Soviet Psychiatry: An Exchange

To the Editors:

It is very tempting to engage in argument with Peter Reddaway (“Should World Psychiatry Readmit the Soviets?” NYR, October 12), to enter the thicket of facts, pseudo-facts and para-facts that constitute his province, together with interpretations, judgment calls and the whole paraphernalia of expertness that he brings to bear on the issues of Soviet psychiatry. Others have different views, and some can even lay claim to expert status as well. But with respect to the major policy question he addresses, namely, whether the U.S.S.R. All-Union Society of Psychiatrists and Narcologists should be readmitted to the World Psychiatric Association, polemics miss the point.

In 1983, the WPA made itself clear. The resolution of the Assembly at the Vienna Congress states that “…the WPA would welcome the return of the All-Union Society to membership but would expect sincere cooperation and concrete evidence beforehand of amelioration of the political abuse of psychiatry in the Soviet Union.” This year, an American delegation, which included Peter Reddaway, spent two weeks in the Soviet Union and issued a report (“Report of the U.S. Delegation to Assess Changes in Soviet Psychiatry, July 12, 1989”). The report contained both good news and bad news, but overall it was clear that the Soviet Union had met the WPA conditions—psychiatric abuse had diminished greatly and sincere cooperation was forthcoming.

Keeping the Soviet Union out of an international body like the World Psychiatric Association is not the way to encourage further progress; there are plenty of opportunities in the world for last-ditch struggles, but isolating Soviet psychiatry seems like a particularly poor place to make a stand. As a political scientist, Peter Reddaway may feel called upon to embrace confrontation while taking a high moral tone. But it is unbecoming for psychiatrists like ourselves for at least two reasons. First of all, there is the deplorable state of our own institutions, the so-called hospitals for the criminally insane. But more generally, we belong to a profession whose essence is conciliation, interchange and a belief in the possibility of human progress. It is our hope that our colleagues will behave in accord with those aspects of our life and work and enter into exchanges and consultation on a universal basis.

Alfred M. Freedman, M.D.
Past President
American Psychiatric Association

Abraham L. Halpern, M.D.
Past President
American Academy of Psychiatry and the Law

Peter Reddaway replies:

It is helpful of Drs. Freedman and Halpern to quote the WPA resolution of 1983 requiring “sincere cooperation” from the All-Union Society before it can be readmitted. But they ignore the evidence presented in my article that much of its cooperation has not been sincere. Here are some examples of this lack of sincerity over the last year:
1. On October 17 the WPA approved a resolution to readmit the All-Union Society (AUS), but only after a semiadmission of past political abuses had been made by the AUS in Athens at the last minute and included in the resolution, and only on two conditions: that a WPA delegation would visit the USSR within the next year and, if its report indicated continuing abuses, the AUS would be subject to possible expulsion by a special meeting of the WPA’s ruling body. The AUS concealed these important circumstances from the Soviet media, which printed distorted accounts of the congress. Even now, a month later, the unprecedented semiadmission—which acknowledged “that previous political conditions created an environment in which psychiatric abuse occurred for non-medical, including political, reasons”—has not been published in the USSR. Apparently it is for export only.

1. Also for export only have been two other documents which played a role in securing the AUS’s conditional readmission. The first is the conciliatory Soviet response released in the US on July 12 to the US report referred to by Freedman and Halpern. Four months after publication in the US, neither the report nor the response has—except for a few brief paragraphs in a couple of non-medical papers—been published in the USSR. This is because, as Soviet psychiatrists have told me, the report criticizes many abuses which the psychiatric establishment has consistently covered up, and the response makes exaggerated, sometimes false statements about change and reform in psychiatry, which, if published in the current atmosphere of glasnost in the USSR, would provoke outrage on the part of the public. The same applies to the second document, a statement by the AUS which was released by a Soviet diplomat at a US Congressional hearing on October 2, and received a good press (see The New York Times, October 3, 1989). This statement announced that a commission had been set up in the USSR to investigate alleged abuses of psychiatry. The commission consisted of eight members and its objectivity was assured by the fact that it was independent of the Ministry of Health. The statement did not, however, provide the members’ names, or the commission’s address, or any evidence that the group would be genuinely independent. More revealing still, when the AUS delegation to the WPA Congress was challenged a fortnight later at a special meeting in Athens to provide this information, the Soviet psychiatrists remained stonily silent. Presumably the commission either does not in fact exist, or it consists of people whose objectivity would not inspire confidence. In any case, the Soviet media have not published the AUS statement.
2. Last summer, long compromised leaders of Soviet psychiatry such as Drs. N. Zharikov and M. Vartanyan argued strongly, I have been reliably informed, that the US report should receive an aggressive rebuttal. But they were overruled by the Ministry of Foreign Affairs, which realized correctly that although such a course might be in these doctors’ personal interests, a continued show of reasonableness about Soviet shortcomings and the benefits of US-Soviet cooperation would stand a better chance of facilitating Soviet readmission to the WPA.

3. Much of the US visit in March was marked by a similar show of reasonableness. But sometimes the mask slipped. Alexander Churkin, for example, the chief psychiatrist of the Ministry of Health, was asked by a Soviet reporter what would happen if the American psychiatrists came up with a different diagnosis of a patient from the Soviet one. His reply was: “They are entitled to their opinion. But it will not be reflected in the patient’s subsequent treatment” (Argumenty i fakty, March 4–10, 1989). Another whose mask slipped was the deputy head of the Kazan special psychiatric hospital, Nail Idrisov. After telling us all day about the need for sincere dialogue and cooperation, that evening he physically ejected from our hotel two young psychiatrists who had started telling us what had been concealed from us during our visit to the hospital.

4. A show of reasonableness was also put on by Dr. Zharikov, the President of the All-Union Society, at the seminar on the last day of our visit. He shook our hands, smiling profusely, but he did not explain why, in 1973, he ruled the well-known dissident Yury Shikhanovich to be psychotic and thus had him consigned to a mental institution. Nor did he or anyone else respond when I asked why the political abuses reported in some Soviet publications had been studiously ignored by the AUS, and had also been avoided during our one-and-a-half-day seminar. The only reaction I got was to be cut off by the chairman, Yury Reshetov, head of the Foreign Ministry’s human-rights bureau, after I had been speaking for five minutes in my first (and last) contribution to the proceedings. The appointment of Dr. Zharikov a year ago to be AUS president did not show a desire for “sincere cooperation.” As an intimate associate of the top practitioner and administrator of psychiatric abuse, Georgy Morozov, who became honorary president, he has predictably avoided any discussion of this abuse, sincere or otherwise.

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5. Another long-time leader of the AUS, Dr. Eduard Babayan, has demonstrated the same rigid refusal to admit any abuse. Recently the magazine New Times (No. 43, 1989) made a handsome apology to the miner Vladimir Klebanov, who tried to form a free trade union in 1977, for having printed Babayan’s libellous statements that he was mentally ill, and for having thus contributed to the suffering he experienced during many ruined years of drug treatment in prison psychiatric hospitals. But Dr. Babayan has remained silent, just as he did in 1985 when accused in the press of corruption. Yet so corrupt is the AUS, and so little concerned about sincere reform, that he remains an honored leader, sitting on both its executive and the editorial board of its journal.

6. When in March 1989 this sad state of the AUS led some brave psychiatrists to form the Independent Psychiatric Association and apply for WPA membership, the AUS leaders were furious. Soon, however, they were advised by clever tacticians that a show of sincere cooperation with the new group was desirable, since it would probably facilitate the AUS’s return to the WPA. So a joint meeting was held for this purpose in May. Zharikov successfully maintained a facade of joviality, but some of his colleagues could not conceal their visceral hostility and fear of the new group. The affable mask of the meeting’s chairman, Dr. Viktor Belov, for example, fell completely off when he suddenly threatened his new colleagues with the prospect of imprisonment for having dared to form their impudent group.

Does all this suggest that the AUS is now a reconstructed, reformist organization seeking sincere cooperation with foreign and domestic colleagues? Why, moreover, do Drs. Freedman and Halpern dismiss, by ignoring them, the strong appeals made by independent psychiatrists like Semyon Gluzman for keeping the AUS out of the WPA until it has reformed itself? Why also do they charge me with (in addition to unspecified “pseudo-facts and para-facts”) wanting to isolate Soviet psychiatry? My article made clear that I share Dr. Gluzman’s view that keeping the AUS out in the short term would have been the quickest way of bringing the isolation to a genuine end.

However, although the readmission of the AUS was in Gluzman’s and my view a wrong decision both morally and tactically, the circumstances in which it occurred nonetheless give cause for hope. It is conditional on a future inspection visit; it was granted only after a semiadmission of abuse had at last been forced out of the AUS, and at the same time the Independent Psychiatric Association was admitted to the WPA as a full member—not, as the AUS delegation falsely reported, as a provisional member. All this will help the reformists in the USSR. Thanks to the efforts of these people, and also of their supporters abroad, especially psychiatrists and others in Holland, Britain, West Germany, and the United States, the citadel of corrupt, politicized psychiatry, the AUS, is under mounting siege. Its walls could possibly fall before too long.