Soviet Psychiatrists Research Articles

Towards Revisiting the Discourse on Soviet (and Post-Soviet) Repressive Psychiatry

Abstract This review essay is prompted by Rustam Alexander’s monograph Gay Lives and ‘Aversion Therapy’ in Brezhnev’s Russia, 1964–1982, which explores the under-researched history of gay lives and conversion therapy practices in the USSR. The essay critically interrogates the discourse surrounding Soviet repressive psychiatry (karatel’naiia psikhiatriia), highlighting its exclusionary narrative toward LGBTIQ+ individuals. Drawing on Alexander’s exploration of the conversion therapy practice of the Soviet psychiatrist Yan Goland, who employed suggestive methods to attempt to alter sexual orientation, the article places Goland’s practice within broader Soviet medical history and post-Soviet political psychiatry. The essay further underscores the relevance of this history in contemporary Russia, where LGBTIQ+ individuals continue to face medicalization and repression, echoing past practices. It concludes by calling for the incorporation of queer and critical psychiatry perspectives into the discourse on psychiatric abuse in Russia.

Outsider Art and Psychiatry in the Late Soviet Period

This article examines the discourse surrounding the Soviet Outsider Art of the 1970s–1980s. The author analyses the characteristics of scientific and scholarly approaches to, and definitions of, Soviet Оutsider Аrt, and the relationship of this phenomena to the contemporary political situation. The research methodology relies on the theory of discourse and discourse analysis, which makes it possible to examine texts and events from highly different fields as parts of an interconnected system. The innovative character of the study lies in the fact that, for the first time, the author considers the discourse of Soviet Оutsider Аrt from the perspective of Soviet policy and international affairs. The lack of specialized works that study Soviet Оutsider Аrt makes the article relevant and innovative. Researchers have not previously considered the connection between Soviet foreign policy, ideology, punitive psychiatry, and the discourse surrounding Outsider Art. In the 1970s, the creative process of the mentally ill became a topic of interest for Soviet psychiatry. The drawings of psychiatric patients were treated as vehicles of their creative impulses and utilized in psychiatric research for diagnostic purposes. Soviet psychiatrists compared the creative abilities of the mentally ill with various artistic movements, primarily surrealism; however, their vocabulary and analytic approach remained strictly psychiatric in nature. The 1980s gave rise to significant interest in this topic by a larger audience, in connection with a rethinking of artistic languages and the creative process. There was a dual attempt to dispel the reputation of “punitive psychiatry” and a growing understanding of the importance of “otherness” in art. Orienting to the discourse of key texts, this article reveals a gradual shift from the language of psychiatry to art in academic and journalistic texts devoted to Outsider Art in the 1970s–1980s.

Misuse of Psychiatry

Misuse of Psychiatry

Peripheral Nerve: Health and Medicine in Cold War Latin America

Peripheral Nerve: Health and Medicine in Cold War Latin America

The role of scientists of the Department of Psychiatry of the S.M. Kirov Military Medical Academy in the development of domestic narcology and pharmacological methods of treating this pathology

The study covers the history of the formation and development of narcology in the Russian Empire and the USSR. The role of the heads and psychiatrists of the Department of Psychiatry and the Clinic of Mental and Nervous Diseases of the S.M. Kirov Military Medical Academy in the fight against alcoholism in the country and the organization of drug treatment was identified. Particular emphasis was laid on the work of Vladimir Mikhailovich Bekhterev, a prominent Russian and Soviet psychiatrist, neuropathologist, physiologist and psychologist, the founder of reflexology and pathopsychological direction in Russia. It was V.M. Bekhterev who did everything to reverse public views on alcoholism and transfer it from the category of moral turpitude to the status of the disease; he organized the research and treatment for alcoholic patients. This paper considers the aspects of scientific development of issues related to narcology by the staff and heads of the department. The priority of domestic psychiatrists in the theoretical justification and practical application of conditioned reflex therapy for alcoholism has been shown.

Образ, идеи и метод Сабины Шпильрейн

The article is devoted to the consideration of the key ideas and features of the scientific method of the outstanding Soviet psychiatrist, pioneer of child and female psychoanalysis S.N. Spielrein. The author pays attention to the analysis of the prevailing stereotypes of perception of Spielrein in scientific literature. The reasons why Spielrein’s legacy was not properly claimed for a long time in the West and in Russia, despite the popularity of psychoanalysis after the October Revolution, are revealed. The hypothesis of why a one-sided view of Spielrein’s role in the history of psychology, characterized by hypertrophied attention to her personal relationship with C. G. Jung, has been put forward. The author shows how Spielrein influenced the development of key concepts of analytical psychology and how Jung assessed this influence, and analyzes her empirical justification of Jung’s theory of complexes. In addition, the author considers in the context of the later discoveries of analytical psychology Spielrein’s ideas about the psychogenesis of schizophrenia, the phylogenesis and ontogenesis of the psyche, the species-psyche (a notion, which became the prototype of the collective unconscious), destruction as a striving for transformation, the inheritance of psychic structures, arising from the species-psyche. Spielrein’s approaches to the study of the psyche are analyzed. Particular emphasis is placed on the way Spielrein interprets the symbolic contents of the psyche, which resembles Jung’s approach and contrasts strongly with what was common among orthodox psychoanalysts. It is also shown how Spielrein became one of the first in psychology to successfully implement an interdisciplinary approach to the study of the psyche.

The Psychopharmacological Revolution in the USSR: Schizophrenia Treatment and the Thaw in Soviet Psychiatry, 1954-64.

Twentieth-century psychiatry was transformed in the 1950s and 1960s by the introduction of powerful psychopharmaceuticals, particularly Chlorpromazine (Thorazine). This paper examines the reception of Chlorpromazine in the Soviet Union and its effect on the Soviet practice of psychiatry. The drug, known in the USSR by the name Aminazine, was first used in Moscow in 1954 and was officially approved in 1955. I argue that Soviet psychiatrists initially embraced it because Aminazine enabled them to successfully challenge the Stalin-era dogma in their field (Ivan Pavlov's 'theory of higher nervous activity'). Unlike in the West, however, the new psychopharmaceuticals did not lead to deinstitutionalisation. I argue that the new drugs did not disrupt the existing Soviet system because, unlike the system in the West, the Soviets were already dedicated, at least in theory, to a model which paired psychiatric hospitals with community-based 'neuropsychiatric dispensaries.' Chlorpromazine gave this system a new lease on life, encouraging Soviet psychiatrists to more rapidly move patients from in-patient treatment to 'supporting' treatment in the community.

Медикализация преступности в советской судебной психиатрии, 1918–1936 гг.

Михаил Александрович Погорелов – аспирант Школы исторических наук и стажер-исследователь Центра источниковедения Национального исследовательского университета «Высшая школа экономики», Москва, Россия. Электроннаяпочта: mikhail.alex.pogorelov@gmail.com
 В статье рассматривается история раннесоветской судебной психиатрии, которая появляется как полноценная академическая дисциплина и судебно-медицинская практика в 1920–1930-е гг. На материалах профессиональных совещаний и съездов, научных работ, законодательных и ведомственных документов рассмотрено, как складывалась профессиональная юрисдикция новой дисциплины и профессии. На короткий период психиатры получили возможность самостоятельно определять задачи и сферу компетенции собственной деятельности. Это, а также неоднозначность раннесоветского уголовного законодательства, привело к значительной экспансии «биосоциального» понимания преступности в судебно-психиатрической практике и теории. Некоторые советские психиатры сформулировали концепции, связывающие антисоциальные действия правонарушителей с их патологической предрасположенностью. Благодаря этому множество «пограничных» случаев – в частности, широко трактуемые психопатии – были включены в юрисдикцию судебной психиатрии. Медикализируя преступность, представители этой дисциплины претендовали на повсеместное проникновение в пенитенциарные учреждения. Ситуация изменилась в 1930-е гг.: реагируя на политические вызовы «социалистического наступления», дисциплина начинает перестраивать собственную профессиональную юрисдикцию. Во-первых, переопределена и сужена категория «психопатов». Невменяемыми и подлежащими принудительному лечению признавались только подсудимые с «тяжелыми» органическими заболеваниями, а все «пограничные» случаи передавались в ведение общей юстиции. Во-вторых, были переформулированы задачи дисциплины: если в 1920-х гг. исследования психиатров охватывали широкий спектр тем, связанных с изучением связей преступности и душевной болезни, а основная цель декларировалась как социальная экспертиза, то в середине 1930-х гг. судебная психиатрия ограничивается узкопрактической задачей – предоставлением экспертных заключений судебно-следственным органам. Эти процессы были связаны со стабилизацией профессиональной юрисдикции и институциализацией судебной психиатрии как академической дисциплины и профессии с четко очерченной сферой компетенции и набором задач, что происходило в условиях «сталинизации» науки и ужесточения юстиции.

Soviet psychiatry and the origins of the sluggish schizophrenia concept, 1912–1936

This article seeks to understand the origins of the Soviet concept of ‘sluggish schizophrenia’, a diagnostic category that was used to imprison political dissidents in the post-WWII era. It focuses on the 1920s and 1930s, a period when Soviet psychiatrists attempted to find ways to diagnose schizophrenia at its earliest stages. The new Soviet state supported these efforts, funding new institutions where clinicians encountered types of patients they had not previously studied. Conceptual disagreements arose about what symptoms could be used to diagnose schizophrenia, and how it could be differentiated from other ‘borderline’ mental disorders such as neurosis and psychopathy. Several research groups used their findings to propose new clinical concepts, including ‘mild schizophrenia’ and sluggish schizophrenia. By the early 1930s Soviet psychiatrists no longer shared a basic consensus about schizophrenia. At the same time, the priorities of the Soviet government under Joseph Stalin ceased to support preventative psychiatry. The result was a 1936 ‘discussion’ at which the concept of mild schizophrenia was criticized and sluggish schizophrenia was held up as a model for how the discipline should develop in the future.

Revolutionizing Cuban Psychiatry: The Freud Wars, 1955-1970.

This article traces the battle over Freud within Cuban psychiatry from its pre-1959 origins through the "disappearance" of Freud by the early 1970s. It devotes particular attention to the visit of two Soviet psychiatrists to Cuba in the early 1960s as part of a broader campaign to promote Pavlov. The decade-long controversy over Freud responded to both theoretical and political concerns. If for some Freud represented political conservatism and theoretical mystification, Pavlov held out the promise of a dialectical materialist future. Meanwhile, other psychiatrists clung to psychodynamic perspectives, or at least the possibility of heterogeneity. The Freudians would end up on the losing side of this battle, with many departing Cuba over the course of the 1960s. But banishing Freud did not necessarily make for stalwart Pavlovians-or vanguard revolutionaries. Psychiatry would find itself relegated to a handmaiden position in the work of revolutionary mental engineering, with the government itself occupying the vanguard.

Soviet Psychiatry through the Prism of Circulation: The Case of Outpatient Psychiatry in the Interwar Period

Soviet Psychiatry through the Prism of CirculationThe Case of Outpatient Psychiatry in the Interwar Period Grégory Dufaud (bio) and Lara Rzesnitzek (bio) The whole mental hygiene movement in Russia has completely revolutionized the concept of psychiatry in the direction of medical, biological, and social hygiene disciplines. —Lev Rozenshtein, First International Congress on Mental Hygiene, 19301 This article examines the transnational dimension of Soviet psychiatry by focusing on outpatient psychiatry. By “outpatient psychiatry,” we mean the policy of care and prevention that took place beyond the walls of psychiatric hospitals and the structures that supported them. This policy was formulated in opposition to the asylum tradition, which had advocated confining patients to help them regain their sanity.2 We use this syntagma less narrowly in reference to the Russian expression to which it corresponds—vnebol´nichnaia psikhiatriia or vnebol´nichnaia psikhiatricheskaia pomoshch´, and more broadly to encompass the various terms most heavily used during the interwar years, [End Page 781] such as “mental hygiene” (psikhogigiena) and “psychiatric assistance” (psikhiatricheskaia pomoshch´). Competing with one another in usage, these terms evolved semantically, as occurred with “psychiatric assistance,” which had by the early 1930s come to designate psychiatric policy in general. In choosing the term “outpatient psychiatry,” we wanted not only to avoid lexicographic difficulties but also to use a fairly neutral expression that allows for establishing equivalency with words that, in languages other than Russian, refer to closely related ideas and similar approaches. Soon after the revolution, psychiatrists developed outpatient psychiatry with the support of officials at the Commissariat of Health (Narkomzdrav), who prioritized the new approach in the late 1920s, once collectivization and forced industrialization began. Through outpatient psychiatry, psychiatrists sought to reduce overcrowding in hospitals, counter the development of chronic symptoms in patients, and attend to pathologies that lacked acute psychotic symptoms but nonetheless required appropriate care. To what extent and in what ways were Soviet psychiatrists’ initiatives inspired by the ideas of their foreign colleagues? Did outpatient psychiatry, as it was implemented in the Soviet Union, generate interest abroad? How were exchanges carried out in practice? In taking up these questions, our investigation draws on the historiography on circulation of knowledge and practices. As Yves Cohen points out, the study of circulation entails resetting global phenomena in a local context. This literature is concerned with the successive transformations of ideas, practices, and objects and with the potential effects of their movement on the original situation. Cohen emphasizes the necessity of identifying “who” and “what” was being displaced, and of studying the discourses that accompany circulation and borrowings.3 For the USSR, this effort raises, of course, the question of the reflective capacity of the actors involved. The image of a country that is self-sufficient and inward-looking has been largely overturned by recent historiography examining transnational exchanges. The area of medicine and health in the interwar period has been largely overlooked, however, while forms of cooperation have drawn the most attention. Susan Solomon has edited a book on collaborations between [End Page 782] German and Soviet doctors. Cast out of the international community, Germany and the USSR drew closer with the signing of the Treaty of Rapallo. Doctors took advantage of this alliance, using their prior connections to develop joint projects that allowed these two medical communities each to pursue their own agendas. After the loss of its colonies at the end of the war, Germany was in need of a new terrain for observation and experimentation; the Soviet Union in turn benefited from German skills and intermediaries who helped Soviet scientists publish their work abroad.4 Michael Z. David has studied the Soviet effort to combat tuberculosis, with preventive mechanisms put in place in the early 1920s culminating in the introduction of the vaccine BCG in the late 1930s. The BCG solution would not have been possible without Soviet collaboration with the Pasteur Institute in France, and David has traced that collaboration step by step from the Soviet side.5 This article covers a wide variety of interactions, drawing on a range of sources from various locations, including Russia, Germany, and the United States. In some regards, our study intersects with Benjamin Zajicek’s analysis...

Fifty years of political abuse of psychiatry – no end in sight

In October 1989, the General Assembly of the World Psychiatric Association (WPA) accepted the Soviet psychiatric association back conditionally, after having been forced to leave the organization six years earlier because of systematic abuse of psychiatry for political purposes. Three weeks later, the Berlin Wall came tumbling down, and in 1991, the Soviet Union itself ceased to exist. However, over the past years, an increasing number of reports on the internment of political activists in former Soviet republics made people realize that 25 years after the decision of the WPA, political abuse of psychiatry still has not been eradicated. Using psychiatry as a means of repression has been a particular favorite of totalitarian regimes with a communist State ideology. Cases have been reported from other countries as well, including Western democratic societies, yet nowhere else has it been developed into a systematic method of repression. While probably the overwhelming majority of Soviet psychiatrists were unaware that they had become part of a perfidious system to treat dissenters as psychiatrically ill on the orders of the Party and the KGB, there is also ample evidence that the core group of architects of the system knew very well what they were doing. When the USSR disintegrated, the practice of using psychiatry against political opponents virtually ceased to exist. What came in its place, however, was a very disturbing collection of other forms of abuses, including human rights abuses due to lack of resources, outdated methods of treatment, lack of understanding of human individual rights and a growing lack of tolerance in society. Starting this century, the number of individual cases of political abuse of psychiatry has increased, in particular, over the past few years in Russia, Belarus and Kazakhstan. The issue of Soviet political abuse of psychiatry had a lasting impact on world psychiatry. It triggered the discussions on medical ethics and the professional responsibilities of physicians (including psychiatrists), resulting in both national and international declarations and ethical codes that address the interface between human rights, professional responsibilities of physicians and medical ethics. En octobre 1989, l’Assemblée générale de l’Association mondiale de psychiatrie (WPA) acceptait le retour conditionnel de l’Association psychiatrique soviétique, après avoir été forcée de quitter l’organisation six ans plus tôt pour abus systématique de la psychiatrie à des fins politiques. Trois semaines plus tard, le mur de Berlin s’écroulait, et en 1991, l’Union soviétique elle-même cessait d’exister. Cependant, au cours des dernières années, un nombre croissant de rapports sur l’internement de militants politiques dans les anciennes républiques soviétiques faisait prendre conscience que, 25 ans après la décision de la WPA, l’utilisation de la psychiatrie à des fins politiques était loin d’être éradiquée. Cette utilisation de la psychiatrie comme moyen de répression a été particulièrement appréciée des régimes totalitaires d’obédience communiste. Des cas ont aussi été signalés dans d’autres pays, y compris dans les sociétés démocratiques occidentales, mais nulle part ailleurs n’ont été développés comme méthode systématique de répression. Bien que sans doute l’écrasante majorité des psychiatres soviétiques ne savaient pas qu’ils étaient devenus partie d’un système pervers pour traiter les dissidents comme malades mentaux sur les ordres du Parti et du KGB, de nombreuses preuves montrent que les architectes du système savaient très bien ce qu’ils faisaient. Lorsque l’URSS s’est désintégrée, l’utilisation de la psychiatrie contre les opposants politiques a pratiquement cessé d’exister. À sa place, cependant, une série troublante d’autres formes d’abus, des violations des droits de l’homme dues au manque de ressources, des méthodes dépassées de traitement, un manque de compréhension des droits humains individuels et une baisse croissante de tolérance dans la société. Depuis quelques années, le nombre de cas individuels de maltraitance politique en psychiatrie a augmenté, en particulier en Russie, en Biélorussie et au Kazakhstan. La question de la maltraitance politique de la psychiatrie soviétique a eu un impact durable sur la psychiatrie mondiale. Il a déclenché des discussions sur l’éthique médicale et les responsabilités professionnelles des médecins (y compris les psychiatres). Il en a résulté des déclarations à la fois nationales et internationales et des Codes d’éthique pour définir l’interface entre les droits, les responsabilités professionnelles des médecins et l’éthique médicale.

What Are We to Believe About How We Believe?

What Are We to Believe About How We Believe? Richard P. Bentall (bio) Keywords delusion, belief, psychosis, classification The status of delusions as beliefs has taxed some of the greatest minds in psychopathology. In their paper, Mullen and Gillett (2014) reflect on this issue, addressing a number of ways in which delusions have been conceptualized, on the whole finding them inadequate. They are particularly concerned that regarding delusions simply as false factual beliefs leads to undue emphasis on criteria such as conviction, resistance to counterargument, and falsity, arguing that, in fact, these criteria do not distinguish between delusions and other highly valued ideas (e.g., religious or political convictions, although these are not discussed). Mullen and Gillett make some telling points, and their paper certainly deserves careful consideration. However, some of their assumptions are not beyond criticism. Delusions and Values It should be noted that Mullen and Gillett seem to assume that ultimately there must be some kind of difference between delusions and other kinds of beliefs; the possibility that this might be an illusion, a socially and culturally embedded consequence of conceiving madness in a particular way (as a medical phenomenon) is just not entertained. Hence, they believe that there is a paradox “that clinicians can reliably identify delusions, while being unable to offer a satisfactory definition in terms of falsity, conviction, or other characteristics” (Mullen and Gillett 2014, 35), and this leads them to worry that a dangerous consequence of viewing delusions as beliefs is that other kinds of beliefs might be misclassified as delusions. This argument led me to wonder just how reliable clinicians’ judgements about delusions really are. Certainly, the distinction is not always made easily. In 1984 brothers Ron and Dan Laffertey murdered their sister-in-law Brenda and her 15-month-old daughter Erica, claiming that they had done so in response to a religious revelation (they belonged to an extreme fundamentalist Mormon sect). The background and implications of the murder are discussed in Jon Krakauer’s (2003) fascinating book, Under the Banner of Heaven, which provides a cautionary tale about the difficulties of deciding when beliefs are delusional. At the Lafferty’s trial, the psychologists and psychiatrists who provided expert testimony failed to agree whether the brothers were mentally ill or religious zealots. (The jury subsequently found them guilty. Ron was sentenced to death but his execution is currently stayed pending further arguments about whether he is mentally competent, apparently a requirement for someone to be executed in the state of Utah.) [End Page 39] Mullen and Gillett also worry that regarding delusions as beliefs places mental health professionals in the business of drawing the acceptable limits of belief. As evidence of where this can lead, they cite the much discussed case of Soviet psychiatrists who decided that political dissidents were mentally ill. Interestingly, it seems that the psychiatrists who were responsible for treating dissidents in this way did so largely in good faith, based on the extremely broad criteria for schizophrenia adopted by the Moscow school, and not as a deliberate strategy of persecution (Reich 1984). The same can be said of those American psychiatrists who, in the same era, classified black protestors campaigning for their political rights as suffering from ‘protest psychosis’ (Metzel 2009; a lesser known episode that illustrates just how much mental health professionals may struggle to distinguish between the delusional and the non-delusional). The world would certainly be an easier place to live and practice psychiatry in if a value-free distinction between delusions and other kinds of beliefs could be found, but sometimes the world fails to order itself in a way that makes our lives easy. Even in physical medicine, diagnostic concepts carry implicit values. (If a swelling of the appendix led to a doubling of IQ without harmful consequences, appendicitis would not be a disease. A bacterial infection is only a disease because it is harmful to the human recipient; from another perspective, it is the micro-organism’s successful occupation of an evolutionary niche.) As the sine qua none of a psychiatric disorder is its behavioral manifestation (taking behavior in its broadest sense to include thoughts and feelings) it...

The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?

In 2013, U.S. President Barack Obama decreed the creation of the Presidential Commission for the Study of Bioethical Issues, as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. In the wake of the work of this Commission, the purpose, goals, possible shortcomings, and even dangers are discussed, and the possible impact it may have upon neuroscience ethics (Neuroethics) both in clinical practice as well as scientific research. Concerns were expressed that government involvement in bioethics may have unforeseen and possibly dangerous repercussions to neuroscience in particular and to medicine in general. The author emphasizes that the lessons of history chronicle that wherever governments have sought to alter medical ethics and control medical care, the results have frequently been perverse and disastrous, as in the examples of the communist Soviet Union and National Socialist (Nazi) Germany. The Soviet psychiatrists’ and the Nazi doctors’ dark descent into ghastly experimentation and brutality was a product of convoluted ethics and physicians willingly cooperating with authoritarianism citing utilitarianism in the pursuit of the ‘collective’ or ‘greater good.’ Thus in the 20th century, as governments infringed on the medical profession, even the Liberal Democracies have not been immune to the corruption of ethics in science and medicine.

Daniel Beer, Renovating Russia: the human sciences and the fate of liberal modernity, 1880–1930, Ithaca and London, Cornell University Press, 2008, pp. ix, 229, £22.95, $45.00 (hardback 978-0-8014-4627-6).

Renovating Russia is addressed primarily to historians well-versed in the current heated debates regarding Russian modernity and liberalism, as well as the continuities and ruptures across the revolutionary divide of 1917. Without clearly articulating it, Beer seeks to answer the eternal Russian question: “Who is to be blamed?” by searching for the intellectual roots of the Bolshevik regime. Historians have pointed variously to a number of western social theorists including Comte, Spenser, Nietzsche, and Freud (to say nothing of the Bolsheviks’ officially acknowledged debt to Marx and Engels) as the intellectual forbears of the Soviet regime. Beer adds to this list several new names: Benedict A Morel, the father of “degeneration” theory, Cesare Lombroso, the major proponent of the concept of the “born criminal”, and a host of European psychiatrists who developed the concept of “mental contagion” or “crowd psychology”. Beer argues that the ideas of “social deviance”, elaborated during the pre-revolutionary period by the Russian “liberal practitioners of human sciences” on the basis of these three concepts, furnished the Soviet regime with the “language of social excision and coercive rehabilitation” (p. 201) that informed, legitimized, and enabled the regime’s violent project of radical social transformation. The first two chapters of the book explore Russian scholars’ responses to Morel’s theory of “degeneration”. The third examines their attitudes to Lombroso’s concept of the “born criminal”. The fourth analyses their investigations into “crowd psychology” and “mental contagion”, and the last one deals with the “appropriation” of these responses, attitudes, and investigations by Soviet psychiatrists and criminologists.

WPA Continues to Pursue Concerns About Chinese Psychiatric Abuses

Back to table of contents Previous article Next article ViewpointsFull AccessWPA Continues to Pursue Concerns About Chinese Psychiatric AbusesAhmed Okasha, M.D.Ahmed OkashaSearch for more papers by this author, M.D.Published Online:4 Feb 2005https://doi.org/10.1176/pn.40.3.00400024 The December 3, 2004, issue of Psychiatric News contained a letter to the editor by Dr. Raymond Freebury, former chair of APA's Committee on International Abuse of Psychiatry. He called for the expulsion of the Chinese Society of Psychiatry (CSP) from the World Psychiatric Association (WPA) in view of alleged abuse of psychiatry against Falun Gong followers, drawing parallels to psychiatric abuse in the former Soviet Union and stating that “there are times when it is indeed better to be cruel in the present to be kind in the long run.”I would first like to remind readers of the WPA's efforts in pursuing the case of the Falun Gong, which were outlined in detail on the WPA electronic bulletin.A delegation of the current, past, and future presidents of the WPA and the chair of the WPA Review Committee met with our CSP colleagues and the Chinese vice minister of health in January 2004. We agreed on a WPA/CSP joint meeting in Beijing for examining records, interviewing patients and their families, or interviewing doctors who were involved in the examination of some of the patients. However, because of disagreement regarding the terms of reference of the mission, we felt it prudent to suspend the WPA delegation visit.The next meeting was on May 4, 2004, with the CSP president and vice president. The CSP again acknowledged that it had identified instances in which Chinese psychiatrists had failed to distinguish between spiritual-cultural beliefs and delusions, and as a result persons had been misdiagnosed and mistreated. The CSP explained that this was due to lack of training and professional skills of some psychiatrists rather than the result of systematic abuse of psychiatry. The CSP has undertaken steps to educate its members and is looking forward to the WPA's assistance in correcting this situation.I would like to draw the attention of readers to the fact that Soviet psychiatrists resigned from the WPA and were not expelled and that the“ improvement” of the situation in the former Soviet Union was not because of WPA pressure but because of regime change. The resignation of Soviet psychiatrists did not reduce the malpractice or provide Soviet psychiatrists with protection in case they decided to challenge their government. Furthermore, at the time Soviet psychiatrists did not show any form of collaboration with the WPA as currently shown by our Chinese colleagues throughout this long investigative process.We need to be clear about what we want the WPA to achieve on the Falun Gong case: an end to alleged abuse and helping our Chinese colleagues out of a situation that involves a lot of political pressure, or making a“ sensational,” “historic” decision. The question deserves a responsible answer.The Madrid Declaration is concerned with the protection of the rights of our patients and the nonabuse of our profession. But we also identified the right of our colleagues to be protected from harassment that might follow.I believe that the demand put on Chinese psychiatrists without WPA support would be a fatal blow to colleagues who serve about one-third of the world's population. As an organization committed to the well-being of patients and the dignity of our profession, we are committed to helping our colleagues and our patients, not to cornering them for the self-satisfaction of having made an“ abstract,” politically correct decision.There is no reason why the WPA should be blamed. We shall continue our investigation in a way that can support our colleagues and their patients without losing them to a political suicide that may appeal to some colleagues. This month a WPA delegation will meet again with our Chinese colleagues to discuss issues of clinical diagnosis, classification, human rights, ethical issues, and forensic psychiatry, as we continue moving the process forward.In a final note, we should remember the chaotic nature of the world in which we live. None of us is immune from the politics of our governments. The recent news about widespread torture is sobering. We might face evidence of involvement of some of our colleagues in some of those atrocious events. It would be all too simple to expel their associations from the WPA on the basis of their oppression by their governments or armies. Our real challenge is to professionally help our colleagues defy those abuses, protected by the solidarity and support of their colleagues worldwide. ▪Ahmed Okasha, M.D., is president of the World Psychiatric Association. ISSUES NewArchived

Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era. By Human Rights Watch and Geneva Initiative on Psychiatry. [New York: Human Rights Watch, 2002. 298 pp. ISBN 1-56432-278-5.

This report on the political misuse of psychiatry in China today and in the past, based primarily on the indefatigable research of Robin Munro, combines human rights concerns with the insights of forensic psychiatry. Munro has adopted the research methodology of Soviet psychiatrist Semyon Gluzman, who proposed three approaches to the study of political psychiatry in any one country: personal examination of victims; the systematic study of the different schools of psychiatric theory; and the examination of a range of psychiatric publications. Although only the third method is available to researchers of the situation in China – a fact that reveals China's lack of transparency in this area – Munro has made good use of it. The result is a searching examination that throws light on the complex interrelationship between political dissent and mental illness in China and on the tendency of its officials, and even its forensic psychiatrists, to conflate or confuse the two. A comparative global context to the study is provided in several sections: a review by psychiatrist Robert Van Doren of the Soviet experience in political psychiatry; a discussion of international standards in ethical psychiatry; a guide to political psychosis; and a historical overview of law and psychiatry in China before and after 1949. Fourteen major documents are included in the appendices, of which the most interesting and disturbing are debates between Chinese psychiatrists during the Cultural Revolution, and a survey of the current situation in China's mental hospitals, or ankang.

Caretakers and collaborators.

A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors' human “experiments” and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians' human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists' role in repressing dissent, Latin American and Turkish military doctors' complicity in torture, and even the South African medical profession's systematic involvement in apartheid may seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse compel an inquiry into medicine's vulnerability to becoming an adjunct to illicit state purposes.

Soviet psychiatrists under Stalinist duress: the design for a new Societ psychiatry and its demise.

A Scientific Session of the USSR Academy of Sciences and the USSR Academy of Medical Sciences met in 1950 in Moscow, to comply with the order of I.V. Stalin to institutionalize the theory of higher nervous activity of I.P. Pavlov. This Scientific Session decreed that annual scientific conferences should be held to consider problems related to Pavlovian physiology. In response to this call, a session on the Physiological Teachings of the Academician I. P. Pavolv on Psychiatry and Neuropathology was convened in Moscow in 1951. Certain influential Soviet psychiatrists - V.A. Giliarovski, M.O. Gurevich and A. S. Shmarian were condemned for adhering to anti-Marxist ideology and to psychiatric theories conceived by Western psychiatrists. The named psychiatrists acknowledged the correctness of the accusations, admitted their errors, and promised in the future to follow Pavlov's teachings on psychiatry. The session's Presidium urged the development of a New Soviet Psychiatry based upon experimental and clinical findings and consistent with the Pavlovian conceptualization of higher nervous activity, which considered pychiatric and neurotic syndromes in terms of the dynamic localization of the brain's functions. Long-range consequences of the 1951 session are considered.

No Asylum: State Psychiatric Repression in the Former U.S.S.R.

Back to table of contents Previous article Next article Book ReviewFull AccessNo Asylum: State Psychiatric Repression in the Former U.S.S.R.Richard S. Winslow, M.D.Richard S. WinslowSearch for more papers by this author, M.D.Published Online:1 Oct 1998https://doi.org/10.1176/ps.49.10.1372-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The story of the use of psychiatry for nonmedical purposes in the former Soviet Union is an important one. It can be in turn horrifying and inspiring, given the abuse of our humane profession, on the one hand, and the bravery of those who fought against the abuse, on the other.Unfortunately, this book makes the story seem a boring one. The authors are, respectively, a professor of international relations and a computer and information technology specialist. The book proves beyond a statistical shadow of a doubt that abuse of psychiatry did indeed occur in the former U.S.S.R. It also describes the chronology, estimated extent, and varied causes of this abuse and the demographic characteristics of those affected.The crucial omission is the human detail. In the midst of all the analyses of the abuse phenomenon, there is not a single personal story of a victim or a profile of a specific abuser. Reading this book is like reading statistics or a sociological tract about crime without any description of the individual victims, survivors, or perpetrators.Books like these can be useful for reference purposes, and the data the authors collected and analyzed are good to have on the permanent record. However, if any book is to be read widely enough to have an impact, it must be readable, and the lack of human detail in what is essentially a human story makes this book very difficult to read. As there is no dearth elsewhere of first-hand accounts by abuse victims, the authors' decision to leave out all human details is puzzling, because their important points could have been made so much more effectively.Contrast, for example, the difference in readability, to say nothing of impact, between the following two paragraphs, both of which deal with the ability of some individuals to exhibit extraordinary courage in the face of the most extreme threats. The first paragraph is from the book being reviewed."Would-be dissuaders may encounter undeterrable or uncompellable individuals whose political, religious, or ethical objectives are so highly valued that no conceivable threat is large enough to counterbalance pursuit of their cherished goals. Individuals holding such objectives cannot be dissuaded from seeking to achieve them. It follows that a class of undeterrable acts may exist, which has a prior probability of virtually 1.0 and therefore will not be prevented by application of any state penalty. Some dissident behavior in the Soviet period may fall into this class."The second paragraph, from a book by Bloch and Reddaway (1), is a quotation of Dr. Anatoly Koryagin, a Soviet psychiatrist, at the time of his trial for "anti-Soviet activities," which included protesting the abuse of psychiatry."My investigation and trial do not constitute an act of justice, but a means of suppressing me for my views. I know that the sentence will be harsh. I do not ask anything of this court. Regardless of the sentence imposed on me, I state that I will never accept the situation which exists in our country, where mentally healthy people are imprisoned in psychiatric hospitals for trying to think independently. I know that long years of physical imprisonment, humiliation, and mockery await me. Fully aware of this, I embark on it in the hope that it will increase the chances for others to live in freedom."Dr. Winslow, who has a master's degree in Russian literature and a special interest in psychiatry in the former U.S.S.R. and its successor states, practices community psychiatry in Seattle.by Theresa C. Smith and Thomas A. Oleszczuk; New York City, New York University Press, 1996, 289 pages, $45