K G B Psychiatry

The basic facts about the corruption of Soviet psychiatry and its use to suppress dissent are now beyond doubt. It has taken ten years to have them widely accepted (a process in which The New York Review has had a part).¹ But the poison of the powerful psychiatric bureaucracy of Drs. Morozov, Lunts, and Snezhnevsky, like that of apartheid, or torture in Latin America, or thought reform in China, runs alarmingly wide and deep. It seems unlikely that a further decade will suffice for cutting off the flow.

This will not be the fault of the Soviet human rights movement. Ever since its main organ, the Chronicle of Current Events, was founded in Moscow in 1968, it began to publish systematic information on how dissenters were being interned in mental hospitals and forcibly, and often very painfully, treated with drugs. Its members have since built up a detailed picture of this complex phenomenon and led the struggle against it with a rare tenacity and courage.

The volume of the documentation is now vast. The Chronicle (which reports of course on many subjects apart from psychiatric abuse) recently produced its forty-seventh and forty-eighth issues, each 180 pages long.² In 1971 Vladimir Bukovsky collected 150 pages of materials, to which Moscow’s Working Commission to Investigate the Use of Psychiatry for Political Purposes has now added a further 250 pages in the form of information bulletins issued over the last year.³ A Question of Madness by the Medvedev brothers described in detail Zhores Medvedev’s internment. Viktor Nekipelov, a poet and member of Yuri Orlov’s Moscow group set up to monitor the Helsinki agreement, has written a long and vivid memoir, Institute of Fools,⁴ on his experiences at the core of the corruption, the Serbsky Institute of Forensic Psychiatry. Shorter memoirs have come from a dozen other ex-victims still in the Soviet Union. And many statements have been made by yet others who have emigrated.

In 1977 the first full-length works of analysis appeared, attempting to assess all these as well as other materials. One, Punitive Medicine, was by Alexander Podrabinek, a member of the Working Commission and a young Moscow medical assistant who was recently put on trial.⁵ The other was by Dr. Sidney Bloch and the present writer.⁶ The conclusions of the two books were—despite the authors’ ignorance of each other’s activity—remarkably similar.

But the last refuge of the honest Western skeptic, the last shreds of his excuse for not accepting the facts at face value, did not perhaps disintegrate until this spring. Before then, a number of Soviet psychiatrists who had recently emigrated had testified to political abuses of psychiatry which they had witnessed. Their testimony was convincing but not very detailed: they were junior doctors who had worked in ordinary mental hospitals not specializing in the treatment of dissenters.

Now from the very heart of Soviet forensic psychiatry we have a new witness, Dr. Yuri Novikov, who has just published six long articles in Der Stern. Before he defected to West Germany last year he had been a section head at the Serbsky Institute as well as a secretary of the Soviet society of psychiatrists. The Serbsky’s director, Academician Georgy Morozov, had regarded him as a protégé and said that one day he might succeed him. However finding himself drawn into an evil system and discounting his capacity to resist and become a dissenter, Novikov saw his only way out in escaping abroad.

His articles in Der Stern⁷ should be conclusive evidence to those who, when pressed, have persisted in calling the abuses “alleged” or “hypothetical.” Not only does Novikov—from his unique insider’s experience—confirm the substance and much of the detail in the materials earlier mentioned, he also adds new evidence of his own. We knew before how the leaders of Soviet psychiatry have tried to head off criticism from psychiatric colleagues abroad, and in particular how they have used lies, pressure, and deception in their efforts to manipulate the World Psychiatric Association (WPA). But Novikov has broadened the picture: he was able to observe Dr. Morozov, the head of the Serbsky Institute, and others pursuing this squalid work, and was even made to take part in it himself.

While the scheming has had some notable successes in dampening criticism within the WPA it has not convinced most independent medical experts. The well-known British medical magazine The Lancet even stated in 1973 that its doubts about Soviet abuses had finally been resolved by a somewhat hysterical official Soviet denial: such extravagant language must, it was thought, be covering up something serious.

The generalized and blanket nature of Soviet denials, sometimes agitated, sometimes cold and brazen, of any political persecution by psychiatrists is itself revealing. No system could be quite so perfect as that claimed by leading Soviet psychiatrists such as Dr. Snezhnevsky and his associates. When pressed by visitors for an actual case of a dissenter who was mentally sick, they presented only a patient called Oleg Smirnov, about whom little was known in the West. They asserted that the wellknown former inmates of mental institutions who have emigrated—Bukovsky, Grigorenko, Gorbanevskaya, Medvedev, Rips, and others—are only in “remission” and will soon revert to schizophrenic states, although this obviously has not happened. Soviet propoganda dwells on the case of an unfortunate émigré in Vienna, Lev Konstantinov, claiming that before his emigration the West campaigned for him as a wrongly interned dissident—when in fact no one had heard of him before his emigration.

At the World Psychiatric Association meeting in Honolulu in August 1977, this mixture of mendacity and evasion, the routine Soviet reaction, clearly helped to swing the vote of the reluctant association for a resolution condemning the USSR. However, no admission of error followed, let alone of systematic political abuse. After some displays of injured innocence, the official reply came in December from the society of Soviet psychiatrists, breaking off relations with those WPA-member associations which had caused the most trouble in Honolulu. It announced:

The slanderous anti-Soviet campaign unleashed by the leadership of the psychiatric associations of the USA, the United Kingdom, Australia and New Zealand, at the present time, makes it impossible for Soviet scholars to continue their scientific contacts and scientific cooperation with them until they give up their slanderous fabrications and attacks, and until they present their apologies to their Soviet counterparts.

This paragraph seems to me to underscore the need for tougher and more determined Western pressure if a real change in the system is ever to be achieved. The recent pressures have been strong enough to protect the better known dissenters from psychiatric internment, and probably to prevent any sharp increase in the rate of internment of those who are less publicized. But a radical improvement in the situation would, I believe, require Western condemnation strong enough to cause such severe embarrassment to the Soviet regime that it would have to dismiss Dr. Morozov and his colleagues, and bring about reforms under new psychiatric leaders. The present leaders will never carry out reforms. They are at the center of the corruption of both the theory and the practice of Soviet psychiatry. Admitting their own “errors” would lay themselves open to removal, disgrace, and possibly even prosecution. This is why Western “quiet diplomacy” will never get far.

The strength of these leaders’ present position—the Honolulu setback notwithstanding—derives from a number of factors. They have good links to the political leadership, especially through the friendship of the KGB chief Andropov with Dr. Morozov, who is both the director of the Serbsky Institute and president of the psychiatrists’ society. They have an iron-tight organizational grip on the profession, which is both demoralized and has low social status. The younger half of this profession has been reared on an almost exclusive diet of Dr. Snezhnevsky’s theories, which equate social deviance with mental illness. And, like their elder colleagues who were intimidated by Stalin, these doctors have little or no access to the main developments in international psychiatry.

But in spite of all this, doctors and medical workers have become aware, mainly through Western radio broadcasts, of the political corruption of Soviet psychiatry and of the domestic and foreign outrage it has provoked. Brave people among them have become active in the human rights movement, and others have emigrated or defected in order to testify to the abuses they have observed. Among those in the first category, Dr. Semyon Gluzman, a young Kiev psychiatrist, was punished with a ten-year sentence, of which he has now served two-thirds.

More recently, Drs. Leonard Ternovsky and Alexander Voloshanovich have joined the Moscow Working Commission, deliberately reinforcing it when Alexander Podrabinek was arrested. Voloshanovich, a psychiatrist, had been working with it unobtrusively for some time. He examined twenty-seven people from many parts of the country who fear possible internment, or reinternment, for their dissenting activities and have therefore asked the commission to compile objective psychiatric reports on them. These reports will, they hope, help to deter the KGB, as the latter’s psychiatrists will hesitate to detect symptoms of “reformist delusions” and to make pseudo-scientific findings of “sluggish schizophrenia” when detailed and fair reports on the same patients are available for publication both in the USSR and abroad.

Twenty-three of Voloshanovich’s reports have reached the West, where they have aroused admiration among psychiatrists for their objectivity and thoroughness. In all except one case, about which he is uncertain, he concludes that the people he examined are not suffering from any form of mental illness. In one instance his opinion is confirmed by that of a British psychiatrist, Dr. Gerard Low-Beer, who examined the same dissenter last April when he spent four days in Moscow observing the commission at work.

The Moscow commission’s role, as Low-Beer reported in a speech to the annual general meeting of the Royal College of Psychiatrists, is many-sided and remarkable. While the Soviet medical profession remains, with rare exceptions like Voloshanovich and Ternovsky, passive, the commission has acted as the catalyst for a surge of grass-roots resistance to the “cops in white coats.” It has developed a sophisticated network of communication with the provinces, where the lesser known dissenters most vulnerable to internment live. When these people are under threat the commission protests to the relevant authorities, arranges examinations by Voloshanovich, and makes it clear that any internment will meet determined resistance and also involve the authorities in bad international publicity. In the last year preventive actions of this sort have successfully warded off a dozen or so internments.

Where the actions fail, or the commission learns of the threat too late, it organizes protests and publicity, sends a representative to the relevant hospital to talk to the doctors and, if possible, the victim, provides the latter and his family with material aid, appeals to Western psychiatric bodies, and, if there is a trial, sends a member to attend and record it. As a result of this type of activity, in fourteen out of twenty-two well-documented cases of dissenters interned over the last year, the victims have been released within two months.

The commission also intervenes and cares for longer standing internees who have been held in the special psychiatric hospitals for three, five, or even ten years. To date, its bulletins have carried information on thirty of these, and also appeals for new information on 103 others.

These cases are often the most tragic. Boris Evdokimov, for example, is a fifty-five-year-old Leningrad journalist who was arrested in 1971 for publishing articles abroad in anti-Soviet émigré journals. The Serbsky ruled him “schizophrenic” and he has since been held in the special hospitals of Leningrad, Dnepropetrovsk, and Kazan. Here he has been forcibly treated with neuroleptic drugs, although these could be dangerous because he is a diabetic. He also suffers from asthma, heart trouble, and high blood pressure. Leonid Plyushch knew him in Dnepropetrovsk, where, in 1976, the doctors wrote in his file that his mental health was normal. Last October his son wrote one of the many appeals to the World Psychiatric Association by dissenters and their relatives following the WPA’s vote in Honolulu to set up a committee to monitor political abuses.

He wrote of his father:

I am convinced that his mental condition is good enough that he does not require compulsory internment in a psychiatric hospital, and also that prolonged imprisonment as an in-patient is dangerous to his physical health…. I ask the committee to do all in its power to have my father released.

Acting as coordinator, publicist, interventionist, and welfare agency, the Working Commission was bound to inconvenience the KGB, whose response has been harassment and arrests. A year ago the first member was arrested. This May it was the turn of the highly exposed Alexander Podrabinek, whose book Punitive Medicine had so angered the authorities in 1977, even though it had circulated only in a summary issued by Amnesty International. Threats and blackmail, which led to the imprisonment of his brother Kirill on a trumped-up charge, had not deterred Alexander, whose reputation in the West gave him a certain immunity. But medical bodies did not speak up loudly enough for him last winter and spring; the KGB apparently felt it could strike without raising a major scandal.

His arrest, however, galvanized some of these bodies into action, notably the psychiatric associations of Britain and Australasia, and the understanding spread in the West that his trial presented the first major test of strength since Honolulu. An International Committee to Defend the Podrabinek Brothers was formed, uniting the efforts of doctors, laymen, and the brothers’ large clan of relatives in New York and other parts of the US; the committee members come from a dozen different countries.⁸ In addition, at the request of Podrabinek’s friends, two British lawyers, Brian Wrobel and Louis Blom-Cooper, Q.C., Chairman of the Howard League for Penal Reform, mounted a vigorous legal defense. Their job was to rebut the single charge against him—that Punitive Medicine contained “deliberate fabrications which defame the Soviet system.”

In July Wrobel went to Moscow to consult with commission members and interview legal officials, and Blom-Cooper conducted a public defense hearing in London. Here ten witnesses who had read Punitive Medicine and either knew Podrabinek personally or were experts on the subject presented their evidence and were cross-examined by Blom-Cooper. Among them were Drs. Novikov and Low-Beer. Five more witnesses sent written statements. All fifteen testified that Punitive Medicine was basically accurate and scholarly, and that most of the minor errors it contained appeared to result from the KGB’s having confiscated the author’s card index.

The evidence was then collected and incorporated into a fifty-four-page brief sent by the lawyers to Moscow, addressed to the court which was to try Podrabinek a month later, and which, under Soviet law, was obliged to take the brief into account. Blom-Cooper and Wrobel listed methodically the thirty-four infringements of Soviet legal procedure which, according to reliable information from Moscow, the investigators had so far committed. Chief among these was their refusal to take evidence from two defense witnesses who had volunteered their highly relevant testimony.

As was expected, the trial of Podrabinek on August 15 was a hasty, furtively conducted farce. Blom-Cooper had been denied a visa, and no foreign journalists, diplomats, or friends of the defendant were admitted, only his father and stepmother. Moreover no defense witnesses were allowed, and each of Podrabinek’s twenty requests to the court was refused. A trial that would have lasted a week or two had it been fair was rushed through in a day.

The haste, however, produced a comic blunder that compounded the already brazenly kangaroo nature of the proceedings. Most of the psychiatrist witnesses had been taught their lines efficiently and asserted that this or that detail in Punitive Medicine was wrong. But one, Dr. Vladimir Moskalkov, who had been too hastily selected, startled the court by confirming what his perjurer colleagues had just denied—the truth of Podrabinek’s statement that a patient had been killed by a doctor when trying to escape from the Sychyovka special hospital. Dr. Moskalkov was hustled out of court, and the judge read out the predetermined sentence: five years of internal exile.

Clearly Podrabinek had not committed his alleged offense, any more than Orlov, Ginzburg, and Shcharansky had committed theirs. Yet the discrepancy in the sentences was striking. Evidently the strong world reactions to the harsh treatment of the latter three, coupled with the vigorous international campaign which developed for Podrabinek within a mere three months of his arrest, had had some effect. The KGB had provoked more of a scandal than it expected. A heavier sentence would not only have angered foreign opinion but also dangerously increased the risk of Soviet psychiatry being expelled from international psychiatric committees and organizations.

Which brings us back to my belief that Western and world bodies have more power and potentially more effective sanctions than they realize. What is needed are the will and the courage to ignore Soviet bluster. For seven years the Soviet regime and psychiatric establishment have been on the defensive over psychiatric practices which come near to occupying the moral territory of the medical crimes of the Nazis. Yet the prosecution of Podrabinek, who has led the resistance to these practices for two years, evoked a hesitant and disunited response from representative Western bodies.

Britain’s Royal College of Psychiatrists did protest and asked to send an observer to the trial. The Foreign Secretary deplored the sentence, saying that he was “very concerned” about the political abuse of psychiatry. But why did the American Psychiatric Association and the American government apparently do nothing? And why was it that the WPA, notwithstanding its concern to proceed carefully in setting up an impartial and effective monitoring committee, could not reflect the Honolulu resolution by at least a whisper of concern? And what about the World Medical Association, to which the American Medical Association and analogous bodies belong? And the World Health Organization? Why have these bodies been silent?

The Moscow Working Commission and the hundreds, probably thousands, of victims of corrupt Soviet psychiatry need the strong moral support of medical associations of all sizes. The Moscow Commission welcomes both visitors and publicity, so individuals could help them. Publishers too could help by issuing Podrabinek’s remarkable book in many languages and thus making his acute insights into the historical, legal, medical, political, and sociological aspects of the problem widely available. “Soviet psychiatry,” he concludes in the book, “has betrayed the humane principles of medicine and discredited itself in the eyes of our contemporaries and descendants.”

How shameful if these words were to prove untrue.