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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, andVladimir 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 asArticle 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 AcademicianAndrei 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 diagnosisEdit

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] 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] TheKGB routinely sent dissenters to psychiatrists for diagnosing to avoid embarrassing publiс trials and to discredit dissidence as the product of ill minds.[12] Highly classified government documents which have become available after the dissolution of the Soviet Union confirm that the authorities consciously used psychiatry as a tool to suppress dissent.[13]

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 Federationacknowledged that before 1991 psychiatry had been used for political purposes and took responsibility for the victims of "political psychiatry."[14]

The political abuse of psychiatry in Russia has continued, nevertheless, since the fall of the Soviet Union[15] and human rights activists may still face the threat of a psychiatric diagnosis for their legitimate civic and political activities.[16]
Sluggish schizophrenia"Edit

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."^[50](Alexander Solzhenitsyn)

Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.^[51] It was the diagnosis of "sluggish schizophrenia" that was most prominently used in cases of dissidents.^[52]Sluggish schizophrenia as one of 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.^[53]According to theGlobal 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.^[54] 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.^[54]

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 Partyand 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.^[54]

Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences, developed a novelclassification of mental disorderspostulating 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 much more prevalent than previously considered since the illness could be presented with comparatively slight symptoms and only progress afterwards.^[54] 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 Schizophreniareported in 1973.^[54] The city with the highest prevalence of schizophrenia in the world was Moscow.^[55] 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.^[54] Their symptoms could be like those of a neurosis or could assume a paranoid character.^[54]The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society.^[54]Thereby, sluggish schizophrenia could have such symptoms as "reform delusions," "perseverance," and "struggle for the truth."^[54] 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."^[56]

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.^[57] Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union and severalEastern European countries.^[58]

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.^[59]American psychiatrist Alan A. Stonestated 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.^[60] One can readily apply this diagnostic scheme to dissenters.^[60] Snezhnevsky was long attacked in the West as an exemplar of psychiatric abuse in the USSR.^[52] The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and this diagnosis to make political dissent into a mental disease.^[61] 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,^[52] and, in dozens of cases, he personally signed a commission decision on legal insanity of mentally healthy dissidents includingVladimir Bukovsky, Natalya Gorbanevskaya, Leonid Plyushch,Mikola Plakhotnyuk,^[62] and Pyotr Grigorenko.^[63]