For many years, in response to widespread accusations about politically motivated psychiatric abuse, Soviet psychiatrists either maintained a proud silence or alleged that they were being libeled. As a result, in 1983 they were actually expelled from the World Psychiatric Association.
By rebuffing any sort of criticism as slander or libel, Soviet psychiatry showed that it had been gravely ill itself for many years. The psychiatrists were adept at diagnosing their patients’ inability to critically assess their own actions as a symptom of their illness; however, the psychiatrists failed to observe this in themselves. To be fair I must note that it was not the psychiatrists themselves who were responsible for introducing the belief in their own infallibility. They were simply the executors of a political and religious line that came from above.
The criticism from the West was shocking. In essence it maintained that in the USSR, healthy people were placed in psychiatric hospitals because of their political and religious convictions. Our Western interlocutors handed the Soviet authorities lists of psychiatric prisoners who, after the start of Gorbachev’s perestroika, for the first time became objects of intense scrutiny by the Soviet Ministry of Foreign Affairs.
Establishing the dictatorship of comprehensive ideology in the USSR had both moral as well as juridical consequences. The political and religious articles of the Criminal Code, along with the bizarre system of psychiatric diagnosis devised by Academician Andrei Snezhnevsky, who propounded the notion of sluggish schizophrenia, facilitated the transformation of nonstandard political or religious convictions into a criminal matter and then a psychiatric diagnosis. Even worse was the subsequent arbitrary action via extrajudicial compulsory hospitalization. The pretext was so-called hospitalization for emergency reasons on account of urgent symptoms. The abuse of psychiatry intensified after the Prague Spring of 1968 and the 1975 signing of the Final Act of the Conference on Security and Cooperation in Europe, which provided a powerful impetus for defending human rights in the USSR.
In organizational terms, the suppression of dissenters was done in two ways. The first, more complicated way involved applying the political and religious articles of the Criminal Code, followed by compulsory treatment in special hospitals run by the Ministry of Internal Affairs. This system worked flawlessly. A person held criminally accountable could be transferred to judicial-psychiatric specialists at any stage of the investigation or by a court. Normally, however, such matters did not reach a court. Moreover, supposedly out of “humanitarian considerations,” defendants who were tried were not brought to court. Many of them never even saw a lawyer face-to-face.
Why were such violations of criminal procedural laws necessary? In some cases even the elastic wording of the Criminal Code allowing persons to be judged for expressing thoughts to a spouse or to friends, or for writing thoughts in a diary, for example, did not suffice to hold persons criminally accountable. That’s where expert opinion came in. The psychiatric instruments of combating dissent were honed to perfection. Psychiatrists were free to act as arbitrarily as they pleased. The arbitrariness of some encouraged the arbitrariness of others. One’s neighbors, one’s boss, or anyone at all could demand that someone be isolated in a psychiatric hospital because of “urgent symptoms.”5 This was the second method of uprooting “heresy” from the “monolithic Soviet society” and suppressing dissenters.
Battling this monster was difficult. To initiate action, my father, then first deputy foreign minister of the USSR, spoke with Prime Minister Nikolai Ryzhkov, who was surprised and indignant upon learning of the scale and methods of psychiatric abuse for nonmedical ends. Ryzhkov asked my father if there was anything on paper. After receiving information I had prepared, he vented his anger at a Politburo meeting according to those present. However, psychiatric repression was so deeply entrenched that even the clear and firm position of Gorbachev, the prime minister, the minister of foreign affairs, and Yakovlev sufficed only to provide a legal basis for the investigatory work that was under way. Moreover, this legal basis was quite shaky. According to the existing rules, everything that transpired at Politburo meetings was strictly confidential. I was not supposed to know about it, let alone refer to it.
Initially the task seemed fairly mundane: figure out what was going on, draft proposals to amend the normative documents, and submit them to the Politburo for the signatures of Shevardnadze and the minister of health. Obstacles arose almost at once. First was the unprecedented opposition we encountered from the Ministry of Health. Naturally we wanted to study the existing protocols. Unexpectedly, the bureaucrats in the ministry told us, “There are no protocols.” We knew that there were. There had to be. Moreover, we had our own set, copies that had come into our hands via means like something from the plot of a detective story.
At my first meeting with Alexander Churkin, the chief psychiatrist of the Ministry of Health of the USSR, I referred to these protocols, using a pretext I had prepared in advance: “I need to report to the leadership the measures we need to take for the USSR to rejoin the World Psychiatric Association.”
This pretext was invented so that the feudal lords and inquisitors of Soviet psychiatry would all agree to the reformation of their domains. Specifically, there were questions about the protocols governing psychiatric examinations.
“There are no such protocols,” Churkin flared.
I took out my notebook and flipped through it to the proper page. “Well, how could there not be, Alexander Alexandrovich? Their full title is ‘Protocols Concerning the Initial Medical Examination of Citizens to Determine Their Mental Health.’ First Deputy Minister of Health [Oleg] Shchepin approved them on 26 June 1984.”
“There is such a protocol,” Churkin acknowledged grudgingly, almost interrogatively. He knew he was trapped. “But how do you know about it?”
“We have our own ways of getting the information we need.”
The psychiatrists had much to hide. According to this document, anyone could be subjected to a compulsory psychiatric examination if one’s conduct “aroused suspicion that he manifested severe psychiatric disturbances that threatened the life and safety of the person in question or those around him.” A special provision stipulated the right of responsible officials, relatives, and neighbors to send for a psychiatrist. Moreover, “individuals who disrupt the work of institutions, enterprises, and so forth by absurd actions, innumerable letters containing absurd contents, as well as groundless demands may be examined by a physician-psychiatrist directly in these institutions.” Therefore, practically any person distinguished from the mass by unusual thoughts or eccentricity, or by insisting on his or her rights, could ultimately be hospitalized against his or her will by deploying the medical terminology “for emergency reasons.”
Together with our judicial “investigations,” we conducted others as well. From every possible source we added names that had not appeared on the original list of victims of punitive psychiatry presented to the Soviet delegation in Vienna. We circulated these revised lists to all departments so they could initiate possible reviews of the fate of the persons named therein. I say “possible” because among those on the lists there turned out to be persons—criminals—who really were suffering from psychiatric illnesses. Sometimes, to be sure, we were deceived in this regard. In the overwhelming majority of cases, the physicians concluded that the victims of punitive psychiatry, whose names appeared on the lists, could be discharged from psychiatric hospitals or transferred from the special hospitals of the Ministry of Internal Affairs to regular hospitals.
The breakthrough came during preparations for Gorbachev’s first visit to the United States. Included among the numerous materials was an official document listing the names of persons who had been discharged from psychiatric hospitals and those who would be discharged prior to the start of the visit. The lists had been compiled with the help of psychiatrists after they had reexamined these patients.
Nevertheless, at the last moment someone somewhere reneged on
his word. The mechanism of releasing dissenters from the psychiatric torture chambers was stuck in neutral gear. We needed to adopt harsh measures to convince the psychiatrists and the concerned ministries and departments that there could be serious consequences if the general secretary of the Central Committee of the CPSU engaged in misinformation. Of course, we exaggerated somewhat, but they snapped to at once. The conclusion I drew was crystal clear: “Do what you want to, but keep your promises. Otherwise, we shall all pay the price.”
It was obvious that a good law was needed to bring order into psychiatry. We possessed a powerful weapon in the initial stage of perestroika in the form of a Leninist-era resolution (directive) from People’s Commissar of Justice Pēteris Stučka, published in Izvestiia, that governed the examination of those suffering from mental illnesses. This directive was presented to Shevardnadze, who fully grasped the lethal power of “Leninist norms” for the Soviet psychiatric inquisition. A whirlwind of activity began to push through a Politburo resolution on the need for a law regulating all aspects of psychiatric care. Unfortunately, the Ministry of Health, allied to the punitive organs, came out on top in the struggle with the Foreign Ministry. Thus, on January 5, 1988, the Presidium of the Supreme Soviet of the USSR issued a decree authorizing compromise regulations governing the provision of psychiatric care. Although it had been drafted on Shevardnadze’s initiative, in the key memorandum to the Central Committee we had been able to exert influence only at the stage of formal balloting by Politburo members.
Despite the decree’s shortcomings, it contained many positive elements. Most important of all, it was the first legislative, rather than bureaucratic, effort to regulate the provision of psychiatric care. It established strict time frames for examining and reexamining patients who had been involuntarily placed in psychiatric hospitals. The decree provided not only administrative but also judicial as well as prosecutorial control over the actions of psychiatrists. Unfortunately, the mechanism of such control was not specified and, therefore, could not function. The special psychiatric hospitals that had been operated by the Ministry of the Interior were to be transferred to the public health services, but this decision, too, was also sabotaged at the last possible moment. One of the excuses given was that the salaries of personnel in the special hospitals were higher than those working in ordinary hospitals. The decree also established the principle of criminal culpability for placing a “person undoubtedly known to be healthy” in a psychiatric hospital. Since it was impossible to say that someone was “undoubtedly” known to be healthy, this was a masterful—and completely useless—formulation.
The decree also contained a provision broad enough to cover almost any abuse: “Persons committing actions that gave sufficient grounds for supposing that they suffered from psychiatric disorders, and who infringed upon public order or the rules of socialist communal life . . . can be subjected to an initial psychiatric examination without their agreement, or the agreement of their relatives or legal representatives.” It would be impossible to think of a vaguer and more expansive formula for any sort of arbitrary action than the notorious “rules of socialist communal life,” since they could be interpreted in a completely capricious fashion. In sum, the positive elements were practically nullified by the absence of an enforcement mechanism and by the traditionally elastic formulations. At the same time, the decree was significant since it actually did facilitate the further reform of psychiatry.
Even with the full support of Shevardnadze, nothing could have been accomplished at that time without the close cooperation of reform-minded personnel in the offices of the Central Committee of the CPSU. The section on human rights, whose work was overseen by Alexander Yakovlev, took up these issues. It was undoubtedly because of the incontestable authority of the all-powerful party apparatus that the psychiatrists began to cooperate with the Ministry of Foreign Affairs.
Later, when things took a dangerous turn, Deputy Minister Adamishin relayed instructions from Shevardnadze that I should act entirely on my own so that no one in the Central Committee bureaucracy or the Foreign Ministry, including my own immediate supervisor Yury Reshetov, would know what I was working on or how. Soon Shevardnadze sent his own special messenger to transmit his order to take possession of all the rough drafts of the papers I had presented to him the previous day. His instructions were that from then on, without exception, I should give him all the papers dealing with psychiatry without first having them officially stamped, in order to leave no paper trail, and transmit them only to the then de facto head of the secretariat of the ministry, the future foreign minister Igor Ivanov. If necessary, I should inform him orally as to who else was in the know and from where the information came.
I am not joking in speaking of the danger. The attempts by various persons to intimidate, including by psychiatric methods—manipulation, intimidation, and provocation—especially by the KGB, were merely a trifle though certainly unpleasant. The major provocation was undertaken on the eve of a visit of American psychiatrists to the USSR. We had initiated this visit based on domestic political considerations; we needed powerful pressure from abroad to spur new efforts toward restructuring psychiatry. The main objective was to gain approval from above to draft an effective law strictly regulating all aspects of psychiatric care that would prevent new abuses by the white-coated guardians of ideological purity. No less important was freeing the maximum number of political and religious prisoners from the psychiatric torture chambers. To secure permission from the Soviet psychiatric “generals,” we informed them that without a successful visit, restoring Soviet membership in the World Psychiatric Association would be impossible.
The first meeting to prepare for the visit of American psychiatrists took place on November 9–12, 1988, in Moscow. It was agreed in advance that the preparations for the visit and the visit itself would take place under the aegis of the Soviet Ministry of Foreign Affairs and the U.S. Department of State. Accordingly, I was appointed to head the Soviet delegation, and my American counterpart was Ambassador Robert Farrand. The American side presented a document outlining conditions it considered necessary for the delegation to conduct its work successfully. Initially, the document seemed unacceptable.
The American delegation had a particular objective in mind—to ascertain whether perestroika was occurring in Soviet psychiatry and whether the preconditions for the abuse of psychiatry for nonmedical purposes still existed. The American specialists drafted a work plan in accordance with this objective. We were presented with a list of forty-eight persons; of those, they wanted to examine fifteen who were hospitalized and twelve who had been discharged from hospital. This plan was eventually carried out.
I will not conjecture about the difficulties the American specialists faced. One thing was clear: the results of their inquiries had to be 100 percent reliable according to criteria applicable in the United States. But implementing the political will of both sides during the initial phase of cooperation depended both on correctly interpreting the intentions of one’s counterparts and on purely technical aspects.
The success of the negotiations was facilitated by the acknowledgment, literally on the eve of their start, by Alexander Churkin, the chief psychiatrist of the Ministry of Health of the USSR, that there were cases of “hyper-diagnosis” and “unjustifiably lengthy periods of compulsory psychiatric treatment.” However, as he himself admitted to me, he fabricated the number of such cases, so the number bore no resemblance to reality. It should not be forgotten that the system Soviet psychiatrists devised for diagnosing psychological illnesses could satisfy the most refined taste of the most demanding politicians—that is, demanding of others, not of themselves! In this context, the word hyper-diagnosis has a distinctly ominous sound.
Just as the “medical” contingent of the Soviet delegation was headed by Churkin, on the American side this function was fulfilled by one of the leading American authorities in the field of judicial psychiatry, Dr. Loren Roth. Thanks very much to his
efforts, a Soviet-American dialogue in the field of psychiatry resumed, and a new impetus was given for reforming Soviet psychiatry. I viewed Dr. Roth as both passionate about his work and trustworthy. When we exchanged views during a critical moment when just the two of us were together, and Dr. Roth virtually confirmed my suppositions concerning the goals and possible results of the visit, I began to feel I was now on solid ground rather than just relying upon my own questionable conjectures.
Naturally, the major divergence between the Americans and us was political. I was granted considerable freedom of maneuver with just one, although very important, caveat: under no circumstances was the Americans’ visit to lead to inspections, but since there actually were calls for inspections, they had to be on a mutual basis. Reshetov and the Soviet psychiatrists anticipated that they would discover political prisoners in American psychiatric hospitals. For form’s sake, I had to go along with this demand for a while.
Robert Farrand stuck to an extremely inflexible position: there was to be no reciprocal visits. “How can there be mutuality when you have political abuses of psychiatry and we do not?” he inquired. When it seemed that we had already agreed to and decided everything, and the members of the Soviet and American delegations began to rise from the table to exchange handshakes and warm congratulations, I felt compelled to take the floor and, summing up the results of the negotiations, emphasize that the visit would take place on the basis of mutuality. Otherwise, responsibility for aborting the visit would lie with the State Department. I knew that the next day, during Secretary of State George Shultz’s visit, I was supposed to meet with Assistant Secretary of State for Human Rights Richard Schifter. I had no doubt that this intelligent and subtle diplomat would take a different stance than that of his subordinate, and that, in fact, is what happened.
Russia's Dead End: An Insider's Testimony from Gorbachev to Putin Page 10