By Robert van Voren
Since the outbreak of the Ukrainian crisis, the former Soviet Union is again daily front-page news. The rapid sequence of events has led to an atmosphere that is very reminiscent of the heydays of the Cold War. In Russia itself it has led to a hunt for “national traitors” and “foreign agents” and observers both inside the country and abroad fear for a return to full-scale Soviet repression.For the outside world this may come as a surprise, human rights activists have been ringing the alarm bells already for quite a few years. Ever since Russian President Vladimir Putin took power, the human rights situation deteriorated and more and more liberties were curtailed. One of the warning signs was the return of the use of psychiatry for political purposesto “prevent” social or political activism or to ostracize an activist from society.
What is political abuse of psychiatry?
Political abuse of psychiatry refers to the misuse of psychiatric diagnosis, treatment and detention for the purposes of obstructing the fundamental human rights of certain individuals and groups in a given society. The practice is common to, but not exclusive to countries governed by totalitarian regimes. In these regimes abuses of the human rights of those politically opposed to the state are often hidden under the guise of psychiatric treatment. In democratic societies “whistle blowers” on covertly illegal practices by major corporations have been subjected to the political misuse of psychiatry.
The Soviet Union was and is not the only country where political abuse of psychiatry has taken place. Over the past decades quite extensive documentation has been published on similar abuses in other countries as well.The fact that the use of psychiatry for political purposes is reported from so many diverse countries reveals an on-going tension between politics and psychiatry, and also that using psychiatry to stifle opponents or solve conflicts appeals not only to dictatorial regimes but also to well-established democratic societies.Nevertheless, it is clear that the political use of psychiatry has been a favorite of collectivist (socialist or communist) regimes. An explanation might be that ideologies that envision ideal societies where all are equal and all will be happy often conclude that those who oppose this must be of an unsound mind.
Soviet psychiatric abuse
Generally speaking, the use of psychiatry to incarcerate dissidents in psychiatric hospitals in the USSR started to have a systematic character in the late 1950s and early 1960s. However, there are cases of political abuse of psychiatry known from a much earlier date.The available evidence shows that in the course of the 1960s the political abuse of psychiatry in the Soviet Union became one of the main methods of repression. By the end of that decade many well-known dissidents were diagnosed as being mentally ill. According to our data, approximately one-third of all political prisoners were diagnosed as being “mentally ill”. A crucial role in this played KGB Chairman Yuri Andropov personally, who in 1967 took the helm of that organization and made de struggle against “ideological diversion” the centerpiece of his KGB work. According to a former general of the Ukrainian KGB, it was Andropov who together with a selected group of associates developed the political abuse of psychiatry as a systematic means of repression.
The political abuse of psychiatry in the Soviet Union developed within a totalitarian environment, which greatly facilitated its growth. The diagnosis of ‘sluggish schizophrenia’, developed by the Moscow School of Psychiatry and in particular by Academician Andrei Snezhnevsky, provided a handy framework to explain this behaviour. According to the theories of Snezhnevsky, schizophrenia was much more prevalent than previously thought, because the illness could be present with relatively mild symptoms and only progress later. According to Snezhnevsky patients with sluggish schizophrenia were able to function almost normally in the social sense. Their symptoms could resemble those of a neurosis or could take on a paranoid quality. The patient with paranoid symptoms retained some insight in his condition, but overvalued his own importance and might exhibit grandiose ideas of reforming society. Thus symptoms of sluggish schizophrenia could be “reform delusions”, “struggle for the truth”, and “perseverance”.
The post-Soviet period
When in 1991 the USSR imploded, all fifteen Soviet republics gained or regained their independence. Some did this with considerable success, others with a long list of hiccups, fallbacks and periods of civil war, bouts of despotism or conflicts with neighbors. The collapse of the USSR saw the development of a non-governmental sector in mental health. Until the late 1980s, Soviet psychiatry was dominated by one psychiatric association, which was directly controlled by the Ministry of Health of the USSR.In the course of the 1990s a dozen psychiatric associations were set up, as well as professional bodies for e.g. psychiatric nurses, relative organizationsand, by the end of the century, the first groups of consumers of mental health care services. A vibrate web of groups, committees and associations emerged that strived to humanize the existing services.
The practice of using psychiatry against political opponents virtually ceased to exist. Some cases surfaced, notably in 1996 in Turkmenistan and in Uzbekistan. What came in place, however, was a very disturbing collection of other forms of abuses. In addition, human rights abuses in the mental health system in the former Soviet republics remained rampant, due to lack of resources, outdated methods of treatment, lack of understanding of human individual rights and a growing lack of tolerance in society where survivalism became the main philosophy of the population at large.
In Russia, the reform movement in mental health had only a limited impact. Many of the mental health institutions remained inhuman environments, while the level of psychiatric care was far from acceptable and knowledge about modern therapeutic approaches, the role of relatives and carers and the self-help capabilities of mental health users remained scarce and limited. One of the main reasons for this situation was the fact that the leadership of Soviet psychiatry in Russia maintained its powerbase. Most leaders of Russian psychiatry also revoked the earlier confession that psychiatry in the Soviet Union had been abused systematically for political purposes and instead referred to “individual cases of “hyper-diagnosis” or “academic differences of opinion”.
Starting this century the number of individual cases of political abuse of psychiatry has increased significantly over the past few years, in particular in Russia, Belarus and Kazakhstan.So far it appears not to be yet a systematic repression of dissidents through the mental health system. In most cases, citizens fall victim to regional authorities in localized disputes, or to private antagonists who have the means to bribe their way through the courts.
The resumption of individual cases of political abuse is closely linked to the deteriorating human rights situation and the fact that lower-level authorities feel much more freedom to clamp down on undesired elements than previously. Again an air of untouchability is returning, and the rule of law has increasingly become subject to political machinations. In particular in Russia much of the structure is still in place that allowed the political abuse of psychiatry to happen. The first cases of renewed political abuse of psychiatry started to emerge in the beginning of the twenty-first century, after Vladimir Putin resumed the Presidency and the downward spiral towards increased repression commenced.[hr]There is no declared interest of the author other than his stance on human rights
In 2013 the European Parliament published my report on the issue of the resumption of the political abuse of psychiatry in the former Soviet republics: Psychiatry as a Toll of Coercion in Post-Soviet Countries, July 16, 2013. Directorate General for External Policies, European Parliament, EXPO/B/DROI/2013/02 There were extensive reports on systematic political abuse of psychiatry in Romania, and also reports on cases in Czechoslovakia, Hungary and Bulgaria. However, in these countries all cases were individual and there was no evidence that any systematic abuse took place. An extensive research on the situation in Eastern Germany came to the same conclusion, although in this socialist country politics and psychiatry appeared to have been very closely intermingled. Later, information appeared on the political abuse of psychiatry in Cuba, and there are frequent reports on systematic abuse of psychiatry for political purposes in the People’s Republic of China. In the 1990s, a case of political abuse of psychiatry took place in The Netherlands, in the course of which the Ministry of Defence tried to silence a social worker by falsifying several of his psychiatric diagnoses and pretending his behaviour was the result of mental health problems. See: Psychiatry under Tyranny, An Assessment of the Political Abuse of Romanian Psychiatry During the Ceausescu Years, Amsterdam, IAPUP, 1989; Süss, S., Politisch Missbraucht? Psychiatrie und Staatssicherheit in der DDR, Berlin, Ch. Links Verlag, 1998; Brown, Ch.A., and Lago, A., The Politics of Psychiatry in Revolutionary Cuba, New York 1991; Munro, R., Judicial Psychiatry in China and its Political Abuses, GIP, Amsterdam, 2001, and Munro, R., China’s Psychiatric Inquisition, Wiley, Simmonds & Hill, London., 2006; Nijeboer, A., Een man tegen de Staat, Papieren Tijger, Breda, 2006 It is also important to note that political abuse of psychiatry stands out from general abusive practices in psychiatry. The latter include general human rights violations in mental institutions, such as adverse living conditions, abuse by staff, unlawful incarceration, inhumane treatment, as well as “economic abuse” of psychiatry. Also, there is also a vast “grey area” involving people who are hospitalized either because they are considered bothersome because of their constant complaints or people who do suffer from mental health problems but who never should have been either compulsorily treated or hospitalized. This was the case in the Soviet Union, but also in China, where many victims are so-called “petitioners”, who travel to Beijing from the provinces in order to issue complaints against local officials. Instead of being heard they are hospitalized and frightened with psychiatric “treatment”. See, among others, Bloch, S. and Reddaway, P., Russia’s Political Hospitals, London, Gollancz, 1977, and Van Voren, R., Cold War in Psychiatry, Amsterdam/New York, Rodopi, 2010.  See Bloch, S., Soviet Psychiatry and Snezhnevskyism, in Van Voren, R.(ed.), Soviet Psychiatric Abuse in the Gorbachev Era, 1989, pp. 55-61. The All-Union Society of Psychiatrists and Neuropathologists (AUSPN).The stationary of the AUSPN even had the heading AUSPN and then as sub-heading “Ministry of Health of the USSR”. This also included “economic abuse” (e.g. having relatives declared mentally ill in order to take control of their possessions, e.g. real estate) to criminals buying their way out to freedom by bribing psychiatrists in delivering false diagnoses. Dmitrieva, D., Alyans Prava i Miloserdiya, Moscow, Nauka, 2001, pp. 116-130 See, for instance, Murphy, Kim: “Speak out. Are you crazy?” in the Los Angeles Times, May 30, 2006.