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?
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