When Vladimir Bukovsky in 1971 leaked to the Western press photocopies of forensic reports on prominent Soviet dissidents who had been incarcerated in psychiatric hospitals, it came with a pointed request to Western psychiatrists that they place the subject of the Soviet dissidents "on the agenda for discussion by the next international congress of psychiatrists."

The congress to which Bukovsky referred was the upcoming meeting of the World Psychiatric Association (WPA) in Mexico City that year. But to Bukovsky's disappointment, and that of others in the dissident and human-rights community, the WPA failed to take up the subject of psychiatric abuse in the Soviet Union.

The follow-up meeting in 1977, in Honolulu, would be different.

The subject of the allegations of Soviet abuse dominated the conference. Ellen Mercer, then the staff liaison to APA's Committee on International Abuse of Psychiatry, recalls that there was a special forum on the issue led by Paul Chodoff, M.D., then a member of the APA committee. Melvin Sabshin, M.D., APA medical director at the time, said other members of the American delegation—including then APA President Jack Weinberg, M.D., as well as Judd Marmor, M.D., Alfred Freedman, M.D., Walter Reich, M.D., and Shervert Frazier, M.D.—directly confronted the Soviets about the charges.

"They denied it, and said it was Cold War politics," Sabshin told Psychiatric News in an interview from his home in London. "They said they had their own classification system and denied the allegations."

The politics of confronting the Soviets at the WPA Congress were complex, with some Western delegations hesitant to alienate the Soviets for fear the All-Union Society of Psychiatrists and Neuropathologists would leave the WPA and thereby diminish the international standing of the body. And Mercer recalled that delegates from some Eastern bloc countries under the domination of the Soviets—especially Poland—made themselves conspicuously absent whenever the issue was brought up.

She also recalled that the issue of how to approach the All-Union Society was contentious even within the APA membership. "Some said that we were ‘alienating our Soviet colleagues,’ while others were very much in favor of [active confrontation], especially in the Assembly," Mercer told Psychiatric News. "So, there was always an active debate."

At the Honolulu meeting, a statement denouncing the abuse of psychiatry and affirming the rights of psychiatric patients—which came to be known as the "Declaration of Hawaii"—was approved by the world body, without specifically mentioning the Soviets. A version of the declaration, updated in 1983 at the WPA meeting in Vienna, Austria, is posted on the WPA Web site (see end of article).

As reported by Robert van Voren in his new book, Cold War in Psychiatry: Human Factors, Secret Actors, a resolution by the British delegation censuring the Soviets passed narrowly by a vote of 90 to 88 (with delegates from Poland and Romania absenting themselves from the vote). An American resolution to establish a review committee that would field complaints about abuses wherever they occurred passed more easily by a vote of 121 to 66.

Sabshin and Mercer said that the Soviets consistently stonewalled the review committee whenever it sought information about allegations of abuse. But events at the Honolulu meeting had drawn a line in the sand, and prior to the next meeting of the WPA in 1983, the Soviet All-Union Society of Psychiatrists and Neuropathologists withdrew under threat of expulsion.

"It would have been a close vote," Sabshin told Psychiatric News. "But I believe the Soviets would have been expelled."

The updated version of the Declaration of Hawaii is posted at <www.wpanet.org/v1/content/ethics-hawaii.shtml>.