New Internationalist

Taking Liberties

Issue 132

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MENTAL HEALTH [image, unknown] Human rights

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Taking liberties
One of the fundamental principles of a just society is that a person
is innocent until proven guilty. But it’s a rule that is not applied to the
mentally ill, in the West or the Soviet Union. Report by Larry Gostin.

Soviet dissident is arrested. His crime: distributing anti-government literature. A psychiatrist testifies that the dissident is ‘unfit to plead’ due to mental illness. The result: the dissident is put away without trial in a maximum security mental hospital for an indefinite period.

A Westerner hearing this chilling scenario will quickly come to the conclusion that the dissident’s human rights are being cynically violated. The Soviet psychiatrist will seem to be colluding with the political authorities, using a false charge of mental illness - usually ‘sluggish’ schizophrenia - to silence a voice that is not mad but politically embarrasing. The ‘crime’, after all, is not a crime in the West. And the charge of mental illness deprives the accused of the opportunity to speak in his defence. The final blow is that, because he is ‘sick’, he can be detained indefinitely under the implicit assumption that he is being treated. This means that his ‘sentence’, unlike that of an ordinary criminal, does not end until his psychiatrist judges him cured.

There have been successive motions of no confidence in the Soviet psychiatry profession within the World Psychiatric Association. And Kremlin-watchers can reel off a string of names like Griorenko, Gorbanevshaya, Bukovsky, Plushch, Gluzman and Sharansky, who have achieved folk hero status on the Western side of the political divide as subjects of psychiatric victimisation.

But how fair is this sinister view of Soviet psychiatry? And how far removed are these practices from what goes on in the West? The questions must be asked, not for the purpose of excusing Soviet psychiatry, but to ensure that such practices are not allowed to proliferate here through ignorance and complacency.

Because the psychiatrist is used as society’s jailer in the West as well as in the East. Every year government figures show that certain prisoners due to be released from prison are simply transferred to a secure hospital to be detained indefinitely - because the authorities don’t want them released. The prisoners are often admitted by psychiatrists as suffering from ‘psychopathic disorder’ - a mental disorder which is, conveniently, neither observable nor treatable (see box).

And in the UK people who are epileptic or hypertensive can be declared legally insane and detained in mental hospital because they might be dangerous. This is a gross violation of human rights: the legal system would never detain an ordinary person just in case they might commit a crime. Why should mentally ill people be a special case?

Crime and punishment

[image, unknown] . 1¼ million doses of mood - altering drugs were dispensed to a UK prison population of 43,000 in 1981. In Holloway prison each inmate received an average of’ three doses a day in 1979.

. At least half of the US’s 1.7 million mental hospital inmates were admitted under protest

. Half of people prescribed psychoactive drugs in the UK arc reluctant to take them.

. Brixton prison in the UK houses 700 people waiting for trial and 100 on short sentences. In 1981 an average of 229 doses of’ psychoactive drugs per prisoner were dispensed: the vast majority to people yet to be judged either insane or guilty.

. Most studies show that ex mental patients are less likely to commit crimes. One survey in New York found ex mental patients’ crime rate to be just one-fourteenth of the crime rate of the general population.

There is a broader sense, too, in which the Western psychiatrist is used to jail those whom society prefers to exclude. S/he houses thousands of mentally ill, mentally handicapped and other homeless people in large asylums, not because that is the best solution for the people in his or her care, but because the community will not tolerate deviance from its social norms. We also jail those who are a potential threat to society and should be in prison - people like sexual psychopaths, for example. whom psychiatrists do not know how to cure.

Nobody can blame the psychiatrist, for the policy is not of his or her making. But s/he remains the compliant agent of that policy. And is this really any different from the Soviet psychiatrist’s situation?

Nonetheless, psychiatrists in the East and West remain confident that they exist only to tend the ill. They believe their activities do not have social or political implications. They are simply caring for people in deep emotional distress. And they operate,they assert, via objective assessment and value-free scientific principles.

But classical psychiatry is not value free at all. On the contrary, it is based upon whole systems of prejudice about the nature of human behaviour and how it can be explained. Virtually every psychiatrist born and trained in the Soviet Union, for instance, honestly believes that mental illness, under certain circumstances, can cause political deviance. And virtually every Western psychiatrist would be prepared to say that mental disorder can result in social deviance, but not in political deviance. Mental illness is itself such an ephemeral and variable subject that it is much more liable to be interpreted according to the prevailing ideology.

In the Soviet Union the legal system and psychiatric profession are in broad agreement about what constitutes crime and deviance. And a parallel general agreement exists between Western legal and psychiatric institutions. All social institutions, I would suggest, are basically moulded by the culture which gave rise to them. And those beliefsystems are too deeply embedded to be separated from what the legal and psychiatric institutions like to see as value-free ‘facts’.

So non-conformity with Soviet culture and beliefs may genuinely suggest to a psychiatrist an overinflated concept of ‘self and a resulting diagnosis of ‘sluggish schizophrenia’. Whereas, in the West, a strong, positive view of the ‘self is considered healthy, and the term ‘sluggish schizophrenia’ severely criticized. Sluggish schizophrenia is a mental illness which ‘may be accompanied by externally correct behaviour and dissimulation’. And Western psychiatrists are suspicious of such a diagnosis, arguing that there can be no illness without overt symptoms. But consider the category ‘psychopath’. Under the Scottish Mental Health Act this is ‘mental illness which is manifested only by abnormally aggressive or seriously irresponsible conduct’. In England and Wales too, the psychopath is defined in exactly the same terms. A psychopath so defined need not even be ‘treatable’ in order to be compulsorily detained. But who defines the dividing line between ‘normal’ and ‘abnormal’ aggression? Who decides, and by what criteria, whether a person is socially irresponsible? So the use of detention in a mental hospital on either side of the political divide is not necessarily based on observable symptoms.

The law relating to mentally ill offenders in the Soviet Union is similar to the law in the UK. Both operate a kind of Catch 22 against the mentally ill: because of their illness they cannot be given an actual prison sentence, yet - also because of their illness - they can be detained in hospital indefinitely without a fair trial. But the Soviet law, if anything, safeguards the liberty of the offender better. At least the patient detainee must be examined at least every six months by a psychiatric commission and a decision made by a court on the need for continued detention. In England and Wales the patient has to wait a year and then only has access to a tribunal. And the length of detention in Soviet special hospitals tends to be considerably less than in the UK.

I have attempted to highlight the considerable similarities in Soviet and Western psychiatry. Despite all this - perhaps because I am a Western commentator and subject to the cultural perceptions of the West - I still believe that the implications of the abuse of psychiatry remain far more sinister in the Soviet Union. Nonetheless, attention must be drawn to the parallels that exist. It is dangerously complacent to criticise practices in the Soviet Union whilst ignoring the possibility that similar abuses can and do occur here.

Larry Gostin, former Legal Director of MIND and researcher
at Oxford University’s Centre for Criminological Research, is now
General Secretary of UK-based civil rights action group,
the National Councilfor Civil Liberties.

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Leonid’s Story

Leonid, a Ukrainian cyberneticist, was arrested in 1972, charged with ‘anti - Soviet agitation and propaganda’ and confined to the Dnepropetrovsk Special Psychiatric Hospital for three years. The doctors at the hospital began to treat him with a drug called Haloperidol (Haldol or Serenace in the West, usually administered to people suffering from psychosis) a month after his arrival and when, two months later, his wife visited him she found him in the following condition:

‘It was impossible to recognise him. His eyes were full of pain and misery, lie spoke with difficulty and brokenly, frequently leaning on the back of his chair for support From time to time he closed his eyes, in the effort to answer questions. Then he began to gasp, to awkwardly unbutton his clothing. His face convulsed and he got cramp in his hands and legs.

After the visit she asked her husband’s psychiatrist why he was being treated with Haloperidol. The doctor replied: ‘We give him whatever is necessary.

A month after this Leonid’s state had further deteriorated. He was incapable of writing letters and asked his wife to stop sending him scientific books since he was no longer capable of reading them. She again approached his psychiatrist, asking why her husband had not at least been given medication to counteract the negative effects of the Halopericiol. The psychiatrist replied that she would divulge nothing - neither of the diagnosis or the treatment.

Four months after this the doctors ceased giving Leonid Haloperidol and instead began administering insulin in large doses. At a meeting with his wife he was, she said, unrecognisable: ‘Great dropsical swelling had occurred: he moved with difficulty; his eyes had lost their liveliness.’

Nine months later they began to administer large doses of Triftazin (another anti-psychotic drug. called Trifluoperazin in die West). Then after another two months they stopped giving him drugs and his physical condition improved considerably. Throughout this whole period Leonid was under constant pressure from his psychiatrists to renounce his political views.

Edited excerpt from Amnesty International’s Book Prisoners of Conscience in the USSR.

Robert’s Story

Robert was convicted of indecent assault on another man. When he appeared in court he was diagnosed as suffering from psycho - pathic disorders by two doctors and the court authorised his detention in Broadmoor - a secure mental hospital in the UK.

While still in Broadmoor Robert was one of five patients to take pan in an experimental treatment programme involving sex hormone implants. The treatment is designed to curb abnormal sexual desires with an anti-male hormone drug, Androcur. taken daily in pill form or implanted in pellet form in buttock or abdomen. Robert had it implanted in his abdomen every three months for two years and "‘as shown pornographic films of young boys every six weeks to test whether lie was still sexually aroused.

As another part of the treatment Robert had an operation on his breast to prevent h becoming enlarged. But as an experiment the operation "‘as only done on the right breast. The left breast consequently continued to grow until it became as large as a woman’s breast and very painful. And he then had to endure the ridicule of other patients and members of staff. He and two other patiently eventually had to have the enlarged breast removed altogether.

The Department of Health and Social Security was questioned about this. They assert that Robert and the other patients were fully informed about and agreed to the treatment programme. But Robert himself claims he was told that if he accepted the treatment and it was successful he would be released within two years. But his mother states that the reason the doctors gave for his continued detention and for the hormone treatment is that he still has homosexual relations with fellow patients. But homosexual relations with consenting adults in private is legal.

Robert was eventually detained under maximum security conditions for ten years - the equivalent of a 15-year prison sentence - for an offence where he caused no physical injury at all. And since he went to hospital instead of prison the medical authorities were able to impose upon him an apparently experimental treatment programme with tragic consequences.

Edited excerpt from MIND's report:
A Human Condition
, by Larry Gostin.


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