Equal to the cruelty of Nazi euthanasia programmes, Soviet psychiatric terror targeted the most vulnerable members of society: the mentally ill. Placement in a psychiatric hospital was as effective a punishment as imprisonment in Mordovian concentration camps in breaking people both physically and psychologically. Thousands of healthy individuals who disagreed with the official Marxist-Leninist ideology and spoke out against the policies of the Communist Party were given fictitious psychiatric diagnoses such as “sluggish schizophrenia” and forced to undergo “treatment” in Soviet mental hospitals. Petro Hryhorenko and Leonid Pliushch are two high-profile victims, but the real numbers of “politically mad” in the USSR were much higher.
Secretary General of the Global Initiative on Psychiatry Robert van Voren is convinced that recent Soviet history should become public knowledge in order to immunize society against possible recurrences of the Soviet practice of politically motivated psychiatric abuse. This problem remains highly relevant, as vividly illustrated by the attempt of Russian authorities to “hide away” Col. Budanov in a psychiatric hospital.
U.W.: What was the role of psychiatry and the mentally ill in the repressive arsenal used by the communist regime? Was it an invention of the Soviet special services, or was psychiatry politically abused earlier?
The first individual case was registered soon after the “October Revolution” of 1917 when Maria Spiridonova ended up in a psychiatric hospital. There were also several other people whom the Bolsheviks did not like too well. In the 1930s, most patients in Kazan were political cases, but the idea was totally different. It was something similar to the situation in Poland in 1981 when, under martial law, dissidents were kept in psychiatric hospitals to keep them away from camps. In the USSR, the situation changed after 1948 when political abuse of psychiatry was initiated. For example, Estonia’s first president, Konstantin Pats, spent time in a prison mental hospital in Kazan. The number of victims constantly grew. However, researchers generally agree that this method was first systemically adopted by Yuri Andropov when he became the KGB chief. His first task was to break the dissident movement, and he evidently decided that psychiatry was just the right thing for this purpose.
In the early 1990s, a number of interesting documents became available, including a report written by KGB General Smorodinsky from Krasnodarsk Krai and signed by Andropov. The report stated that there were about 13,000 especially dangerous individuals that would have to be put in mental hospitals, but there were only 3,000 free beds in the existing facilities. So Smorodinsky’s proposal was to build new mental hospitals. His report explained why those persons were so dangerous: they wanted to flee the country, communicated with foreigners and disseminated propaganda materials. Andropov indicated in his report that this was not the only such region and that more mental institutions had to be built in other parts of the USSR. Buildings were added to most Soviet psychiatric hospitals in 1974-76 or brand new institutions were constructed which were, in essence, prison mental hospitals. There were 16 special mental hospitals in the USSR, such as in Blahoveshchenk and Volgograd. Many of them are now closed. Dissidents were put there for short periods, 2-3 months, for purposes of intimidation or after a long stay in special mental hospitals prior to release. According to our calculations, about one-third of all dissidents spent time in mental hospitals and another one-third ended up in Soviet camps. I found some very interesting information when I was working in the archive of the Stasi service, which used to actively cooperate with the KGB and hold joint annual meetings to figure out the best ways to fight enemies of the socialist order. For example, Filip Bobkov, director of the KGB’s 5th Department that dealt with dissidents, essentially stated that half of those arrested were mentally ill. In summer 1989, when Germany’s unification was in full swing, Bobkov came to Berlin and told Stasi Director Erich Mielke that it was the work of the mentally ill. Mielke was furious and said that those were antisocialist elements but clearly not mad people.
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We spent a long time trying to find the criteria according to which some dissidents were sent to camps, while others were put in mental hospitals. Perhaps it all depended on the individual. The calculation seems to have been that those who were too strong for camps were assigned to mental hospitals. But if a person was in a hospital and his case received a lot of publicity abroad, he would be sent to a camp or released, and then a new case would be opened later. Thus, there were many different reasons.
U.W.: What was Soviet psychiatry like after Stalin, under Khrushchev and later? Why did Soviet psychiatrists cooperate with the KGB so easily? Did they realize what they were doing?
This is the key question. After the 1950s Soviet psychiatry detached itself from world psychiatry. One infamous meeting of the Academy of Sciences and the Academy of Medical Sciences declared the Pavlovian school of Academician Andrei Snezhnevsky the main one and the only correct one. After that, the USSR almost completely halted the publication of Western psychiatric literature. What happened in foreign psychiatry was known only to the nomenklatura people (about 10 individuals) who were able to travel abroad. Most psychiatrists in the USSR either cooperated directly with the KGB or were its secret informants, such as academicians Georgiy Morozov, Nikolai Zharikov and Marat Vartanyan.
Ordinary psychiatrists who were trained in the USSR knew only the theory of the Moscow School. An important part of its theory and practice was so-called “sluggish schizophrenia”, a diagnosis used against dissidents. In fact, it is a very serious and perfidious mental illness that begins to develop slowly and inconspicuously. A person believes that he is healthy, and the people around him do not notice a thing, either. The main symptoms are an obsessive search for the truth, insistence, a desire of reform, self-assurance, etc. Such symptoms were very convenient in declaring dissidents mentally ill.
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A narrow circle of notable Soviet psychiatrists who were able to freely travel abroad were perfectly aware of what they were doing, but I am certain that 99 per cent of Soviet psychiatrists either did not understand or were sincerely convinced that dissidents were indeed mad. Or they understood that something fishy was going on but wanted to live and thus forced themselves into cooperation with the regime. The entire Soviet Union lived like that, and psychiatrists were people just like anyone else.
U.W.: What was the situation with the rights of the mentally ill in the USSR? In what way was it different from the Western model?
The conditions in Soviet mental hospitals were very similar to those in the West in the 1920s and the 1930s. I first saw an ordinary Soviet psychiatric department in summer 1991 in Pavlovka. Its smell is unforgettable, and it was frightening. I have almost never seen anything like that in all my practice in Africa and Asia.
Soviet mental patients did not have rights or protection. The treatment was very cruel – large doses of haloperidol, aminazine, maetil, shock therapy by insulin and sulfozinum. In the early days of Ukraine’s independence, people died of diabetes mellitus for lack of insulin, while mental hospitals had an ample supply of the drug to be used for shock therapy.
U.W.: Where and how is political abuse of psychiatry being practiced today? Is there evidence that this repressive practice has recurred in modern Russia and Belarus?
Modern Russia is a KGB-ruled country. The only difference is that the KGB used to be boosted by the power of the Communist Party, while today the Federal Security Service is a pro-government party that rules the country. Vladimir Putin is one of them. They are well aware that the world has changed and that there are new technological possibilities, but they have found their purely Russian solution. There are still cases of abuse of psychiatry in Russia, but it is not part of government policy.
Pure cases of Soviet-type psychiatry can now be observed in Vietnam. The leaders of Vietnamese psychiatry speak fluent Russian and have studied in Moscow under the Snezhnevsky school.
The case of China is an interesting topic in its own right. Chinese society is divided into countless strata. Those who are closest to the Ministry of Security and the police continue to abuse psychiatry today almost in the same way as in the USSR or even worse. However, the Chinese psychiatrists who work under the Ministry of Public Health are completely pro-Western and do not want to have anything to do with what the Chinese power structures desire to dictate.
The situation with psychiatry is very bad in Asia and Africa. However, it is a matter of poverty, not intentional repression. In Colombo, Sri Lanka, we have been able to completely overhaul the forensic psychiatric department, upgrade it and create adequate conditions for patients. Believe me, it does not take millions of dollars to do that.
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U.W.: In the 1970s and the 1980s, you came to the USSR on many occasions and collected information about patients in places of forced imprisonment. How was that possible?
It all began with reading Solzhenitsyn’s GULAG Archipelago. Then I made friends with Vladimir Bukovsky who had his own plans for me. He wanted me to become a correspondent in Moscow so that I could be a “postbox” for Soviet dissidents. He introduced me to Peter Redway, a London-based professor who organized a mission of couriers to the USSR to provide humanitarian aid and collect information. I first came to the USSR in February 1980, to Leningrad and Moscow, precisely at the time when dissidents began to be arrested one after another. I met some of them and collected the necessary information. Most of them were arrested several weeks after we met. My biggest personal blow was the imprisonment of Mart Niklus, an Estonian human rights advocate and political prisoner. He came from Tartu to Moscow in order to deliver a letter to the Politburo in which he demanded to have the Molotov-Ribbentrop Pact annulled and Estonia’s right to self-determination restored. He was well aware of what was going to happen next. When he returned to Tartu, he faced imprisonment and 15 years of exile. It seemed to me that I could not live as a normal human being as long as he was in a concentration camp and that I had to help others like him. Niklus served time until 1987. The USSR was my home and space, even though it was not my Fatherland. Since I was most interested in dissidents that were thrown into mental hospitals by the regime, I familiarized myself with psychiatry as such. I am not a doctor. I am a Sovietologist, but after 35 years of dealing with psychiatry you understand that it is a complex phenomenon.
U.W.: You were one of the key organizers and leaders of numerous campaigns in the West to support the release of Soviet dissidents from prisons and condemn repressive psychiatric practices used against them. How much awareness and interest in these things did the West have in the 1970s and the 1980s?
Everything you are asking about was familiar to the West. Interest emerged in the late 1960s, largely caused by Western journalists stationed in Moscow. There was a very interesting case: when Andrei Sakharov wrote his first essay in 1968, a Dutch journalist was the first to get his hands on the manuscript. He translated it into Dutch and then dictated it over the telephone to his editor in Amsterdam. Of course, KGB men were listening in, but they did not have an interpreter on hand, so they failed to grasp what the message was. This is how this text was leaked to the West and was published in a number of the world’s leading newspapers. Curiously, human rights were a very important part of Western policies. Politicians of all stripes were constantly talking about dissidents and prisoners in the USSR.
By comparison, their attitude toward modern Russia and China is completely different. In the case of the latter, [a critical stance] is virtually impossible, because no one wants to invest their money in solving the issue of repressive psychiatry in a country that is a big economic partner. The situation is the same with Russia. Now the Russian opposition cannot expect the kind of support the West lent in Soviet times. Precise calculation and pragmatism rules today. Support for Soviet dissidents was part of the anti-Soviet policy.
In 1988, Eduard Shevarnadze, a former Interior Ministry general, decided that the USSR should put an end to the political abuse of psychiatry. The Americans told him then that they knew the Soviet Union wanted to hold a prestigious conference on human rights in Moscow, but as long as psychiatric repression continued, it would not happen. And then at a Politburo meeting, Shevarnadze insisted on abandoning the political persecution of dissidents.
U.W.: In 1980, you were one of the founders of an international organization for counteracting political abuse of psychiatry and became its Secretary General in 1986. What impact has your organization had, and what methods has it used to support Soviet dissidents who were put in mental hospitals?
The Global Initiative on Psychiatry indeed emerged in the early 1980s. Initially, it was a committee that coordinated actions aimed against the political abuse of psychiatry in the USSR. The main goal at the time was to organize a campaign to expel Soviet psychiatrists from the World Psychiatric Organization. We were successful in doing so. The organization acquired its present shape step by step. After the dissolution of the USSR, we decided to refocus our efforts on creating humane psychiatry, first in the former Soviet countries of Eastern Europe. Now we are active in 36 countries worldwide.
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The topic of Soviet political abuse of psychiatry has had a huge impact of world psychiatry and the development of its ethics. This question was first put on the agenda of the WPA Congress in Mexico City in 1971. At the time, Vartanyan was a member of the WPA’s Executive Committee, and they refused to raise this topic altogether. This was not only because of Vartanyan; there was another reason: a world-famous psychiatrist from Argentina who was very close to dictator Jorge Videla was also present at the congress. In Latin America, psychiatrists were not accustomed to putting dissidents in prison. Rather, they were asked to suggest the best ways to torture victims. These psychiatrists were perfectly aware that if they started discussing Soviet psychiatry, Argentine psychiatry would soon become a target, too. South Africans had the same understanding. Vartanyan managed to play on these feelings.
Later, the Declaration of Hawaii was finally adopted. After that, all normal psychiatric associations have had codes of ethics that specify, among other things, the kind of money psychiatrists may accept from pharmaceutical companies, etc. We may not have been the force that ended the abuse of psychiatry in the USSR, but the very effort to do so humanized contemporary psychiatry.
Robert van Voren is a Dutch Sovietologist, human rights advocate and political writer. In the 1970s and the 1980s, he actively collected information about Soviet dissidents who had been forcefully placed in mental hospitals. He has authored more than one hundred publications in the Western European press focused on the political abuse of psychiatry in the USSR, and is the Secretary General of the Global Initiative on Psychiatry. His book On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir Putin has recently been translated into Ukrainian.