Political abuse of psychiatry in the Soviet Union

In the Soviet Union, systematic political abuse of psychiatry took place. Soviet psychiatric hospitals known as "psikhushkas" were used by the authorities as prisons in order to isolate hundreds or thousands of political prisoners from the rest of society, discredit their ideas, and break them physically and mentally. This method was also employed against religious prisoners and most especially against well-educated former atheists who adopted a religion. In such cases their religious faith was determined to be a form of mental illness that needed to be cured. Formerly highly classified extant documents from “Special file” of the Central Committee of the Communist Party of the Soviet Union published after the dissolution of the Soviet Union demonstrate that the authorities of the country quite consciously used psychiatry as a tool to suppress dissent.

Following the fall of the Soviet Union, it was often reported that some opposition activists and journalists were detained in Russian psychiatric institutions in order to intimidate and isolate them from society. In modern Russia, human rights activists also face the threat of psychiatric diagnosis as a means of political repression.

The allegations about punitive psychiatry taking place in Russia were rejected by Russian scientists. According to Professor R.A. Nadzharov, Doctor of Medical Sciences and Deputy Director of the USSR Academy of Medical Sciences' Psychiatric Institute,

"There can be no doubt that talk in the West of 'the forced commitment to psychiatric hospitals' of certain 'dissident' representatives of the intelligentsia is nothing other than a component part of the anti-Soviet propaganda campaign that certain circles are trying to stir up in pursuit of highly improper political aims.'"

Background
Political abuse of psychiatry is the misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society. It entails the certification and committal of citizens to psychiatric facilities based upon political rather than mental health-based criteria. Many authors, including psychiatrists, also use the terms "Soviet political psychiatry"     or "punitive psychiatry" to refer to this phenomenon.

In the book Punitive Medicine by Alexander Podrabinek, the term "punitive medicine", which is identified with "punitive psychiatry," is defined as "a tool in the struggle against dissidents who cannot be punished by legal means." Punitive psychiatry is neither a discrete subject nor a psychiatric specialty but, rather, it is a disciplinary function arising within many applied sciences in totalitarian countries where members of a profession may feel themselves compelled to service the diktats of power. Psychiatric confinement of sane people is uniformly considered a particularly pernicious form of repression and Soviet punitive psychiatry was one of the key weapons of both illegal and legal repression.

Psychiatry possesses an inherent capacity for abuse that is greater than in other areas of medicine. The diagnosis of mental disease can give the state license to detain persons against their will and insist upon therapy both in the interest of the detainee and in the broader interests of society. In addition, receiving a psychiatric diagnosis can in itself be regarded as oppressive. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. In the period from the 1960-s to 1986, the abuse of psychiatry for political purposes was reported to have been systematic in the Soviet Union and episodic in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia. The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community. Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. As scholars have long argued, governmental and medical institutions have at times coded threats to authority as mental disease during periods of political disturbance and instability. Nowadays, in many countries, political prisoners are still sometimes confined and abused in mental institutions.

In the Soviet Union dissidents were often confined in the so-called psikhushka, or psychiatric wards. Psikhushka is the Russian ironic diminutive for "mental hospital". One of the first psikhushkas was the Psychiatric Prison Hospital in the city of Kazan. In 1939 it was transferred to the control of the NKVD, the secret police and the precursor organization to the KGB, under the order of Lavrentiy Beria, who was the head of the NKVD. International human rights defenders such as Walter Reich have long recorded the methods by which Soviet psychiatrists in Psikhushka hospitals diagnosed schizophrenia in political dissenters. Western scholars examined no aspect of Soviet psychiatry as thoroughly as its involvement in the social control of political dissenters.

As early as 1948, the Soviet secret service took an interest in this area of medicine. It was one of the superiors of the Soviet secret police, Andrey Vyshinsky, who first ordered the use of psychiatry as a tool of repression. A system of political abuse of psychiatry was developed at the end of Joseph Stalin's regime. However, according to Alexander Etkind, punitive psychiatry was not simply an inheritance from the Stalinist era as the GULAG (the acronym for Chief Administration for Corrective Labor Camps, the penitentiary system in the Stalin years) was an effective instrument of political repression and there was no compelling requirement to develop an alternative and expensive psychiatric substitute. The abuse of psychiatry was a natural product of the later Soviet era. From the mid-1970s to the 1990s, the structure of mental health service conformed to the double standard in society, that of two separate systems which peacefully co-existed despite conflicts between them: The hundreds of hospitals in the provinces combined components of both systems.
 * 1) the first system was punitive psychiatry that straight served the institute of power and was led by the Moscow Institute for Forensic Psychiatry named after Vladimir Serbsky;
 * 2) the second system was composed of elite, psychotherapeutically oriented clinics and was led by the Leningrad Psychoneurological Institute named after Vladimir Bekhterev.

Joint Session
A precursor of later abuses in psychiatry in the Soviet Union was the so-called "Joint Session" of the USSR Academy of Medical Sciences and the Board of the All-Union Neurologic and Psychiatric Association in October 1951. Held in the name of Ivan Pavlov it considered the status of several leading neuroscientists and psychiatrists of the time, including Grunya Sukhareva, Vasily Gilyarovsky, Raisa Golant, Aleksandr Shmaryan, and Mikhail Gurevich, who were charged with practicing "anti-Pavlovian, anti-Marxist, idealistic [and] reactionary" science that was damaging to Soviet psychiatry. During the Joint Session these eminent psychiatrists, motivated by fear, had to publicly admit that their scientific positions were in error and they also had to promise to conform Pavlovian doctrines. However, these public declarations of obedience proved insufficient as in the closing speech of the congress, the lead author of the event's policy report, Andrei Snezhnevsky stated that they “have not disarmed themselves and continue to remain in the old anti-Pavlovian positions”, thereby causing “grave damage to the Soviet scientific and practical psychiatry”. The vice president of the USSR Academy of Medical Sciences accused them of "diligently fall[ing] down to the dirty source of American pseudo-science”. The congressional members who articulated these accusations, among them Irina Strelchuk, Vasily Banshchikov, Oleg Kerbikov, and Andrei Snezhnevsky, were characterized by careerist ambition and fears for their own positions. Not surprisingly, many of them were advanced and appointed to leadership positions shortly after the session.

The Joint Session also had negative an impact on several leading Soviet academic neuroscientists, such as Pyotr Anokhin, Aleksey Speransky, Lina Stern, Ivan Beritashvili, and Leon Orbeli. They were labeled as anti-Pavlovians, anti-materialists and reactionaries and subsequently they were dismissed from their positions. In addition to losing their laboratories some of these scientists were subjected to torture in prison. The Moscow, Leningrad, Ukrainian, Georgian, and Armenian schools of neuroscience and neurophysiology were damaged for a period due to this loss of personnel. The Joint Session ravaged productive research in neurosciences and psychiatry for years to come. It was pseudoscience that took over.

After the joint session of the USSR Academy of Sciences and the USSR Academy of Medical Sciences on June 28 — July 4, 1950 and during the session of the Presidium of the Academy of Medical Sciences and the Board of the All-Union Society of Neuropathologists and Psychiatrists on October 11–15, 1951, the leading role was given to Snezhnevky's school. The 1950 decision to give monopoly over psychiatry to the Pavlovian school of Snezhnevsky was one of the crucial factors in the rise of political psychiatry. The Soviet doctors, under the incentive of Sneznevsky, devised a "Pavlovian theory of schizophrenia" and increasingly applied this diagnostic category to political dissidents.

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." (Alexander Solzhenitsyn)

Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes. It was the diagnosis of "sluggish schizophrenia" that was most prominently used in cases of dissidents. The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and this diagnosis to make political dissent into a mental disease. According 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. The diagnosis "sluggish schizophrenia," a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Andrei Snezhnevsky, furnished a very handy framework for explaining this behavior. 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 Party and 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.

A. Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences, developed a novel classification of mental disorders postulating an original set of diagnostic criteria. The Soviet model of schizophrenia is based on the hypothesis that a single fundamental characteristic, by which schizophrenia spectrum disorders are distinguished clinically, is their longitudinal course. The hypothesis implies that there are three main types of schizophrenia:
 * 1) the continuous type that is defined as unremitting, proceeding with either a rapid (“malignant”) or a slow (“sluggish”) progression and has a poor prognosis in both instances;
 * 2) the periodic, or recurrent type that is characterized by an acute attack followed by full remission with minimal progression, if any;
 * 3) the mixed, or shift-like, type (“schubweise” — in German “schub” means phase or attack), a mixture of continuous and periodic types that occurs periodically and is characterized by only partial remission.

This systematization of schizophrenia types attributed to Snezhnevsky is still used in Russia  and refers sluggish schizophrenia to the continuous type.

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. 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." 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. 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. Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters. 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. 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 Schizophrenia reported in 1973. 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. Their symptoms could be like those of a neurosis or could assume a paranoid character. The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society. Thereby, sluggish schizophrenia could have such symptoms as "reform delusions," "perseverance," and "struggle for the truth." As Vladimir Stayzhkin 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."

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. Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union and several Eastern European countries.

Someone of those present at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute once asked him a rather provocative question: “Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?” Since the question was asked with an ironical smile, in the debate, Morozov replied, smiling ironically as well, “You know, dear colleagues, this is a very peculiar disease: there are not delusional disorders, there are not hallucinations, but there is schizophrenia!”

American psychiatrist Alan A. Stone stated that Western criticism of Soviet psychiatry aimed at Sneznevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia with a "sluggish type" manifestation by "reformerism" including other symptoms. One can readily apply this diagnostic scheme to dissenters. Snezhnevsky was long attacked in the West as an exemplar of psychiatric abuse in the USSR. 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, including those of the biologist Zhores Medvedev, the mathematician Leonid Plyushch, and Vladimir Bukovsky whom Snezhnevsky diagnosed as schizophrenic on 5 July 1962. In 1980, the Special Committee on the Political Abuse of Psychiatry, established by the Royal College of Psychiatrists in 1978, charged Snezhnevsky with involvement in the abuse and recommended that Snezhnevsky, who had been honoured as a Corresponding Fellow of the Royal College of Psychiatrists, be invited to attend the College's Court of Electors to answer criticisms because he was responsible for the compulsory detention of this celebrated dissident, Leonid Plyushch. Instead Snezhnevsky chose to resign his Fellowship.

Mass abuse onset
The campaign to declare political opponents mentally sick and to commit dissenters to mental hospitals began in the late 1950s and early 1960s. As Vladimir Bukovsky, commenting on the nascency of the political abuse of psychiatry, wrote, Nikita Khrushchev reckoned that it was impossible for people in a socialist society to have anti-socialist consciousness, and whenever manifestations of dissidence could not be justified as a provocation of world imperialism or a legacy of the past, they were merely the product of mental disease. In his speech published in the state newspaper Pravda on 24 May 1959, Khrushchev said: "A crime is a deviation from generally recognized standards of behavior frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offences, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal."

In May 1967, Yuri Andropov became the KGB Chairman. On 3 July 1967, he made a proposal to establish for dealing with the political opposition the KGB’s Fifth Directorate (ideological counterintelligence). At the end of July, the directorate was established and entered in its files cases of all Soviet dissidents including Andrei Sakharov and Alexander Solzhenitsyn. In 1968, Andropov as the KGB Chairman issued his order “On the tasks of State security agencies in combating the ideological sabotage by the adversary”, calling for struggle against dissidents and their imperialist masters. He aimed to achieve “the destruction of dissent in all its forms” and insisted that the struggle for human rights had to be considered as a part of a wide-ranging imperialist plot to undermine the Soviet state’s foundation.

On 29 April 1969, Andropov submitted to the Central Committee of the Communist Party of the Soviet Union an elaborated plan for creating a network of mental hospitals to defend the “Soviet Government and socialist order” from dissenters. The proposal by Andropov to use psychiatry for struggle against dissenters was implemented. On 15 May 1969, there was issued Decree No. 345–209 on "measures for preventing dangerous behavior (acts) on the part of mentally ill persons." This Decree ratified the practice of having undesirables hauled into detention by psychiatrists. Under this practice, the psychiatrists were told whom they should examine, and they might fetch this individual with the assistance of the police or entrap him to come to the hospital. The psychiatrists doubled as interrogators and as arresting officers. The doctors fabricated a diagnosis requiring internment, and no court judgment was required for confining the individual indefinitely.

Practically in all cases, dissidents were examined in the Serbsky Central Research Institute for Forensic Psychiatry which conducted forensic-psychiatric expert evaluation of persons brought to justice under political articles. Certified, the persons were sent for involuntary treatment to special hospitals of the system of the Ministry of Internal Affairs (MVD) of the Russian Federation. In 1960s and 1970s, the trials of dissenters and their referral for “treatment” to special psychiatric hospitals of the system of MVD came out into the open before the world public, and information of “psychiatric terror,” which the leadership of the institute was flatly denying, began to appear. The majority of psychiatric repressions date from the late 1960s to the early 1980s.

According to dissident poet Naum Korzhavin, the atmosphere at the Serbsky Institute in Moscow altered almost overnight when a Daniil Lunts became chief of the Fourth Department otherwise known as the Political Department. Previously, psychiatric departments had been regarded as a 'refuge' against being dispatched to the Gulag, but thenceforth that policy altered. The first reports of dissenters being hospitalized on non-medical grounds date from the early 1960s, not long after Georgi Morozov was appointed director of the Serbsky Institute. Both Morozov and Lunts were personally involved in numerous well-known cases and were notorious abusers of psychiatry for political purposes. Daniil Lunts was characterized by Viktor Nekipelov as "no better than the criminal doctors who performed inhuman experiments on the prisoners in Nazi concentration camps."

Sergei Pisarev
Cases of political abuse of psychiatry have been known since the 1940s and 1950s, including the case of Sergei Pisarev, a party official who was arrested after criticizing the work of the Soviet secret police in the context of the so-called Doctors' Plot, an anti-Semitic campaign propelled at Stalin's instructions which should have brought about a new terror wave in the Soviet Union and possibly the extermination of the remaining Jewish communes that had outlived the Second World War. Pisarev was committed to the Special Psychiatric Hospital in Leningrad which along with an analogous hospital in Sychevka has started functioning since the Second World War. After his discharge, Pisarev began a campaign against political abuse of psychiatry, concentrating himself on the Serbsky Institute which he viewed to be the seat of the trouble. As a consequence of his efforts, the Central Committee of the Communist Party constituted a committee which investigated the situation and came to the conclusion that the political abuse of psychiatry was actually taking place. The report, however, vanished in a desk drawer and never brought about any action taken.

Pyotr Grigorenko
In 1961, Pyotr Grigorenko started to openly criticize what he considered the excesses of the Khrushchev regime. He maintained that the special privileges of the political elite did not comply with the principles laid down by Lenin. Grigorenko formed a dissident group — The Group for the Struggle to Revive Leninism. Soviet psychiatrists sitting as legally constituted commissions to inquire into his sanity diagnosed him at least three times — in April 1964, August 1969, and November 1969. When arrested, Grigorenko was sent to Moscow's Lubyanka prison, and from there for psychiatric examination to the Serbsky Institute where the first commission, which included Snezhnevsky and Lunts, diagnosed him as suffering from the mental disease in the form of a paranoid delusional development of his personality, accompanied by early signs of cerebral arteriosclerosis. Lunts, reporting later on this diagnosis, mentioned that the symptoms of paranoid development were "an overestimation of his own personality reaching messianic proportions" and "reformist ideas." Grigorenko was irresponsible for his actions and was thereby forcibly committed to a special psychiatric hospital. While there, the government deprived him of his pension despite the fact that, by law, a mentally sick military officer was entitled to a pension. After six months, Grigorenko was found to be in remission and was released for outpatient follow-up. He required that his pension be restored. Although he began to draw pension again, it was severely cut. He became much more active in his dissidence, stirred other people to protest some of the State's actions and received several warnings from the KGB. As Grigorenko had followers in Moscow, he was lured to Tashkent, half a continent away. Again he was arrested and examined by psychiatric team. None of the manifestations or symptoms cited by the Lunts commission were found by the second commission held in Tashkent under the chairmanship of Fyodor Detengof. The diagnosis and evaluation made by the commission was that "Grigorenko's [criminal] activity had a purposeful character, it was related to concrete events and facts… It did not reveal any signs of illness or delusions." The psychiatrists reported that he was not mentally sick, but responsible for his actions. He had firm convictions which were shared by many of his colleagues and were not delusional. Having evaluated the records of his preceding hospitalization, they concluded that he had not been sick at that time either. The KGB brought Grigorenko back in Moscow and, three months later, arranged a second examination at the Serbsky Institute. Once again, these psychiatrists found that he had "a paranoid development of the personality" manifested by reformist ideas. The commission, which included Lunts and was chaired by Morozov, recommended that he be recommitted to a special psychiatric hospital for the socially dangerous. Eventually, after almost four years, he was transferred to a usual mental hospital.

In 1979 in New York, Grigorenko was examined by the team of psychologists and psychiatrists including Alan A. Stone, the then President of American Psychiatric Association. The team came to conclusion that they could find no evidence of mental disease in Grigorenko and his history consistent with mental disease in the past. In 1981, Pyotr Grigorenko told about his psychiatric examinations and hospitalizations in his memoirs V Podpolye Mozhno Vstretit Tolko Krys (In Underground One Can Meet Only Rats) translated into English under the title Memoirs in 1982. Only in 1992, the official post-mortem forensic psychiatric commission of experts met at Grigorenko’s homeland removed the stigma of mental patient from him and confirmed that the debilitating treatment he underwent in high security psychiatric hospitals for many years was groundless. The 1992 psychiatric examination of Grigorenko was described by the Nezavisimiy Psikhiatricheskiy Zhurnal in its numbers 1–4 of 1992.

Viktor Rafalsky
Viktor Rafalsky, a political prisoner, dissident and author of unpublished plays, novels, and short stories, was committed to Soviet psychiatric prisons in Lviv, Dnipropetrovsk, and Leningrad for 24 years because of belonging to a clandestine Marxist group (from 1954 to 1959), writing anti-Soviet prose (from 1962 to 1965), and possessing anti-Soviet literature (from 1968 to 1983). In the winter of 1987, he was discharged and pronounced sane. In 1988, Viktor Rafalsky published the first version of his memoirs Reportazh iz Niotkuda (Reportage from Nowhere) describing his confinement in Soviet psychiatric hospitals.

Joseph Brodsky
At the very end of 1963, the poet Joseph Brodsky was committed for observation to the Kashchenko psychiatric clinic in Moscow where he stayed for several days. A few weeks later, his second hospitalization took place: on 13 February he was arrested in Leningrad. Brought to trial for “pursuing a parasitic way of life”, Brodsky was accused of being a poet and of not doing more “productive” work. There were two hearings of the trial dated 18 February and 13 March 1964. The judge ordered to send him “for an official psychiatric examination during which it will be determined whether Brodsky is suffering from some sort of psychological illness or not and whether this illness will prevent Brodsky from being sent to a distant locality for forced labor. Taking into consideration that from the history of his illness it is apparent that Brodsky has evaded hospitalization, it is hereby ordered that division No. 18 of the militia be in charge of bringing him to the official psychiatric examination.” On 18 February, the Dzerzhinsky District Court sent Brodsky for psychiatric examination to "Pryazhka," Psychiatric Hospital No. 2 where he spent about three weeks, from 18 February to 13 March. In the mental hospitals, Brodsky was given "tranquilizing" injections, wakened in the middle of the night, immersed into a cold bath, wrapped in a wet sheet, and put next to the heater so that the sheet would cut into his body when it dried. These two stints at psychiatric establishments formed the experience underlying Gorbunov and Gorchakov written and called by Brodsky "an extremely serious work." . In 1972, when the authorities considered Brodsky for exile and sought an expert opinion on his mental health, they consulted Snezhnevsky who, without examining him personally, diagnosed him as schizophrenic and concluded that he was "not valuable person at all and may be let go."

Valery Tarsis
In 1965 in the West, strong public awareness that Soviet psychiatry could be subject to political abuse arose with publication of the book Ward 7 by Valery Tarsis, a writer born in 1906 in Kiev. He based the book upon his own experiences in 1963–1964 when he was detained in the Moscow Kashchenko psychiatric hospital for political reasons.

The fictionalised documentary Ward No. 7 by Tarsis was a first literary work to deal with the Soviet authorities' abuse of psychiatry. In a parallel with the story Ward No. 6 by Anton Chekhov, Tarsis implies that it is the doctors who are mad, whereas the patients are completely sane, although unsuited to a life of slavery. Individuals in ward No. 7 are not cured, but persistently maimed; the hospital is a jail and the doctors are gaolers and police spies. Most doctors know nothing about psychiatry, but make diagnoses arbitrarily and give all patients the same medication — an algogenic injection or the anti-psychotic drug aminazin known in English as Thorazine. Tarsis denounces Soviet psychiatry as pseudo-science and charlatanism and writes that, firstly, it has pretenses of curing the sickness of men's souls, but denies the existence of the soul; secondly, since there is no satisfactory definition of mental health, there can be no acceptable definition of mental disease in Soviet society.

In 1966, Tarsis was permitted to emigrate to the West, and was soon deprived of his Soviet citizenship. As the 1966 memorandum to the Politburo of the Central Committee of the Communist Party of the Soviet Union reported, "KGB continues arrangements for further compromising Tarsis abroad as a mentally ill person."

Evgeni Belov
Shortly after publishing Ward 7, a second case of political abuse of psychiatry gave rise to attention in Great Britain. Evgeni Belov, a young Moscow interpreter contracted by a group of four British students, made friends with them. At first he was positive about Soviet system, but gradually became more critical and began to voice demand for more freedom. Calling for a free press and free trade unions, Belov began to write letters to the Party. As a consequence, his membership in the Party was suspended and he was summoned to appear before a committee. He declined, and instead sought justice higher up by writing protest letters to Leonid Brezhnev himself. When British students returned from a short trip to Tokyo, Belov had vanished. To their shock, it emerged that he had been committed to a mental hospital. A campaign to get him out yielded no results. A British newspaper published a letter in which Belov's father stated that his son was really sick, and the campaign came to a grinding halt. However, the public interest had been activated.

Alexander Esenin-Volpin
Awareness in the West was also raised by the case of Alexander Esenin-Volpin, a son of the famous Russian poet Sergei Esenin and born in 1924. In 1946, he was first committed to the Leningrad Special Psychiatric Hospital for writing a poem considered anti-Soviet. During Khrushchev's reign, Esenin-Volpin was later hospitalized three times: in 1957, in 1959–1960 in the same the Leningrad Special Psychiatric Hospital and, finally, in 1962–1963. In 1968, Esenin-Volpin was again hospitalized, and for this once his case achieved the attention in the West. In February 1968, 99 Soviet mathematicians and scientists signed a protest letter to the Soviet officials demanding his release. After a wave of protests, he was discharged and permitted to immigrate to the USA where he obtained the position of professor of mathematics. In 2010, Alexander Magalif, who hospitalized Esenin-Volpin, recollected that he had seen a little mark made by a pencil in the corner of the referral to treatment of Esenin-Volpin: "not to discharge from the hospital without coordination with KGB."

Yuli Daniel
In 1965, the writer Yuli Daniel was arrested due to his satirical anti-Stalinist works and outspoken protest at the human rights abuse in the USSR. Daniel was kept in a mental hospital of the Gulag where he was refused medical treatment in order to destroy his will.

Viktor Fainberg
Viktor Fainberg was one of the seven persons who demonstrated on Red Square in Moscow in 1968 against the intervention into Czechoslovakia. He was committed for compulsory treatment to the Special Psychiatric Hospital in Leningrad where he was confined for five years. During his confinement, a psychiatrist working in the establishment, Marina Voikhanskaya, fell in love with him and helped him as much as she could. After his discharge, they married and emigrated to the United Kingdom. When they had divorced, Viktor moved to Paris and Marina remained in the United Kingdom.

AGDHR members
In 1968, the human rights movement in the USSR focused directly on Soviet political psychiatry, organizing public protests and writing international bodies. In 1969, a group of about 14 activists including Sergei Kovalyov, a future Russian human rights ombudsman, constituted the Action Group for the Defence of Human Rights in the USSR. The group composed a first samizdat (self-published) human rights bulletin, the Chronicle of Current Events. Among the members of the Action Group were individuals who subsequently fell victim to psychiatric abuse themselves: the poetess Natalya Gorbanevskaya who in 1968 demonstrated on Red Square against bringing Soviet tanks into Czechoslovakia; Vladimir Borisov who later was one of the founders of the independent labor movement in the Soviet Union; Vladimir Maltsev, a translator; and Leonid Plyushch, a Ukrainian cyberneticist who was committed to the Special Psychiatric Hospital of Dnepropetrovsk and was awfully tortured with neuroleptics.

Valeria Novodvorskaya
In 1968, Valeria Novodvorskaya created an underground student organization whose purpose was to overthrow the Soviet state. On 5 December 1969, she was arrested in the Palace of Congresses, where before the start of a performance of the opera October she was handing out and scattering leaflets written in verse form until she was approached by KGB men. She was later sentenced to indefinite detention in the prison psychiatric hospital in Kazan. Her experience in this hospital was described in her largest collection of writings entitled Po Tu Storonu Otchayaniya (Beyond Despair). Novodvorskaya was also committed in mental hospital later, in 1978 as a member of the Free Interprofessional Association of Workers and in September 1990 as a person responsible "for insulting President"; at that time she was discharged after the 1991 putsch. In the early 1990s, psychiatrists of the Independent Psychiatric Association of Russia and G. N. Sotsevich proved the absence of mental illness in Novodvorskaya.

Natalya Gorbanevskaya
After the Red Square demonstration against the invasion into Czechoslovakia, August 1968 saw the arrest of Natalya Gorbanevskaya well known in the West due to her book Red Square at Noon describing the demonstration. A few days later, the Serbsky Institute found her non-accountable and made diagnosis of "deep psychopathy—the presence of mild, chronic schizophrenic process cannot be excluded." She was allowed to return to the care of her mother. In November 1969, a psychiatric commission again examined her, diagnosed "psychopathic personality with symptoms of hysteria and a tendency to decompensation", but considered that psychiatric hospitalization was not required. A month later, she was again arrested and sent to the Serbky Institute for psychiatric examination in April 1970. The investigating commission chaired by Morozov found her non-responsible and suffering from "chronic, mental illness in the form of schizophrenia." The commission found in her the presence of changes in the thinking processes and in the critical and emotional faculties characteristic of schizophrenia. It was concluded that Gorbanevskaya took part in the Red Square demonstration in a state of the mental disease.

Zhores Medvedev
On 29 May 1970, Zhores Medvedev, an internationally respected and prominent scientist, was forcibly taken from his apartment in Obninsk and committed to a mental hospital where he was held, without legitimate medical justification, until 17 June 1970. The leadership was instantly faced with the action of strong collective protest initiated by top Soviet scientists including Igor Tamm and Pyotr Kapitsa. Medvedev's release was achieved only after intense pressure from intellectuals and scientists both within and outside of the USSR. He was largely hospitalized because of the publication abroad of his book of Trofim Lysenko. In widely circulated books, Zhores Medvedev had criticized the "geneticist" Lysenko and had also expressed his straightforward disagreement with restrictions on communication with scientists abroad. He was removed from his position as head of a laboratory at the Institute of Medical Radiology and this removal was illegal, he said. The diagnosis in the case-notes was "incipient schizophrenia," the diagnosis made by the psychiatric commission was "psychopathic personality with paranoid tendencies." What happened to Medvedev was not a separate incident; rather, it was part, in Medvedev's words, of "the dangerous tendency of using psychiatry for political purposes, the exploitation of medicine in an alien role as a means of intimidation and punishment — a new and illegal way of isolating people for their views and convictions." This experience was reflected in Zhores Medvedev's and Roy Medvedev's book A Question of Madness: Repression by Psychiatry in the Soviet Union published by Macmillan in London in 1971.

Andrei Sakharov
In 1971, renowned Soviet physicist Andrei Sakharov supported a protest of two political prisoners, V. Fainberg and V. Borisov, who announced a hunger strike against "compulsory therapeutic treatment with medications injurious to mental activity" in a Leningrad psychiatric institution. In 1984, after publishing an article by Andrei Sakharov in the United States urging a buildup of nuclear weapons in the West, Soviet officials declared him "a talented, but sick man." When sent into internal exile to Gorky "for his own peace of mind," he received the due medical attention: "Soviet medics are taking all necessary measures to restore his health."

Viktor Nekipelov
Viktor Nekipelov, a well-known dissident poet, was arrested in 1973, sent to the Section 4 of the Serbsky Institute of Forensic Psychiatry for psychiatric evaluation, which lasted from 15 January to 12 March 1974, was judged sane (which he was), tried, and sentenced to two years' imprisonment. In 1976, he published in samizdat his book Institute of Fools: Notes on the Serbsky Institute based on his personal experience at Psychiatric Hospital of the Serbsky Institute  and translated into English in 1980. In this account, he wrote compassionately, engagingly, and observantly of the doctors and other patients; most of the latters were ordinary criminals feigning insanity in order to be sent to a mental hospital, because hospital was a "cushy number" as against prison camps. According to the President of the Independent Psychiatric Association of Russia Yuri Savenko, Nekipelov's book is a highly dramatic humane document, a fair story about the nest of Soviet punitive psychiatry, a mirror that psychiatrists always need to look into. However according to Malcolm Lader, this book as an indictment of the Serbsky Institute hardly rises above tittle-tattle and gossip, and Nekipelov destroys his own credibility by presenting no real evidence but invariably putting the most sinister connotation on events. After publishing his book, he was sentenced to the maximum punishment for "anti-Soviet agitation and propaganda" of seven years in a labor camp and then five years in internal exile.

AFTU members
In November 1977, a group of unemployed and workers led by Vladimir Klebanov, a former coalminer from the Donbas region of the Ukraine, announced the formation in the Soviet Union of the Association of Free Trade Unions of Workers (AFTU) whose purposes were to meet obligations achieved by collective bargaining; to induce workers and other employees to join free trade union associations; to implement those decisions of the Association which concern the seeking of justice and the defense of rights; to educate Association members in the spirit of irreconcilability toward wastefulness, inefficiency, deception, bureaucracy, deficiencies, and a negligent attitude toward national wealth. These purposes show that AFTU was in all respects an organization whose right to exist is guaranteed by the international obligations of the Soviet Union. On 19 December 1977, Klebanov along with two other workers in Donetsk was arrested by the Soviet militia and released nine days later, after international protests against his incarceration. Worker Gavriil Yankov was incarcerated in Moscow mental hospital for two weeks. On 1 February 1978, AFTU publicly announced the institution of its organizational Charter. Several days later, Klebanov was again detained by Soviet police and sent from Moscow to psychiatric prison hospital in Donetsk. Group member Nikolaev and workers Pelekh and Dvoretsky were also placed under psychiatric detention.

SMOT members
By October 1978 it was apparent that arrests and repressions had resulted in the dissolution of AFTU. But the cause of trade union rights was to be invigorated by a new group, the Free Interprofessional Association of Workers known by its Russian acronym, SMOT, whose first press conference was held in Moscow on 28 October 1978. The objectives of SMOT were to defend its members in cases of violation of their rights in different spheres of their daily activities: political, domestic, religious, spiritual, cultural, social, and economic; to look into the legal basis of the workers' complaints; to ensure that these complains were brought to the notice of relevant organizations; to facilitate a quick solution to complaints of workers; and in cases of negative results, to publicize them widely before international and Soviet public. The leadership of SMOT was headed by a native of Leningrad electrician Vladimir Borisov incarcerated in Soviet mental hospitals because of his human rights activism for a total of nine years in 1960s and 1970s. In November and December 1978, Soviet police searched the homes of SMOT activists, and SMOT members Vladimir Borisov, Valeriya Novodvorskaya, Albina Yakoreva, and Lev Volokhonsky were arrested and detained by Soviet authorities. Both Borisov and Novodvorskaya were held in mental hospitals.

Figures
At least 365 people were treated for "politically defined madness" in the Soviet Union, and there were surely hundreds more. On basis of the available data and materials accumulated in the archives of the International Association on the Political Use of Psychiatry, one can confidently conclude that thousands of dissenters were hospitalized for political reasons. From 1994 to 1995, an investigative commission of Moscow psychiatrists explored the records of five prison psychiatric hospitals in Russia and discovered about two thousand cases of political abuse of psychiatry in these hospitals alone. In 2005, Anatoly Prokopenko, referring to the Document Fund of the Central Committee of CPSU and the prison records of the three hospitals — Sychyovskaya, Leningrad and Chernyakhovsk hospitals — to which human rights activists managed to get in 1991, drew the conclusion that psychiatry had punished about twenty thousand people for purely political reasons. But this is only a little part, Prokopenko said, and the data on how many people in total had been in all of sixteen prison hospitals and in one and a half thousand open type psychiatric hospitals are inaccessible to us because the secret parts of the achieves of the prison psychiatric hospitals and hospitals overall are inaccessible. The figure of fifteen or twenty thousand political prisoners in psychiatric hospitals of the MVD of the USSR was presented in the book Bezumnaya Psikhiatriya (Mad Psychiatry) published by Prokopenko in 1997.

According to Viktor Luneyev, actual struggle against dissent was manyfold larger than it was registered in sentences, and we do not know how many persons were kept under surveillance of secret services, held criminally liable, arrested, sent to psychiatric hospitals, expelled from their work, restricted in their rights everyway. No objective counting of repressed persons is possible without fundamental analysis of archival documents. The difficulty of this method is that the required data are very diverse and are not in one archive. They are in the State Archive of the Russian Federation, in the archive of the Goskomstat of Russia, in the archives of the MVD of Russia, the FSB of Russia, the General Prosecutor's Office of the Russian Federation, in the Russian Military and Historical Archive, in archives of constituent entities of the Russian Federation, in urban and regional archives, as well as in archives of the former Soviet Republics that now are independent countries of the Commonwealth of Independent States and the Baltics.

Soviet psychiatric abuse exposed
In 1971, Vladimir Bukovsky smuggled to the West a file of 150 pages documenting the political abuse of psychiatry. The documents were photocopies of forensic reports on prominent Soviet dissidents. These documents were attended with a letter by Bukovsky requesting Western psychiatrists to explore the six cases documented in the file and tell whether these persons should be hospitalized or not. The documents were sent by Bukovsky to The Times and, when translated by The Working Group on the Internment of Dissenters in Medical Hospitals, were examined by forty-four psychiatrists from the Department of Psychiatry, Sheffield University. The psychiatrists described the documents in British Journal of Psychiatry of August 1971 and wrote a letter to The Times. In this letter published on 16 September 1971, they reported that four of the six dissidents manifested no signs or history of mental disease, and the other two had minor psychiatric problems many years ago, quite removed from the events related to their internment. The group of British psychiatrists concluded: "It seems to us that the diagnoses on the six people were made purely in consequence of actions in which they were exercising fundamental freedoms…" They recommended discussing the issue in the course of the forthcoming World Psychiatric Association (WPA) World Congress in Mexico in November 1971.

Congress in Mexico City
The Congress in Mexico City was held on November 28 — December 4, 1971. The statement of the forty-four British psychiatrists was circulated to the 7000 delegates in English, Spanish, and French. There were statements from the Soviet Human Rights Committee describing the part played by Snezhnevsky, a head of the Soviet delegation, in the Medvedev case. When speakers demanded that the Congress go on record against the confinement of dissidents in psychiatric hospitals, the Soviet delegation and Snezhnevsky instantly walked out. They said that they could not talk about the issue since the Congress lacked official interpretation into Russian. At this congress, Western psychiatrists tried to censure their Soviet colleagues for the first time. But the charges of psychiatric abuse were new, the campaign was disorganized, and Snezhnevsky, who headed the Soviet delegation, remained unscathed. He said in rebuttal that the accusations were a "cold-war maneuver carried out at the hands of experts." The WPA General Secretary Denis Leigh said that the WPA was under no obligation to accept complaints from one member society directed against another member society, and he informed Snezhnevsky of the complaints and sent him the "Bukovsky Papers." Leigh proposed to constitute a committee for considering the ethical aspects of psychiatric practice, but also in this instance the issue of political abuse of psychiatry in the USSR was not mentioned.

One of the key apologists of Soviet psychiatric abuse, Soviet psychiatrist Marat Vartanyan, was chosen as associate secretary of the Executive Committee. A day after the Mexico Congress Vartanyan announced publicly that the nature of Soviet system was such that this could not possibly happen. As Robert van Voren wrote, the Armenian Vartanyan was as slick as one could be, and had no problem lying in the twinkling of an eye. He was masterful in his dealings with the WPA and continued to represent the Soviet Union at symposiums and congresses of the WPA. Being in grain hospitable, flamboyant, full of humor and with a Western style, Vartanyan managed to fool one after another. In the end, no action was taken by the Congress. As Psychiatric News reported, it became apparent that the WPA leaders had no desire to take an action which would have alienated the USSR delegation and would quite probably make them "walk out" and sever communications for some time to come.

Bukovsky and Gluzman in prison
The failure to debate the issue opened the door for Soviet authorities to adjudge Bukovsky to 12 years of camp and exile, and to enlarge the use of psychiatry as a tool of repression. In January 1972, Bukovsky was convicted of spreading anti-Soviet propaganda under Article 70 of the RSFSR Criminal Code, mainly on the ground that he had, with anti-Soviet intention, circulated false reports that mentally healthy political dissenters were incarcerated in mental hospitals and were subjected to abuse there. In 1974, Bukovsky and the incarcerated psychiatrist Semyon Gluzman wrote A Manual on Psychiatry for Dissenters, in which they provided potential future victims of political psychiatry with instructions on how to behave during inquest in order to avoid being diagnosed as mentally sick. The Manual focuses on how "the Soviet use of psychiatry as a punitive means is based upon the deliberate interpretation of heterodoxy (in one sense of the world) as a psychiatric problem." Semyon Gluzman, a first psychiatrist in the Soviet Union who openly opposed Soviet abuse of psychiatry against dissenters, was one of three authors of the document An In Absentia Psychiatric Opinion on the Case of P.G. Grigorenko  otherwise known as An In Absentia Forensic-psychiatric Report on P.G. Grigorenko; this document started circulating in samizdat form in 1971   and was based on the medical record of Grigorenko  who spoke against the human rights abuses in the Soviet Union. Gluzman came to the conclusion that Grigorenko was mentally sane and had been taken to mental hospitals for political reasons. In the late 1970s and early 1980s, Gluzman was forced to serve seven years in labor camps and three years in Siberian exile for refusing to diagnose Grigorenko as having the mental illness.

In December 1976, in his eleventh year of psychiatric hospitals and prison camps, Bukovsky was exchanged by the Soviet government for the imprisoned Chilean Communist leader Luis Corvalán at Zürich airport and, after a short stay in the Netherlands, took up refuge in Great Britain where later moved from London to Cambridge for his studies in biology. Voluntary and involuntary emigration allowed the authorities to rid themselves of many political active intellectuals including writers Valentin Turchin, Georgi Vladimov, Vladimir Voinovich, Lev Kopelev, Vladimir Maximov, Naum Korzhavin, Vasily Aksyonov and others.

The appeal made by Bukovsky in 1971 caused the formation of the first groups to campaign against the political abuse of psychiatry in the Soviet Union. In France, a group of doctors constituted the "Committee against the Special Psychiatric Hospitals in the USSR," while in Great Britain a "Working Commission on the Internment of Dissenters in Mental Hospitals" was created. Among its founding members were Peter Reddaway, a Sovietologist and lecturer at the London School of Economics and Political Science, and Sidney Bloch, a South-African born psychiatrist. In September 1975, there was formed the "Campaign Against Psychiatric Abuse" (CAPA), an organization constituted as the British section of the Initiating Committee Against Abuses of Psychiatry for Political Purposes and composed of psychiatrists, other doctors, and laymen. In July 1976 in Trafalgar Square, CAPA held a rally against the abuse of psychiatry in the USSR. In 1978, Royal College of Psychiatrists established the Special Committee on abuse of psychiatry. 20 December 1980 saw the formation in Paris of the International Association on the Political Use of Psychiatry (IAPUP) whose first secretary was Gérard Bles of France.

Honolulu Congress
In 1975, the American Psychiatric Association agreed to host the WPA's sixth World Congress of Psychiatry during August 28 – September 3, 1977, in Honolulu. The request to discuss the Soviet issue during the World Congress of the World Psychiatric Association in Honolulu was made by Americans and the British and was supported by other societies.

On 10 September 1976, Chairman of the KGB Yuri Andropov submitted to the Central Committee of the Communist Party of the Soviet Union his report informing of "anti-Soviet campaign with nasty fabrications regarding the alleged use psychiatry in the USSR as an instrument in the political struggle with 'dissidents'." The report alleged that the campaign was a carefully planned anti-Soviet action in which a noticeable part was played by the British Royal College of Psychiatrists under the influence of pro-Zionist elements and that the KGB was undertaking measures through operational channels to counter hostile attacks. In October 1976, the Ministry of Health constituted a special working group to develop a plan of action for a counter campaign. The working group had among its members leading Soviet psychiatrists Andrei Snezhnevsky, Georgi Morozov, Marat Vartanyan, and Eduard Babayan under the chairmanship of Deputy Minister of Health Dmitri Venediktov. The plans they worked out consisted in, inter alia, compiling documents with counterarguments for being spread before and during the World Congress; actively lobbying the media for explaining the human nature of Soviet medicine; actively lobbying inside the World Psychiatric Association for preventing the issue from being put on the agenda; lobbying the World Health Organization for exerting pressure on the WPA not to allow this unacceptable anti-Soviet campaign; and establishing closer working relations with positively inclined colleagues in the West. In February 1977, representatives of the secret services of the USSR, the German Democratic Republic (GDR), Poland, Hungary, Czechoslovakia, Bulgaria, and Cuba met in Moscow to talk about a common approach to the issue of political abuse psychiatry and the upcoming World Congress in Honolulu. This meeting was mainly chaired by Major General Ivan Pavlovich Abramov, deputy head of the Fifth Directorate of the KGB (which dealt, inter alia, with dissenters), with the support of deputy head of the First Division of the Fifth Directorate Colonel Romanov who, according to the report, would travel with the Soviet delegation to Honolulu as "political advisor". The minutes of the meeting demonstrate that Western preparations for the Honolulu World Congress were under the Soviet concern in which the leading part was played by the KGB of the Soviet Union. Not long before the World Congress, a high-level conference was held in East Berlin, and the Soviet psychiatric leaders met with colleagues from Czechoslovakia, Poland, the GDR, Hungary, and Bulgaria to coordinate their positions. Much to the vexation of Georgi Morozov, the Romanians did not come to this meeting, while both the Hungarians and the Poles openly criticized the Soviet stance.

However, all this activity of the Soviets cold not prevent the issue from dominating the Congress from the very outset. At the fist plenary session of the Congress, the introduction of the Declaration of Hawaii  took place. This statement of ethical principles of psychiatry had been drafted by the Ethical Sub-Committee of the Executive Committee established in 1973 in response to the increasing number of protests against using psychiatry for non-medical reasons. One of the principles stated in the Declaration was that a psychiatrist must not take part in compulsory psychiatric treatment in the absence of mental disease, and the Declaration also included other clauses which could be considered as heaving a bearing on the political abuse psychiatry. The General Assembly accepted the Declaration of Hawaii without difficulty, and without opposition by the Delegation of the Soviets. However, the Declaration was later criticized by Hanfried Helmchen, who found its ethical guideline No 1 to be misleading and stated that when health, personal autonomy and growth—without referring to mental illness—are to be formulated as the direct aim of psychiatry, the menace of vast expansion of psychiatry will increase and that the renunciation of an illness concept appeared to be an essential source for the 'total psychiatrisation of everybody and everything' which was also deplored by Blomquist in his commentary. At the plenary session, an Ethics Committee was also established under the chairmanship of Costas Stephanis from Greece; among of the members was Marat Vartanyan from the USSR.

The Soviet issue passed the General Assembly less easily. The Soviets did all possible to prove their point, and according to the report of the Soviet delegation, Marat Vartanyan had successfully prevented former Soviet political prisoner Leonid Plyushch from being registered as a delegate at the Congress and "anti-Soviet materials" from being spread in the main congress hall. In 1977 at the World Congress in Honolulu, Snezhnevsky again defended psychiatric practices used in his country. Two motions were put to the vote, a British one condemning the systematic political abuse of psychiatry in the USSR and an American one calling on the World Psychiatric Association to constitute a Review Committee to investigate the allegations of political abuse of psychiatry. The British resolution passed with 90 to 88 votes and only because the Poles did not come and the Russians, having been tardy in their dues payments, were not allowed to cast all votes allocated to them.

On 31 August I977, the General Assembly of the World Psychiatric Association during its meeting in Honolulu for the VI World Congress of Psychiatry adopted the following resolution: "That the WPA take note of the Abuse of Psychiatry for political purposes and that it condemn those practices in all countries where they occur and call upon the professional organisations of psychiatrists in those countries to renounce and expunge those practices from their country and that the WPA implement this resolution in the first instance in reference to the extensive evidence of the systematic abuse of Psychiatry for political purposes in the USSR."

This resolution of the WPA is unprecedented in that it was the first time that an international professional association specifically condemned a great power. This resolution was the climax of a lengthy campaign in the West to expose the Soviet practice of committing some of its political and other dissenters to mental hospitals. The allegations, confirmed by some Soviet psychiatrists who had fled or emigrated to the West, induced the World Psychiatric Association to condemn the USSR for the "systematic abuse of psychiatry for political purposes." Kremlin spokesmen ignored the action as a provocation "by a handful of antipsychiatric and antisocial elements" and began a propaganda campaign to contradict the accusations. The American resolution requesting to set up a Review Committee received a larger majority of votes, 121 votes against 66. Snezhnevsky returned to Moscow wounded, with members of his delegation putting the blame for their defeat on the "Zionists."

1978 saw a public statement made by Soviet psychiatrist Yuri Novikov, who was the head of a section of the Serbsky Institute for six years and first secretary of the Association of Soviet Psychiatrists until he left the Soviet Union in June 1977. In his statement, he said that political abuses of psychiatry took place in the Soviet Union and that it was not the scale of this that mattered, but the fact that it existed.

Review Committee
In December 1978, the Review Committee was set up under the chairmanship of Canadian psychiatrist Jean-Yves Gosselin and, in August 1979, received the first complaints submitted by the British Royal College of Psychiatrists. From the very first day, the Soviets refused to recognize its existence. Originally they attempted to prevent its establishment, maintaining that it would divert the WPA from its major function, namely the exchange of scientific ideas. When the Review Committee was constituted, the Soviet society asserted overtly that they would not collaborate with the Review Committee, and they confirmed their stance in three letters, in which they claimed that the Review Committee was an "illegal formation," that it would continue not to acknowledge its existence and that no cooperation could be expected. That stance would remain unaltered over the years to come. Finally, the Review Committee was largely made powerless when the President and General Secretary of the WPA decided to bypass it and began to communicate with the Soviets directly.

However, later, at the General Assembly during the World Congress in Vienna in 1983, the status and work of the Review Committee were discussed and it was resolved to allow the Committee to become statutory. The General Assembly resolved further to change the Committee scope towards complaints about not only political but any abuse of psychiatry. As it was emphasized, the WPA is not a human rights organization and the Review Committee should only examine complaints about specific acts of abuse carried out by specific psychiatrists against specific persons. The 1999 General Assembly modified the mandate of the Review Committee as follows: "The Review Committee shall review complaints and other issues and initiate investigations on the violations of the ethical guidelines for the practice of psychiatry as stated in the Declaration of Madrid and its additional guidelines in order to make recommendations to the Executive Committee as to any possible action."

Working Commission to Investigate the Use of Psychiatry For Political Purposes
In January 1977, Alexandr Podrabinek along with a 47 year-old self-educated worker Feliks Serebrov, a 30 year-old computer programmer Vyacheslav Bakhmin and Irina Kuplun established the Working Commission to Investigate the Use of Psychiatry for Political Purposes. The Commission was formally linked to the Moscow Helsinki Group founded by Yuri Orlov along with ten others including Elena Bonner and Anatoly Shcharansky in 1976 to monitor Soviet compliance with the human rights provisions of the Helsinki Accords. The commission was composed of five open members and several anonymous ones, including a few psychiatrists who, at great danger to themselves, conducted their own independent examinations of cases of alleged psychiatric abuse. The leader of the commission was Alexandr Podrabinek who published a book Punitive Medicine containing a "white list" of two hundred of prisoners of conscience in Soviet mental hospitals and a "black list" of over one hundred medical staff and doctors who took part in committing people to psychiatric facilities for political reasons.

The psychiatric consultants to the Commission were Alexander Voloshanovich and Anatoly Koryagin. The task stated by the Commission was not primarily to diagnose persons or to declare people who sought help mentally ill or mentally healthy. However, in some instances individuals who came for help to the Commission were examined by a psychiatrist who provided help to the Commission and made a precise diagnosis of their mental condition. At first it was psychiatrist Alexander Voloshanovich from the Moscow suburb of Dolgoprudny, who made these diagnoses. But when he had been compelled to emigrate on 7 February 1980, his work was continued by the Kharkov psychiatrist Anatoly Koryagin. Koryagin's contribution was to examine former and potential victims of political abuse of psychiatry by writing psychiatric diagnoses in which he deduced that the individual was not suffering from any mental disease. Those reports were employed as a means of defense: if the individual was picked up again and committed to mental hospital, the Commission had vindication that the hospitalization served non-medical purposes. Also some foreign psychiatrists including the Swedish psychiatrist Harald Blomberg and British psychiatrist Gery Low-Beer helped in examining former or potential victims of psychiatric abuse. The Commission used those reports in its work and publicly referred to them when it was essential.

The commission gathered as much information as possible of victims of psychiatric terror in the Soviet Union and published this information in their Information Bulletins. For the four years of its existence, the Commission published more than 1,500 pages of documentation including 22 Information Bulletins in which over 400 cases of the political abuse of psychiatry were documented in great detail. Summaries of the Information Bulletins were published in the key samizdat publication, the Chronicle of Current Events. The Information Bulletins were sent to the Soviet officials, with request to verify the data and notify the Commission if mistakes were found, and to the West, where human rights defenders used them in the course of their campaigns. The Information Bulletins were also used to provide the dissident movement with information about Western protests against the political abuse. Peter Reddaway said that after he had studied official documents in the Soviet archives, including minutes from meetings of the Politburo of the Central Committee of the Communist Party of the Soviet Union, it became evident to him that Soviet officials at high levels paid close attention to foreign responses to these cases, and if someone was discharged, all dissidents felt the pressure had played a significant part and the more foreign pressure the better. Over fifty victims examined by psychiatrists of the Moscow Working Commission between 1977 and 1981 and the files smuggled to the West by Vladimir Bukovsky in 1971 were the material which convinced most psychiatric associations that there was distinctly something wrong in the USSR.

The Soviet authorities responded aggressively. Members of the group were being threatened, followed, subjected to house searches and interrogations. In the end, the members of the Commission were subjected to various terms and types of punishments: Alexander Podrabinek was sentenced to 5 years' internal exile, Irina Grivnina to 5 years' internal exile, Vyacheslav Bakhmin to 3 years in a labor camp, Leonard Ternovsky to 3 years' labor camp, Anatoly Koryagin to 8 years' imprisonment and labor camp and 4 years' internal exile, Alexander Voloshanovich was sent to voluntary exile. In the autumn of 1978, the British Royal College of Psychiatrists carried a resolution in which it reiterated its concern over the abuse of psychiatry for the suppression of dissent in the USSR and applauded the Soviet citizens, who had taken an open stance against such abuse, by expressing its admiration and support especially for Semyon Gluzman, Alexander Podrabinek, Alexander Voloshanovich, and Vladimir Moskalkov.

Resolutions for expulsion or suspension
On 12 August 1982, in preparation for the World Congress in Vienna, the American Psychiatric Association sent out to all member societies of the World Psychiatric Association a memorandum announcing their intention to organize a forum for discussing the issue of Soviet psychiatric abuse prior to the General Assembly in Vienna. On 18 January 1983, the Ambassador of the Soviet Union to the German Democratic Republic (GDR), Gorald Gorinovich, delivered a message from the Central Committee of the Communist Party of the Soviet Union to the Central Committee of the Socialist Unity Party of Germany in which it said that the abnormal situation which had developed within the World Psychiatric Association put in effect its whole activity in question and that for this reason, All-Union Society took the decision to withdraw from the WPA. On 22 January 1983, the British Medical Journal published a letter by Allan Wynn, the chairman of the Working Group on the Internment of Dissenters in Mental Hospitals, reporting that in consequence of the continued abuse of psychiatry in the Soviet Union the American, British, French, Danish, Norwegian, Swiss, and Australasian member societies of the World Psychiatric Association with the support indicated by many of its other members proposed resolutions for the expulsion or suspension of membership of the Soviet Society of Neurologists and Psychiatrists, which would be considered at the World Congress of the World Psychiatric Association in Vienna in July 1983. On 31 January 1983, the All-Union Society officially resigned from the World Psychiatric Association under threat of expulsion. In their letter of resignation, the Soviets complained about a "slanderous campaign, blatantly political in nature… directed against Soviet psychiatry in the spirit of the 'cold war' against the Soviet Union" and, being especially angry about the memorandum of the American Psychiatric Association of August 1982, charged the WPA leadership with complicity by not having spoken out against this mailing.

According reports on hearing before the Subcommittee on Human Rights and International Organizations of the Committee on Foreign Affairs and the Commission on Security and Cooperation in Europe on 20 September 1983, the national associations justly held the opinion that 10 years of mild public protests, quiet diplomacy, and private conversations with Soviet official psychiatrists had produced no significant change in the level of Soviet abuses, and that this approach had, thereby, failed. In January 1983, the number of member associations of the World Psychiatry Association, voting for the suspension or expulsion of the Soviet Union, rose to nine. Inasmuch as these associations would have half the votes in the WPA governing body, the Soviets was now, in January, almost sure to be voted out in July.

According the statement made by the chairman of the APA Committee on International Abuse of Psychiatry and Psychiatrists Harold Vysotsky at the hearing, the Committee on behalf of certain persons had written hundreds of letters to the USSR, including those to authorities of the Soviet Government, to patients themselves, the families of patients, the psychiatrists who were treating these patients, but only indirectly heard from the families of patients and had never received a response from the authorities. In the statement, he mentioned that 20 cases were referred over to the World Psychiatric Association for further investigation by their committee to review alleged abuses of psychiatry for political purposes and a number of these cases were sent to the All Union Society of Neuropathologists and Psychiatrists of the USSR for clarification and response, but when months and months went by and the World Psychiatric Association had received no response from Soviet colleagues, the American Psychiatric Association and a number of other psychiatric associations across the world carried a resolution which stated: "If the All-Union Society of Psychiatrists and Neuropathologists of the USSR does not adequately respond to all enquiries from the World Psychiatric Association regarding the issue of psychiatric abuse in that country by April 1, 1983, that the All-Union Society should be suspended from membership in the World Psychiatric Association until such time that these abuses cease to exist."

Vienna Congress
The Seventh World Congress of the WPA was scheduled to meet on July 10 – 16, 1983, at Vienna where heated discussion and a close vote on the resolutions were anticipated. The General Assembly of the World Psychiatric Association in Vienna was likely one of the most tense and disorganized meetings in its existence. Some delegates, especially those from Israel, Mexico, Egypt, Cuba, and the GDR angrily appealed to the WPA Executive Committee not to accept the resignation of the Soviets, whereas others voiced the view that it was a fact of life one had to live with, an opinion supported by the WPA President Pierre Pichot. The debate was preceded by a discussion of various resolutions which had been submitted, but the state of affairs was so perplexing that some delegates did not even know which resolution they were asked to vote upon. Finally a resolution drafted by the British delegate Kenneth Rawnsley, who served as the fourth president of the Royal College of Psychiatrists from 1981 to 1984, was carried by 174 votes to 18, with 27 abstentions. The resolution was strikingly conciliatory in tone: "The World Psychiatric Association would welcome the return of the All-Union Society of Neuropathologists and Psychiatrists of the USSR to membership of the Association, but would expect sincere co-operation and concrete evidence beforehand of amelioration of the political abuse psychiatry in the Soviet Union."

Releases
The freedoms of the Gorbachev period diminished the human rights movement because many of their decades-long concerns such as suppression of free expression, imprisonment of dissidents, and psychiatric abuse were no longer the main problems facing Soviet society. 1986 saw the discharge of nineteen political prisoners from mental hospitals. In 1987, sixty-four political prisoners were discharged from mental hospitals. In early 1988, Chief Psychiatrist Aleksandr Churkin stated in an interview with Corriere della Sera issued on 5 April 1988 that 5.5 million Soviet citizens were on the psychiatric register and that within two years 30% would be removed from this list. However, a year later the journal Ogoniok published a figure of 10.2 million provided by the state statistics committee. In 1990, Zhurnal Nevropatologii i Psikhiatrii Imeni S S Korsakova published almost the same figure of 10 million people registered at psychoneurological dispensaries and 335,200 hospital beds used in the Soviet Union by 1987. At a press conference held in Moscow on 27 October 1989, Gennady Milyokhin claimed that of the three hundred patients named by international human rights organizations, "practically all had left hospital."

Visit of the US delegation
In 1989, the stonewalling of Soviet psychiatry was overcome by perestroika and glasnost (meaning "policy of transparency" in High Russian). Over the objection of the psychiatric establishment, the Soviet government permitted a delegation of psychiatrists from the USA, representing the United States government, to carry out extensive interviews of suspected victims of abuse. They traveled to the Soviet Union on 25 February 1989. The group consisted of about 25 people among whom were Bill Farrand of the State Department; Loren Roth as head of the psychiatric team; psychiatrists of the National Institute of Mental Health, including Scientific Director of the US Delegation Darrel A. Regier, Harold Visotsky from Chicago as head of the hospital visit team, and four émigré Soviet psychiatrists living in the United States. There also were State Department interpreters, two attorneys, Ellen Mercer of the American Psychiatric Association and Peter Reddaway.

The delegation was able systematically to interview and assess present and past involuntarily admitted mental patients chosen by the visiting team, as well as to talk over procedures and methods of treatment with some of the patients, their friends, relatives and, sometimes, their treating psychiatrists. Whereas the delegation originally sought interviews with 48 persons, it eventually saw 15 hospitalized and 12 discharged patients. About half of the hospitalized patients were released in the two months between the submission of the initial list of names to the Soviets authorities and the departure from the Soviet Union of the US delegation. The delegation came to the conclusion that nine of the 15 hospitalized patients had disorders which would be classified in the United States as serious psychoses, diagnoses corresponding broadly with those used by the Soviet psychiatrists. One of the hospitalized patients had been diagnosed as having schizophrenia although the US team saw no evidence of mental disorder. Among the 12 discharged patients examined, the US delegation found that nine had no evidence of any current or past mental disorder; the remaining three had comparatively slight symptoms which would not usually warrant involuntary commitment in Western countries. According to medical record, all these patients had diagnoses of psychopathology or schizophrenia.

When returned home after a visit of more than two weeks, the delegation wrote its report which was pretty damaging to the Soviet authorities. The delegation established not only that there had taken place systematic political abuse of psychiatry but also that the abuse had not come to an end, that victims of the abuse still remained in mental hospitals, and that the Soviet authorities and particularly the Soviet Society of Psychiatrists and Neuropathologists still denied that psychiatry had been employed as a method of repression. The report was published in Schizophrenia Bulletin, Supplement to Vol. 15, No. 4, 1989. As far as Robert van Voren could establish, the report was never published in the USSR. Only after twenty years, in 2009, the report was traslated into Russian, and its Russian version was published not in Russia but in Netherlands, on the website of the Global Initiative on Psychiatry.

Athens Congress
In the months prior to the Eighth World Psychiatric Assembly in Athens, there was substantial dispute about the possible readmittance of the All-Union Society to the WPA. The Eighth World Congress of the World Psychiatric Association was held between 12 and 19 October 1989 in Athens. The Congress was reminiscent of the previous World Congress in 1983 in Vienna, and the one before that in 1977 in Honolulu. The issue of the Soviet political abuse of psychiatry raised its ugly head, and dominated the WPA proceedings.

On 16 October, the Soviet delegation convened a press conference. The panel was uniformly evasive and defensive. After a detailed and lengthy account by Karpov of Soviet psychiatric reforms in which he emphasized the specialities of the new mental health legislation and in particular the legal safeguards for patients, other panellists worked out on what they considered as positive aspects of the new developments. However then, abruptly, this sense of optimism was disrupted by the bluntest of questions posed by Anatoly Koryagin: Had political psychiatric abuse occurred or not? Alexander Tiganov, who played a prominent part in the press conference, answered hesitatingly that "such cases" could have taken place during the period of stagnation "but there was a need to distinguish between psychiatric, legal and political aspects." Koryagin persevered with his challenge and countered that these answers failed to clarify whether an acknowledgment was being made that Soviet psychiatry had been misused for political reasons.

Koryagin stated that readmission would offer carte blanche to the KGB to continue its repressive practices, that there would be further abuse of psychiatry, and that the plight of prisoners would be hopeless. He proposed four conditions for readmission:
 * 1) Soviet psychiatrists must acknowledge previous political abuses and reject them;
 * 2) all detainees must be released;
 * 3) participation in monitoring of future practice must be obligatory;
 * 4) and representatives of the World Psychiatric Association must be permitted to function freely on Soviet territory.

Several national associations, including the Royal College of Psychiatrists, the Australasian College, the Swiss Psychiatric Association, and the West German Psychiatric Association insisted that the Soviet Society should not be admitted until specific conditions had been satisfied; these included the release of all dissidents unjustifiably detained in psychiatric hospitals, and the dissociation by the authorities from the past abuse and their obligation to prevent its repetition.

The Soviet delegation to the 1989 World Congress of the WPA in Athens eventually agreed to admit that the systematic abuse of psychiatry for political purposes had indeed taken place in their country. At the Congress, the Soviet Society's International Secretary Pyotr Morozov on behalf of his delegation made a statement containing the following five points, which are quoted in full: "# The All-Union Society of Psychiatrists and Narcologists publicly acknowledges that previous political conditions created an environment in which psychiatric abuse occurred for non-medical, including political, reasons.
 * 1) Victims of abuse shall have their cases reviewed within the USSR and also in cooperation with the WPA, and the registry shall not be used against psychiatric patients.
 * 2) The All-Union Society unconditionally accepts the WPA review instrument.
 * 3) The All-Union Society supports the changes in the Soviet law with full implementation relevant to the practice of psychiatry and the treatment and protection of the rights of the mentally ill.
 * 4) The All-Union Society encourages an enlightened leadership in the psychiatric professional community."

Felice Lieh Mak, just chosen as President-Elect, proposed a resolution which included the statement read by Morozov, and then adding that within one year the Review Committee should visit the Soviet Union and that if evidence of continued political abuse of psychiatry were to be found, a special meeting of the General Assembly should be convoked to give consideration to suspension of membership of the Soviets. In the end, 291 votes were cast for the resolution, 45 against, with 19 abstentions. The Soviets were readmitted to the WPA under conditions and on the ground of having made a public confession of the existence of previous psychiatric abuse and having given a commitment to review any present or subsequent cases and to sustain and introduce reforms to the psychiatric system and new mental health legislation.

Deeply shocked, Anatoly Koryagin, who had considered the statement by the Soviets as completely hypocritical and insincere and had not thought that the Soviets would be permitted to return, officially renounced his Honorary Membership of the WPA by submitting on 8 November 1989 to the WPA General Secretary a short letter: "On 17th October 1989 the All Union Society of Psychiatrists and Narcologists of the USSR, which counts among its members criminal psychiatrists, guilty of psychiatric abuses for political purposes, was readmitted to the World Psychiatric Association. As I do not wish to be a member of an organization together with that kind of persons, I renounce the honorary membership of the World Psychiatric Association, which I held since 1983."

The Soviet delegates returned to Moscow jubilantly. In an interview with a Soviet television crew, Marat Vartanyan replied to the question whether any conditions had been set to a Soviet return: "No, that is wrong information, which you received from somewhere. There were no conditions. We set the conditions. That is, we proposed… eh… the Executive Committee of the WPA to come to us on an official visit to the Soviet Union within a year."

The next day, the government newspaper Izvestiya carried a report on 19 October which did not mention any of the conditions while asserting that the All Union Society had been granted full membership. The dissemination of disinformation on the part of the Soviets had distinctly not yet come to an end. Only on 27 October 1989, Meditsinskaya Gazeta reported the conditions set by the WPA General Assembly.

Establishing the IPA
In 1989, the Independent Psychiatric Association of Russia (IPA) was created as an association publicly opposing itself to official Soviet psychiatry and its offspring, the All-Union Society of Neuropathologists and Psychiatrists, which was completely under the control of the Soviet government and implemented its political principles. From the very beginning the IPA and its President Yuri Savenko had to take on human rights functions in addition to educational ones: first, it was necessary to uncover the ideological basis on which the Soviet psychiatry carried out its punitive activities; second, it was necessary to develop legal norms which would forever prevent such abuses; third, it was necessary to show that it is not society that needs to be protected from the mentally ill, but the ill need to be protected from society as a whole, not only from the authorities; fourth, it was necessary to overcome rigidity and inhumane nature of modern domestic psychiatry detached from its old roots and, at the same time, artificially isolated from Western humanistic trends.

Visit of the WPA delegation
The WPA team spent three weeks in the Soviet Union, from 9 to 29 June 1991, and saw ten cases, all of which had been diagnosed by Soviet psychiatrists as having schizophrenia. When reviewed case notes and the results of their own interviews, the WPA team confirmed the diagnosis of schizophrenia only in one case and reported that there was still a wide gap between Soviet criteria for the diagnosis of schizophrenia and those used internationally in other countries. Of the six individuals committed to a Special Psychiatric Hospital, four of the cases were distinctly of a political nature and of these four, three had never been mentally sick.

In a letter sent in 1991 to Aleksandr Tiganov, the new chairman of the All Union Society (or, the now called themselves, the Federation of Societies of Psychiatrists and Narcologists of the Commonwealth of Independent States), the WPA General Secretary Juan José Lopez Ibor wrote that the All Union Society made in the General Assembly a Statement that included five items, several of which was not yet fulfilled, and that thereby, the Executive Committee unanimously agreed that it would not recommend continuing membership of the society in June 1993. Less than two months after the visit of the team to the Soviet Union, a coup against Mikhail Gorbachev was carried out. The coup failed and was followed by the dissolution of the USSR. As a consequence, the All Union Society remained without a country to represent. The USSR Federation of Psychiatrists and Narcologists officially resigned from the World Psychiatric Association in October 1992.

Russian Mental Health Law
In Russia, the enactment of its Mental Health Law took place under dramatic circumstances despite the need for the Law because of 80 year delay, after which the Law passed by Russia beside all developed countries, and despite dimensions of political abuse of psychiatry which were unprecedented in history and were being persistently denied for two decades from 1968 to 1988. When Soviet rule was coming to an end, the decision to develop the Mental Health Law was taken from above and under the threat of economic sanctions from the United States. At a meeting held by the Health Committee of the Supreme Soviet of the USSR in the autumn of 1991, the Law was approved, particularly in the speeches by the four members of the WPA commission, but this event was followed by the dissolution of the Soviet Union. In 1992, a new commission was created under the Supreme Soviet of the Russian Federation and used a new concept of developing the Law; a quarter of the commission members were the representatives of the IPA. The Law has been put in force since 1 January 1993. Adoption of the Law On Psychiatric Care and Guarantees of Citizens’ Rights during Its Provision is regarded as an epoch-making event in the history of domestic psychiatry, as establishing the legal basis for psychiatric care, and, first of all, mediating all involuntary measures through judicial procedure. That is a main post-Soviet achievement of Russian psychiatry and the foundation for a basically new attitude to the mentally ill as persons reserving all their civil and political rights and freedoms. In 1993, when the IPA printed the Law in 50 thousand copies for general reader, quite a number of heads of the Moscow psychoneurologic dispensaries refused to circulate the Law. Over time, these difficulties were overcome. It became obligatory to know the Law to pass the certification exam.

However, article 38, which was once included in the Law as a guarantee of keeping the whole Law for patients of psychiatric hospitals, is still not working, and, as a result, the service independent of health authorities to defend rights of patients in psychiatric hospitals is still not created. According to a report of the European Committee against Torture, the Law does not reflect patient's right to obtain a court decision of involuntary hospitalization. In a hospital courtroom, its judge announces the decision, but the patient does not obtain any motivated decision. There are sometimes cases where the patient is not informed by the court at all and hears about the court decision from his or her treating doctor or head of the unit.

In 2004, proponents of mental health reform could hardly prevent the effort by the doctors of the Serbsky Institute for Social and Forensic Psychiatry to roll back some reforms in Russia's landmark 1992 law on mental health. Over five years, from 1998 to 2003, the Serbsky Center made three attempts to submit to Duma readings amendments and additions to the Law, but the IPA and general public managed to successfully challenge these amendments, and they were finally laid on the table.

Analysis
In 1990, Psychiatric Bulletin of the Royal College of Psychiatrists published the article Compulsion in psychiatry: blessing or curse? by the Russian psychiatrist Anatoly Koryagin. It contains analysis of the abuse of psychiatry and eight arguments by which the existence of a system of political abuse of psychiatry in the USSR cаn easily be demonstrated. As Koryagin wrote, in a dictatorial State with a totalitarian regime, such as the USSR, the laws have at all times served not the purpose of self-regulation of the life of society but have been one of the major levers by which to manipulate the behavior of subjects. Every Soviet citizen has constantly been straight considered state property and been regarded not as the aim, but as a means to achieve the rulers' objectives. From the perspective of state pragmatism, a mentally sick person was regarded as a burden to society, using up the state's material means without recompense and not producing anything, and even potentially capable of inflicting harm. Therefore, the Soviet State never considered it reasonable to pass special legislative acts protecting the material and legal part of the patients' life. It was only instructions of the legal and medical departments that stipulated certain rules of handling the mentally sick and imposing different sanctions on them. A person with a mental disorder was automatically divested of all rights and depended entirely on the psychiatrists' will. Practically anybody could undergo psychiatric examination on the most senseless grounds and the issued diagnosis turned him into a person without rights. It was this lack of legal rights and guarantees that advantaged a system of repressive psychiatry in the country.

According to O.V. Lapshin, Russia until 1993 did not have any specific legislation in the field of mental health except uncoordinated instructions and articles of laws in criminal and administrative law, orders of the USSR Ministry of Health. In the Soviet Union, any psychiatric patient could be hospitalized by request of his headman, relatives or instructions of a district psychiatrist. In this case, patient’s consent or dissent mattered nothing. The duration of treatment in a psychiatric hospital also depended entirely on the psychiatrist. All that made the abuse of psychiatry possible to suppress those, who disagreed with the political regime, and that created the vicious practice of ignoring the rights of the mentally ill.

According to Yuri Savenko, the president of the Independent Psychiatric Association of Russia (the IPA), punitive psychiatry arises on the basis of the interference of three main factors: Their interaction system is principally sociological: the presence of the Penal Code article on slandering the state system inevitably results in sending a certain percentage of citizens to forensic psychiatric examination. Thus, it is not psychiatry itself that is punitive, but the totalitarian state uses psychiatry for punitive purposes with ease.
 * 1) ideologizing of science, its breakaway from the achievements of world psychiatry;
 * 2) lack of legal basis;
 * 3) the total nationalization of mental health service.

According to Larry Gostin, the root cause of the problem was the State itself. The definition of danger was radically extended by the Soviet criminal system to cover 'political' as well as customary physical types of 'danger'.

According to Semyon Gluzman, abuse of psychiatry to suppress dissent is based on condition of psychiatry in a totalitarian state. Psychiatric paradigm of a totalitarian state is culpable for its expansion into spheres which are not initially those of psychiatric competence.

Richard Bonnie, a professor of law and medicine at the University of Virginia School of Law, mentioned the deformed nature of the Soviet psychiatric profession as one of the explanations for why it was so easily bent toward the repressive objectives of the state, and pointed out the importance of a civil society and, in particular, independent professional organizations separate and apart from the state as one of the most substantial lessons from the period.

According to Moscow psychiatrist Alexander Danilin, the so-called "nosological" approach in the Moscow psychiatric school established by A.V. Snezhnevsky boiles down to the ability to make an only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept "sluggish schizophrenia" introduced some time once by Andrei Vladimirovich Snezhnevsky, academician, whom Danilin called a political offender.

St Petersburg academic psychiatrist Yuri Nuller notes that the concept of Snezhnevsky's school allows, for example, to consider schizoid psychopathy or schizoidism as the early, sluggishly progressing stages of an inevitable progredient process rather than the personality characteristics of an individual, which may not develop along the path of schizophrenic process at all. That results in the extreme expansion of diagnosing sluggish schizophrenia and the harm it has done. Nuller adds that within the scope of the sluggish schizophrenia concept, any deviation from the norm evaluated by a doctor can be regarded as schizophrenia, with all the ensuing consequences for an examinee. That creates ample opportunity for voluntary and involuntary abuses of psychiatry. However, neither A.V. Snezhnevsky nor his followers, according to Nuller, found civil and scientific courage to review their concept that clearly reached a deadlock.

In 1977, British psychiatrist David Cooper asked Michel Foucault the same question which Claude Bourdet had formerly asked Viktor Fainberg during a press conference given by Fainberg and Plyushch: when the USSR has the whole penitentiary and police apparatus, which could take charge of anybody, and which is perfect in itself, why do they use psychiatry? Foucault answered it was not a question of a distortion of the use of psychiatry but that was its fundamental project.

K. Fulford, A. Smirnov, and E. Snow state: “An important vulnerability factor, therefore, for the abuse of psychiatry, is the subjective nature of the observations on which psychiatric diagnosis currently depends.” According to American psychiatrist Thomas Szasz, these authors, who correctly emphasize the value-laden nature of psychiatric diagnoses and the subjective character of psychiatric classifications, fail to accept the role of psychiatric power. Musicologists, drama critics, art historians, and many other scholars also create their own subjective classifications; however, lacking state-legitimated power over persons, their classifications do not lead to anyone’s being deprived of property, liberty, or life. For instance, plastic surgeon’s classification of beauty is subjective, but the plastic surgeon cannot treat his or her patient without the patient’s consent, therefore, there cannot be any political abuse of plastic surgery. The bedrock of political medicine is coercion masquerading as medical treatment. What transforms coercion into therapy are physicians diagnosing the person’s condition a “illness,” declaring the intervention they impose on the victim a “treatment,” and legislators and judges legitimating these categorizations as “illnesses” and “treatments.” In the same way, physician-eugenicists advocated killing certain disabled or ill persons as a form of treatment for both society and patient long before the Nazis came to power. Szasz argued that the spectacle of the Western psychiatrists loudly condemning Soviet colleagues for their abuse of professional standards was largely an exercise in hypocrisy. According to Szasz, the problem, from which psychiatric abuse stems, is psychiatric power that is just as prevalent in democratic societies as it was in the USSR. He stated that psychiatric abuse, such as people usually associated with practices in the former USSR, was connected not with the misuse of psychiatric diagnoses, but with the political power built-in to the social role of the psychiatrist in democratic and totalitarian societies alike. In a 1994 article Szasz stated that “the classification by slave owners and slave traders of certain individuals as Negroes was scientific, in the sense that whites were rarely classified as blacks. But that did not prevent the 'abuse' of such racial classification, because (what we call) its abuse was, in fact, its use.” The collaboration between psychiatry and government leads to what Szasz calls the “therapeutic state”, a system in which disapproved actions, thoughts, and emotions are repressed ("cured") through pseudomedical interventions. Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured. According to Szasz, “the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion.”

Residual problems
Robert van Voren noted that after the fall of the Berlin Wall, it became apparent that the political abuse of psychiatry in the USSR was only the tip of the iceberg, the sign that much more was basically wrong. This much more realistic image of Soviet psychiatry showed up only after the Soviet regime began to loosen its grip on society and later lost control over the developments and in the end entirely disintegrated. It demonstrated that the actual situation was much sorer and that many individuals had been affected. Millions of individuals were treated and stigmatized by an outdated biologically oriented and hospital-based mental health service. Living conditions in clinics were bad, sometimes even terrible, and violations of human rights were rampant.

According to Robert van Voren, although for several years, especially after the implosion of the USSR and during the first years of Boris Yeltsin's rule, the positions of the Soviet psychiatric leaders were in jeopardy, now one can firmly conclude that they succeeded in riding out the storm and retaining their powerful positions. In addition, they also succeeded in avoiding an inflow of modern concepts of delivering mental health care and a fundamental change in the structure of psychiatric services in Russia. On the whole, in Russia, the impact of mental health reformers has been the least. Even the reform efforts made in such places as St. Petersburg, Tomsk, and Kaliningrad have faltered or were encapsulated as centrist policies under Vladimir Putin brought them back under control.

At his press conference in 2008, Semyon Gluzman said that the surplus in Ukraine of hospitals for inpatient treatment of the mentally ill was a relic of the totalitarian communist regime and that Ukraine did not have epidemic of schizophrenia but somehow Ukraine had about 90 large psychiatric hospitals including the Pavlov Hospital where beds only in its children's unit were more than in the whole of Great Britain.

In 1994, there was organized a conference concerned with the theme of political abuse of psychiatry and attended by representatives from different former Soviet Republics — from Russia, Belarus, the Baltics, the Caucasus, and some of the Central Asian Republics. Dainius Puras made a report on the situation within the Lithuanian Psychiatric Association, where discussion had been held but no resolution had been passed. Yuri Nuller talked over how in Russia the wind direction was gradually changing and the systematic political abuse of psychiatry was again being denied and degraded as an issue of "hyperdiagnosis" or "scientific disagreement." It was particularly noteworthy that Tatyana Dmitrieva, the Director of the Serbsky Institute, was an active adherent of this view. This was not so queer, because she was a close friend of the key architects of "political psychiatry."

In the early 1990s, Tatyana Dmitrieva, the Director of the Serbsky Center, brought the required words of repentance for political abuse of psychiatry which had had unprecedented dimensions in the Soviet Union for discrediting, intimidation and suppression of the human rights movement carried out primarily in this institution. Her words were widely broadcasted abroad but were limitedly published in the St. Petersburg newspaper Chas Pik within the country. However, in her 2001 book Aliyans Prava i Milosediya (The Alliance of Law and Mercy), Dmitrieva wrote that there were no abuses in psychiatry and if there were those, they were no more than in the vaunted Western countries. Moreover, the mentioned book by Dmitrieva administers to the old and new national intellectuals the rebuke that professor Vladimir Serbsky and others were wrong not to cooperate with the police department because otherwise there would have been neither revolution nor bloodshed and that the current intellectuals are wrong to oppose the authorities.

While speaking of the Serbsky Center, Yuri Savenko alleges that “practically nothing has changed. They have no shame at the institute about their role with the Communists. They are the same people, and they do not want to apologize for all their actions in the past.” Attorney Karen Nersisyan agrees: “Serbsky is not an organ of medicine. It’s an organ of power.”

In 2004, Savenko stated that the passed law on state expert activity and introduction of profession of forensic expert psychiatrist actually destroyed adversary-based examinations and that the Serbsky Center turned into a complete monopolist of forensic examination, which it had never been under Soviet rule. Formerly, a court could include any psychiatrist in a commission of experts, but now the court only chooses an expert institution. An expert has the right to participate only in commissions, in which he is included by the head of his expert institution, and can receive the certificate of qualification as an expert only after having worked in a state expert institution for three years. The Director of the Serbsky Center Dmitrieva was, at the same time, the head of the forensic psychiatry department which is only one in the country and is located in her Center. No one had ever had such a monopolism.

According to Savenko, the Serbsky Center has long labored to legalize its monopolistic position of the Main expert institution of the country. It turned out to be a considerable drop in the level of its expert reports. Such a drop was inevitable and foreseeable in the context of the Serbsky Center efforts to eliminate adversary character of the expert reports of the parties and then to maximally degrade the role of a professional as a reviewer and critic of a presented expert report.

On 28 May 2009, Yuri Savenko wrote to the President of the Russian Federation Dmitry Medvedev an open letter, in which Savenko asked Medvedev to submit to the State Duma a draft law prepared by the Independent Psychiatric Association of Russia to address a sharp drop in the level of forensic psychiatric examinations, which Savenko attributed to a lack of competition within the sector and its increasing nationalization. The open letter says that the level of the expert reports has dropped to such an extent that it is often a matter of not only the absence of entire sections of a report, even such as the substantiation of its findings, and not only the gross contradiction of its findings to the descriptive section of the report, but it is often a matter of concrete statements which are so contrary to generally accepted scientific terms that doubts about the disinterestedness of the experts arise. According to the letter, courts, in violation of procedural rules, do not analyze expert report, its coherence and consistency in all its parts, do not check experts’ findings for their accuracy, completeness, and objectivity.

On 15 June 2009, the working group chaired by the Director of the Serbsky Center Tatyana Dmitrieva sent the Supreme Court of the Russian Federation a joint application whose purport was to declare appealing against the forensic expert reports of state expert institutions illegal and prohibit courts from receiving lawsuits filed to appeal against the reports. The reason put forward for the proposal was that appeals against expert reports are allegedly filed “without regard for the scope of case” and that one must appeal against an expert report “only together with a sentence.” In other words, according to Yuri Savenko, all professional errors and omissions are presented as untouchable by virtue of the fact that they were infiltrated into the sentence. That is cynicism of administrative resources, cynicism of power, he says.

The draft of the application to the Supreme Court of the Russian Federation was considered in the paper “Current legal issues relevant to forensic-psychiatric expert evaluation” by Elena Shchukina and Sergei Shishkov focusing on the inadmissibility of appealing against an expert report without regard for the scope of evaluated case. While talking about appealing against “reports”, the authors of the paper, according to lawyer Dmitry Bartenev, mistakenly identify reports with actions of experts (or an expert institution) and justify the impossibility of “parallel” examination and evaluation of actions of experts without regard for the scope of evaluated case. Such a point of view taken by the authors appears clearly erroneous because abuse by experts of rights and legitimate interests of citizens including trial participants, of course, may be a subject for a separate appeal.

In 2010, when the outpatient forensic-psychiatric examination of Yulia Privedyonnaya, a member of a youth organization, was carried out in the Sebsky Center, its experts asked her the question “What do you think of Putin?” that Savenko called an inappropriate, unseemly, indelicate, and police one.

Memoirs
The widely known sources including published and written memoirs of victims of psychiatric arbitrariness convey moral and physical sufferings experienced by victims of psychiatric arbitrariness in special psychiatric hospitals of the USSR. In 1965, Valery Tarsis published in the West his book Ward 7: An Autobiographical Novel based upon his own experiences in 1963–1964 when he was detained in the Moscow Kashchenko psychiatric hospital for political reasons. The book was a first literary work to deal with the Soviet authorities' abuse of psychiatry. In 1968, the Russian poet Joseph Brodsky wrote Gorbunov and Gorchakov, a forty-page long poem in thirteen cantos consisting of lengthy conversations between two patients in a Soviet psychiatric prison as well as between each of them separately and the interrogating psychiatrists. The topics vary from the taste of the cabbage served for supper to the meaning of life and Russia's destiny. The poem was translated into English by Harry Thomas. The experience underlying Gorbunov and Gorchakov was formed by two stints of Brodsky at psychiatric establishments. In 1970, the book Red Square at Noon by Natalya Gorbanevskaya was published in Russian and English. Some parts of the book describe special psychiatric hospitals and psychiatric examinations of dissidents. In 1971, Zhores Medvedev and Roy Medvedev published their joint book A Question of Madness: Repression by Psychiatry in the Soviet Union describing the hospitalization of Zhores Medvedev for political purposes and the Soviet practice of diagnosing political oppositionists as the mentally ill. In 1976, Viktor Nekipelov published in samizdat his book Institute of Fools: Notes on the Serbsky Institute documenting his personal experience at Psychiatric Hospital of the Serbsky Institute. In 1980, the book was translated and published in English. Only in 2005, the book was published in Russia. In 1977, British playwright Tom Stoppard wrote the play Every Good Boy Deserves Favour that criticized the Soviet practice of treating political dissidence as a form of mental illness. The play is dedicated to Viktor Fainberg and Vladimir Bukovsky, two Soviet dissidents expelled to the West. In 1978, the book To Build a Castle: My Life as a Dissenter by Vladimir Bukovsky, describing dissident movement, their struggle or freedom, practices of dealing with dissenters, and dozen years spent by Bukovsky in Soviet labor camps, prisons and psychiatric hospitals, was published and later translated into English. In 1979, Leonid Plyushch published his book History's Carnival: A Dissident's Autobiography in which he described how he and other dissidents were committed to psychiatric hospitals. At the same year, the book was translated into English. In 1981, Pyotr Grigorenko published his memoirs V Podpolye Mozhno Vstretit Tolko Krys (In Underground One Can Meet Only Rats) that included story of his psychiatric examinations and hospitalizations. In 1982, the book was translated into English under the title Memoirs. In 1983, Yevgeniy Nikolaev’s book Predavshie Gippokrata (The betrayal of Hippocrates), when translated from Russian into German under the title Gehirnwäsche in Moskau, was first published in München and told about psychiatric detention of its author for political reasons. In 1984, the book under its original title was first published in Russian that the book had originally been written in. In the 1983 novel Firefox Down by Craig Thomas, captured American pilot Mitchell Gant is imprisoned in a KGB psychiatric clinic "associated with the Serbsky Institute", where he is drugged and interrogated to force him to reveal the location of the Firefox aircraft, which he has stolen and flown out of Russia. In 1987, Robert van Voren published his book Koryagin: A man Struggling for Human Dignity telling about psychiatrist Anatoly Koryagin who resisted political abuse of psychiatry in the Soviet Union. In 1988, Reportazh iz Niotkuda (Reportage from Nowhere) by Viktor Rafalsky was published. In the publication, he described his confinement in Soviet psychiatric hospitals. In 1993, Valeria Novodvorskaya published her collection of writings Po Tu Storonu Otchayaniya (Beyond Despair) in which her experience in the prison psychiatric hospital in Kazan was described. In 1996, Vladimir Bukovsky published his book Judgement in Moscow containing an account of developing the punitive psychiatry based on documents that were being submitted to and considered by the Politburo of the Central Committee of the Communist Party of the Soviet Union. The book was translated into English in 1999. In 2001, Nikolay Kupriyanov published his book GULAG-2-SN which has the foreword by Anatoly Sobchak, covers repressive psychiatry in Soviet Army, and tells about humiliations Kupriyanov underwent in the psychiatric departments of the Northern Fleet hospital and the Kirov Military Medical Academy. In 2002, St. Petersburg forensic psychiatrist Vladimir Pshizov published his book Sindrom Zamknutogo Prostranstva (Syndrome of Closed Space) describing hospitalization of Viktor Fainberg. 2003 saw the book Moyа Sudba i Borba protiv Psikhiatrov (My Destiny and Struggle against Psychiatrists) by Anatoly Serov who worked as a lead design engineer before he was committed to a psychiatric hospital. In 2010, Alexander Shatravka published his book Pobeg iz Raya (The Escape from Paradise) in which he described how he and his companions were caught after they illegally crossed the border between Finland and the Soviet Union to escape from the latter country and, as a result, were confined to Soviet psychiatric hospitals and prisons. In his book, he also described methods of brutal treatment of prisoners in the institutions.

The use of psychiatry for political purposes in the USSR was discussed in two television documentaries: They Chose Freedom produced by Vladimir V. Kara-Murza in 2005 and Prison Psychiatry produced by Anatoly Yaroshevsky of NTV in the same year.

Documents
From 1987 to 1991, the International Association on the Political Use of Psychiatry published forty-two numbers of Documents on the Political Abuse of Psychiatry in the USSR archived by the Columbia University Libraries in archival collection Human Rights Watch Records: Helsinki Watch, 1952–2003, Series VII: Chris Panico Files, 1979–1992, USSR, Psychiatry, International Association on the Political Use of Psychiatry, Box 16, Folder 5–8 (English version) and Box 16, Folder 9–11 (Russian version). A number of various documents and reports were published in Information Bulletins by the Working Commission to Investigate the Use of Psychiatry For Political Purposes, Chronicle of Current Events by the Moscow Helsinki Group and in the books Punitive Medicine by Alexandr Podrabinek, Bezumnaya Psikhiatriya (Mad Psychiatry) by Anatoly Prokopenko, Judgement in Moscow by Vladimir Bukovsky, Sovietskaya Psikhiatriya—Zabluzhdeniya i Umysel (Soviet Psychiatry: Fallacies and Intent) by Ada Korotenko and Natalia Alikina, and Kaznimye Sumashestviem (The Executed by Madness).

According to the Commentary on the Russian Federation Law on Psychiatric Care, persons, who were subjected to repressions in form of commitment for compulsory treatment to psychiatric medical institutions and were rehabilitated in accordance with the established procedure, receive indemnity payment; thereby the Russian Federation acknowledged the facts of the use of psychiatry for political purposes and the responsibility of the state to the victims of “political psychiatry.”