Soviets Gets APA, WPA Scrutiny Over Abuse of Psychiatry

One of APA’s great crusades in decades past was its opposition to the misuse and abuse of psychiatry for political purposes by the rulers of the Soviet Union, a story well chronicled in the pages of Psychiatric News.

Photo courtesy of Ellen Mercer

Perhaps the earliest reference in Psychiatric News to the problem came in a letter from Sheldon Kardener, M.D., of Los Angeles. He was moved by a CBS television program in 1970 about Russian dissidents.

“I was particularly appalled by the Soviet regime’s utilizing the label of ‘insane,’ with subsequent interminable mental hospitalization, as a means of suppressing the expression of these dissident intellectuals,” he wrote in the September 2, 1970, issue. “What is so terribly appalling is that such a political weapon could not be used without the complicity of Soviet psychiatry.”

Kardener went on to compare that “perversion of medicine” with the role of German doctors during the Nazi era.

In the next issue, another APA member called for the Association to “express its vigorous opposition to the misuse of psychiatry for purposes of political oppression.”

Such abuses had been going on in the Soviet Union for decades.

In fact, a leading Soviet psychiatrist, Andrei Snezhnevsky, managed to invent a convenient diagnosis—“sluggish schizophrenia”—that was a euphemism for criticizing the government and was used to confine dissidents as mental patients.

The practice drew the ire of many in the West.

“A large and important country had invented a way of abusing psychiatry,” recalled former APA President Lawrence Hartmann, M.D., recently. Hartmann, now retired as a professor of psychiatry at Harvard, was closely involved with the American response to the misuse of psychiatry. “It was important for us to comment on and, if possible, change.”

The response of APA and the World Psychiatric Association (WPA) encompassed the intersection of international affairs, ethics, and social psychiatry, said Hartmann. APA members heard directly from a leading victim of the abusive practices.

In 1971, one dissident, Vladimir Bukovsky, smuggled out documents relating to the psychiatric incarceration of six other individuals, bringing the process to the attention of Western media and psychiatrists. For that “anti-Soviet activity,” he was sentenced to prison but was deported in 1976 and spoke on a panel at APA’s 1977 Annual Meeting in Toronto.

“Bukovsky traced the events and factors that contributed to the evolution of what he called ‘a vast system of psychiatric abuse for political purposes,’ ” wrote reporter B.S. Herrington in the June 17 issue.

Some Soviet psychiatrists rationalized their actions by saying that commitment to a psychiatric hospital was better than being sent to a labor camp in Siberia (or worse). But times had changed, said Bukovsky.

“ ‘Now, he declared, ‘any attempt to present the practice of sending people to psychiatric prisons as [a] means of “helping them” is an outright lie and hypocrisy. The main features of today’s psychiatric prisons, of which psychiatrists can no longer claim to be unaware, include intensive treatment (with no regard to harmful effects), indefinite periods of confinement, the necessity of showing repentance in order to be freed, the discreditation of the person and his ideas, constant blackmail after the person’s release, and his complete lack of any right. …’ ”

One result of this activity was the WPA’s 1977 passage of a statement of ethical principles and a resolution condemning abuses of psychiatry for political purposes, with specific reference to the Soviet Union. Six years later, the Soviet Union withdrew from the WPA.

“The surprise move, coming five months before WPA holds its World Congress of Psychiatry in Vienna, appeared designed to head off Western attempts to investigate alleged abuses,” reported the March 4, 1983, issue of Psychiatric News.

Some APA members thought the Soviet withdrawal was the doing of political higher-ups, and some felt that both sides acted too hastily.

“The retreat was a signal that the new Soviet political regime ‘has hardened its position toward human rights in general,’ ” added Walter Reich, M.D. “By withdrawing from the WPA, they told the West, ‘If you try to push us around, we’ll just go away.’

“Reich opposed moves to expel or suspend the Soviet psychiatrists from the WPA because he saw the world body as a valuable forum in which to confront them with their destructive role in the larger society. Now, he added, there is no reason for them to attend meetings, hear criticisms, or receive Western visitors.”

Former APA President Lawrence Kolb, M.D., offered an extended presentation to the Board of Trustees, arguing in favor of engagement rather than condemnation, reported Psychiatric News in its April 15, 1983, issue.

By the late 1980s, the new winds of glasnost and perestroika (“openness” and “government reform”) were blowing through the Soviet Union, the precursor to its breakup a few years later. The April 7, 1989, issue reported that a group of American psychiatrists had been invited to visit the Soviet Union and returned with “firsthand evaluation of the state of Soviet psychiatry, particularly forensic psychiatry.”

The delegation included representatives of APA and the National Institute of Mental Health. Highlights of their report appeared in the August 4 issue.

The group interviewed 27 current or former “patients” and learned about false diagnoses and the misuse of psychotropic drugs. The Americans recommended that the Soviet psychiatrists use international diagnostic criteria, reevaluate their use of drugs, appoint legal counsel for commitment proceedings, strengthen review procedures, and lessen “the ‘deprivations and restrictions’ imposed on patients in the Special Psychiatric Hospitals.”

Soviet psychiatrists disagreed with some of the report conclusions but did find it “a valuable and useful document” and noted that changes were under way or contemplated.

Eventually, Soviet—and later, Russian—psychiatry did move closer to world standards and ended its objectionable practices, said Hartmann. During his term as APA president in 1991-1992, Hartmann was invited to St. Petersburg, Russia, to see the changes.

“We were not simply looking around to see what we could do in the Cold War,” said Hartmann of APA’s work in the 1970s and 1980s. “Were we helping psychiatry if we paid attention only to what was happening on our own street or did we care what happened to psychiatry elsewhere? Psychiatry doesn’t stop at national frontiers.” ■