggerates and slanders it, but Pekhterev, by doing so, misses the main point: living conditions in the Serbsky Institute were not bad, those who passed through psychiatric examination there were in a certain sense "on holiday" in comparison with the living conditions of the Gulag; and all the same, everyone was aware that the Serbsky Institute was more than the "gates of hell" from where people were sent to specialized psychiatric hospitals in Chernyakhovsk, Dnepropetrovsk, Kazan, Blagoveshchensk, and that is not all.[137] Their life was transformed to unimaginable horror with daily tortures by forced administration of drugs, beatings and other forms of punishment.[137] Many went crazy, could not endure what was happening to them, some even died during the "treatment" (for example, a miner from Donetsk Alexey Nikitin).[137] Many books and memoirs are written about the life in the psychiatric Gulag and every time when reading them a shiver seizes us.[137] The Soviet psychiatric terror in its brutality and targeting the mentally ill as the most vulnerable group of society had nothing on the Nazi euthanasia programs.[138] The punishment by placement in a mental hospital was as effective as imprisonment in Mordovian concentration camps in breaking persons psychologically and physically.[138] The recent history of the USSR should be given a wide publicity to immunize society against possible repetitions of the Soviet practice of political abuse of psychiatry.[138] The issue remains highly relevant.[138]

According to Fedor Kondratev, an expert of the Serbsky Center and supporter of Snezhnevsky and his colleagues who developed the concept of sluggish schizophrenia in the 1960s,[139] those arrested by the KGB under RSFSR Criminal Code Article 70 ("anti-Soviet agitation and propaganda"), 190-1 ("dissemination of knowingly false fabrications that defame the Soviet state and social system") made up, in those years, the main group targeted by the period of using psychiatry for political purposes.[140] It was they who began to be searched for "psychopathological mechanisms" and, therefore, mental illness which gave the grounds to recognize an accused person as mentally incompetent, to debar him from appearance and defence in court, and then to send him for compulsory treatment to a special psychiatric hospital of the Ministry of Internal Affairs.[140] The trouble (not guilt) of Soviet psychiatric science was its theoretical overideologization as a result of the strict demand to severely preclude any deviations from the "exclusively scientific" concept of Marxism–Leninism.[3] This showed, in particular, in the fact that Soviet psychiatry under the totalitarian regime considered that penetrating the inner life of an ill person was flawed psychologization, existentionalization.[3] In this connection, one did not admit the possibility that an individual can behave "in a different way than others do" not only because of his mental illness but on the ground alone of his moral sets consistently with his conscience.[3] It entailed the consequence: if a person different from all others opposes the political system, one needs to search for "psychopathological mechanisms" of his dissent.[3] Even in cases when catamnesis confirmed the correctness of a diagnosis of schizophrenia, it did not always mean that mental disorders were the cause of dissent and, all the more, that one needed to administer compulsory treatment "for it" in special psychiatric hospitals.[3] What seems essential is another fact that the mentally ill could oppose the totalitarianism as well, by no means due to their "psychopathological mechanisms", but as persons who, despite having the diagnosis of schizophrenia, retained moral civic landmarks.[141] Any ill person with schizophrenia could be a dissident if his conscience could not keep silent, Kondratev says.[142]

According to St Petersburg psychiatrist Vladimir Pshizov, with regard to punitive psychiatry, the nature of psychiatry is of such a sort that using psychiatrists against opponents of authorities is always tempting for the authorities, because it is seemingly possible not to take into account an opinion by the person who received a diagnosis.[143] Therefore, the issue will always remain relevant.[143] While we do not have government policy of using psychiatry for repression, psychiatrists and former psychiatric nomenklatura retained the same on-the-spot reflexes.[143]

As Ukrainian psychiatrist Ada Korotenko notes, the use of punitive psychiatry allowed of avoiding the judicial procedure during which the accused might declare the impossibility to speak publicly and the violation of their civil rights.[144] Making a psychiatric diagnosis is insecure and can be based on a preconception.[145] Moreover, while diagnosing mental illness, subjective fuzzy diagnostic criteria are involved as arguments.[145] The lack of clear diagnostic criteria and clearly defined standards of diagnostics contributes to applying punitive psychiatry to vigorous and gifted citizens who disagree with authorities.[145] At the same time, most psychiatrists incline to believe that such a misdiagnosis is less dangerous than not diagnosing mental illness.[145]

German psychiatrist Hanfried Helmchen says the uncertainty of diagnosis is prone to other than medical influence, e.g., political influence, as was the case with Soviet dissenters who were stifled by a psychiatric diagnosis, especially that of "sluggish schizophrenia," in order to take them away from society in special psychiatric hospitals.[146]

According to Russian psychologist Dmitry Leontev, punitive psychiatry in the Soviet Union was based on the assumption that only a madman can go against public dogma and seek for truth and justice.[147]

K. Fulford, A. Smirnov, and E. Snow state: "An important vulnerability factor, therefore, for the abuse of psychiatry, is the subjective nature of the observations on which psychiatric diagnosis currently depends."[148] The concerns about political abuse of psychiatry as a tactic of controlling dissent have been regularly voiced by American psychiatrist Thomas Szasz,[149] and he mentioned that these authors, who correctly emphasized the value-laden nature of psychiatric diagnoses and the subjective character of psychiatric classifications, failed to accept the role of psychiatric power.[150] Musicologists, drama critics, art historians, and many other scholars also create their own subjective classifications; however, lacking state-legitimated power over persons, their cla

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