Psychaitry and Control

Contents
Political abuse of psychiatry
1.1
By country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.1
Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.2
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.3
Cuba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.4
India
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.5
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.6
Nazi Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.7
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.8
Romania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.9
Russia
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.10 South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.11 Soviet Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.12 United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.2
Psychiatric reprisals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.3
See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.4
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.5
External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Political abuse of psychiatry in the Soviet Union
10
2.1
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
2.2
Joint Session
13
2.3
Sluggish schizophrenia
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
2.4
Political trend toward mass abuse onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
2.5
Examination and hospitalization
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
2.6
Struggle against abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
2.7
Classication of the victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
2.8
Incomplete gures estimated due to some archival documents . . . . . . . . . . . . . . . . . . . . . .
18
2.9
Theoretical analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.10 Residual problems
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i
25
ii
CONTENTS
2.11 Documents and memoirs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
2.12 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
2.13 References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
2.14 Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
2.15 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
Struggle against political abuse of psychiatry in the Soviet Union
61
3.1
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
3.2
Soviet psychiatric abuse exposed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
3.3
Congress in Mexico City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
65
3.4
First responses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
66
3.5
Honolulu Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
67
3.6
UN Principles for the Protection of Persons with Mental Illness . . . . . . . . . . . . . . . . . . . . .
68
3.7
Review Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
68
3.8
Working Commission to Investigate the Use of Psychiatry For Political Purposes . . . . . . . . . . . .
69
3.9
Resolutions for expulsion or suspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
70
3.10 Vienna Congress
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
71
3.11 Releases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
71
3.12 Visit of the US delegation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
72
3.13 Establishing the IPA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
3.14 Athens Congress
3.15 Visit of the WPA delegation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76
3.16 Russian Mental Health Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76
3.17 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
77
3.18 References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
77
3.19 Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
82
3.20 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
91
Anti-psychiatry
98
4.1
99
4.2
History
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.1
Precursors
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.2
Early 1900s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
4.1.3
1940s and 1950s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
4.1.4
1960s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
4.1.5
Since 1970 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Challenges to psychiatry
99
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.2.1
Civilization as a cause of distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.2.2
Evolution research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.2.3
Normality and illness judgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
CONTENTS
iii
4.2.4
Psychiatric labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.2.5
Tool of social control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
4.2.6
Psychiatry and the pharmaceutical industry
4.2.7
Electroconvulsive therapy
4.2.8
Political abuse of psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
4.2.9
Therapeutic State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
. . . . . . . . . . . . . . . . . . . . . . . . . . . 109
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
4.2.10 Total Institution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

4.3
Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
4.3.1
Involuntary hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
4.4
Psychiatry as pseudoscience and failed enterprise
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
4.5
Diverse paths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
4.6
See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
4.7
References
4.8
Works cited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
4.9
Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4.10 External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

5
Antipsychology
5.1
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Biopsychiatry controversy
126
6.1
Overview of opposition to biopsychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.2
Research issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.3
6.2.1
Current status in biopsychiatric research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.2.2
Focus on genetic factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
6.2.3
Focus on biochemical factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
6.2.4
Reductionism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Economic inuences on psychiatric practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

6.3.1
6.4
6.5
6.6
7
125
Pharmaceutical industry inuence on the psychiatric profession . . . . . . . . . . . . . . . . . 128
See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

6.4.1
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
6.4.2
Groups critical of the biomedical paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

6.5.1
Criticisms from psychologists & the medical profession . . . . . . . . . . . . . . . . . . . . . 129
6.5.2
Methodological issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Against Therapy
7.1
132
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
iv
CONTENTS
7.2
Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
7.3
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
7.4
External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Outline of the psychiatric survivors movement

8.1
What is the psychiatric survivors movement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
8.2
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
8.2.1
8.3
8.4
8.6
8.7
People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
8.4.1
8.5
Supporters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
History of the psychiatric survivors movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

8.3.1
Pharmaceutical industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8.5.1
Psychiatric services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8.5.2
Public agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8.5.3
Legal framework for psychiatric treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Organisations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8.6.1
Advocacy groups, by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8.6.2
Self-help groups
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Related movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

8.7.1
133
Anti-psychiatry movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
8.8
See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
8.9
External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
The Protest Psychosis
139
9.1
See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
9.2
References
9.3
External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
10 Sluggish schizophrenia
142
10.1 Development of theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

10.2 Use against political dissidents
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
10.3 Premises for using the diagnosis
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.4 Popularity of diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

10.5 Systematics by Snezhnevsky
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
10.5.1 Conditions posed as symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

10.6 Recognizing method, treatment and study
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
10.7 Western criticism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

10.8 Recurrence in post-Soviet Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
CONTENTS
10.9 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

10.10References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
10.11Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
10.12Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
11 Drapetomania
11.1 Etymology
156
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
11.2 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

11.2.1 Prevention and remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
11.2.2 Contemporary criticism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
11.3 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
11.4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
11.5 Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
11.6 External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
12 Bullying in medicine
160
12.1 Underlying psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

12.2 Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
12.3 Bullying of medical students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
12.4 Bullying of junior (trainee) physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
12.5 Bullying cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
12.6 Bullying in psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
12.7 Doctors bullying/abusing patients and nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
12.8 Bullying in nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
12.9 In popular culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
12.10See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
12.11References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
12.12Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
12.13External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
13 Bullying in nursing
167
13.1 Bullying acts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

13.2 Incivility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.3 Bullying of nurses by managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.4 Nurse bullying inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.5 Associated terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.6 Remedial action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.7 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
vi
CONTENTS
13.9 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
13.9.1 Books . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
13.9.2 Academic papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
13.9.3 Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
14 List of medical ethics cases
172
14.1 Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

14.2 Controversies relating to termination of mechanical ventilation and life support . . . . . . . . . . . . . 172
14.3 Person wishes for assisted suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
14.4 Person wishes for euthanasia for another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
14.5 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
15 Workplace safety in healthcare settings
174
15.1 Aggression in the healthcare industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

15.2 Classication models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
15.3 Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
15.4 Coping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
15.4.1 Assertiveness training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
15.4.2 Evaluating the eectiveness of training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
15.5 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
15.6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
16 Psychiatric survivors movement
16.1 History
180
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
16.1.1 Precursors
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
16.1.2 Early 20th century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

16.1.3 1950s to 1970s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
16.1.4 1980s and 1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
16.2 The movement today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
16.3 Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
16.4 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
16.5 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
16.6 External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
17 Liberation by Oppression
188
17.1 Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

17.2 Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
17.3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
18 Double bind
189
CONTENTS
vii
18.1 Explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

18.2 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
18.3 Complexity in communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
18.4 Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
18.5 Phrase examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
18.6 Positive double binds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
18.7 Theory of logical types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
18.8 Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
18.9 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
18.10In evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
18.11Usage in Zen Buddhism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
18.12Girard's mimetic double bind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
18.13Neuro-linguistic programming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
18.14See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
18.15Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
18.16References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
18.17External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
18.18Text and image sources, contributors, and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
18.18.1 Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
18.18.2 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
18.18.3 Content license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Chapter 1

Political abuse of psychiatry is the misuse of psychiatry, including diagnosis, detention, and treatment for the purposes
of obstructing the fundamental human rights of certain groups and individuals in a society.* [1]* [2]* :491 In other words,
abuse of psychiatry including one for political purposes is deliberate action of getting citizens certied, who, because of
their mental condition, need neither psychiatric restraint nor psychiatric treatment.* [3] Psychiatrists have been involved
in human rights abuses in states across the world when the denitions of mental disease were expanded to include political
disobedience.* [4]* :6 As scholars have long argued, governmental and medical institutions code menaces to authority as
mental diseases during political disturbances.* [5]* :14 Nowadays, in many countries, political prisoners are sometimes
conned and abused in mental institutions.* [6]* :3 Psychiatric connement of sane people is a particularly pernicious
form of repression.* [7]
Psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine.* [8]* :65 The diagnosis of
mental disease allows the state to hold persons against their will and insist upon therapy in their interest and in the broader
interests of society.* [8]* :65 In addition, receiving a psychiatric diagnosis can in itself be regarded as oppressive.* [9]* :94 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.* [8]* :65 The use of hospitals instead
of jails prevents the victims from receiving legal aid before the courts, makes indenite incarceration possible, discredits
the individuals and their ideas.* [10]* :29 In that manner, whenever open trials are undesirable, they are avoided.* [10]* :29
Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history
and seen during the Nazi era and the Soviet rule when political dissenters were labeled as mentally illand subjected
to inhumane treatments.* [11] In the period from the 1960s up to 1986, abuse of psychiatry for political purposes
was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania,
Hungary, Czechoslovakia, and Yugoslavia.* [8]* :66 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.* [12] Political abuse of psychiatry also takes place in the People's
Republic of China.* [1] Psychiatric diagnoses such as the diagnosis of sluggish schizophreniain political dissidents in
the USSR were used for political purposes.* [13]* :77
1.1 By country
1.1.1
Canada
The Duplessis Orphans were several thousand orphaned children that were falsely certied as mentally ill by the government of the province of Quebec, Canada, and conned to psychiatric institutions.
Dr Donald Ewen Cameron's operation was running from what is today known as the Allen Memorial Institute (AMI),
part of the Royal Victoria Hospital, and not to be confused with the non-governmental organization based in Montreal,
AMI-Qubec Agir contre la maladie mentale.
1
1.1.2
CHAPTER 1. POLITICAL ABUSE OF PSYCHIATRY
China
In 2002, Human Rights Watch published the book Dangerous Minds: Political Psychiatry in China Today and its Origins
in the Mao Era written by Robin Munro and based on the documents obtained by him.* [14]* [15] The British researcher
Robin Munro, a sinologist who was writing his dissertation in London after a long sojourn in China, had traveled to China
several times to survey libraries in provincial towns and had gathered a large amount of literature which bore the stamp
secretbut at the same time was openly available.* [16]* :242 This literature included even historical analyses going back
to the days of the Cultural Revolution and concerned articles and reports on the number of people who were taken to
mental hospitals because they complained of a series of issues.* [16]* :242 It was found, according to Munro, that the
involuntary connement of religious groups, political dissidents, and whistleblowers had a lengthy history in China.* [17]
The abuse had begun in the 1950s and 1960s, and had grown extremely throughout the Cultural Revolution.* [16]* :242
During the period of the Cultural Revolution, from 1966 to 1976, it achieved its apogee, then under the reign of Mao
Zedong and the Gang of Four, which established a very repressive and harsh regime.* [17] No deviance or opposition in
thought or in practice was tolerated.* [17]
The documents told of a massive abuse of psychiatry for political purposes during the leadership of Mao Zedong, during
which millions of people had been declared mentally sick.* [16]* :242 In the 1980s, according to the ocial documents,
there was political connotation to fteen percent of all forensic psychiatric cases.* [16]* :242 In the early 1990s, the numbers had dropped to ve percent, but with beginning of the campaign against Falun Gong, the percentage had again
increased quite rapidly.* [16]* :242
Chinese ocial psychiatric literature testies distinctly that the Communist Party's notion of political dangerousness
was long since institutionally engrafted in the diagnostic armory of China's psychiatry and included in the main concept
of psychiatric dangerousness.* [14]* :4
The Peoples Republic of China is the only country which appears to abuse psychiatry for political purposes in a systematic way, and despite international criticism, this seems to be continuing.* [1] Political abuse of psychiatry in the
Peoples Republic of China is high on the agenda and has produced recurring disputes in the international psychiatric
community.* [1] The abuses there appear to be even more widespread than in the Soviet Union in the 1970s and 1980s
and involve the incarceration ofpetitioners, human rights workers, trade union activists, followers of the Falun Gong
movement, and people complaining against injustices by local authorities.* [1]
It also seemed that, China had hardly known high security forensic institutions until 1989.* [16]* :243 However, since then,
the Chinese authorities have constructed the entire network of special forensic mental hospitals called Ankang which in
Chinese is forPeace and Health.* [16]* :243 By that time, China had had 20 Ankang institutions with the sta employed
by the Ministry of State Security.* [16]* :243 The psychiatrists who worked there were wearing uniforms under their white
coats.* [16]* :243
The political abuse of psychiatry in China seems to take place only in the institutions under the authority of the police
and the Ministry of State Security but not in those belonging to other governmental sectors.* [16]* :243 Psychiatric care
in China falls into four sectors that hardly connect up with each other.* [16]* :243 These are Ankang institutions of the
Ministry of State Security; those belonging to the police; those that fall under the authority of the Ministry of Social
Aairs; those belonging to the Ministry of Health.* [16]* :243 Both the sectors belonging to the police and the Ministry
of State Security are the closed sectors, and, consequently, information hardly ever leaks out.* [16]* :243 In the hospitals
belonging to the Ministry of Health, psychiatrists do not contact with the Ankang institutions and, actually, had no idea
of what occurred there, and could, thereby, sincerely state that they were not informed of political abuse of psychiatry in
China.* [16]* :243
In China, the structure of forensic psychiatry was to a great extent identical to that in the USSR.* [16]* :243 On its own, it is
not so strange, since psychiatrists of the Moscow Serbsky Institute visited Beijing in 1957 to help their Chinesebrethren
, the same psychiatrists who promoted the system of political abuse of psychiatry in their own USSR.* [16]* :243 As a
consequence, diagnostics were not much dierent than in the Soviet Union.* [16]* :244 The only dierence was that the
Soviets preferredsluggish schizophreniaas a diagnosis, and the Chinese generally cleaved to the diagnosisparanoia
or paranoid schizophrenia.* [16]* :244 However, the results were the same: long hospitalization in a mental hospital,
involuntary treatment with neuroleptics, torture, abuse, all aimed at breaking the victims will.* [16]* :244
In accordance with Chinese law that contains the concept ofpolitical harm to societyas legally dangerous mentally ill
behavior, police take into mental hospitals political maniacs,dened as persons who write reactionary letters, make
1.1. BY COUNTRY
anti-government speeches, orexpress opinions on important domestic and international aairs.* [18] Psychiatrists are
frequently caught involved in such cases, unable and unwilling to challenge the police, according to psychiatry professor at
the Peking University Yu Xin.* [19] As Mr. Lius database suggests, todays most frequent victims of psychiatric abuse
are political dissidents, petitioners, and Falun Gong members.* [20] Psychiatrists are frequently caught involved in these
cases, unable and unwilling to challenge the police, according to psychiatry professor at the Peking University Yu Xin. In
the beginning of the 2000s, Human Rights Watch accused China of locking up Falun Gong members and dissidents in a
number of Chinese mental hospitals managed by the Public Security Bureau.* [20] Access to the hospitals was requested
by the World Psychiatric Association (WPA), but denied by China, and the controversy subsided.* [20]
The WPA attempted to conne the problem by presenting it as Falung Gong issue and, at the same time, make the impression that the members of the movement were likely not mentally sound, that it was a sect which likely brainwashed
its members, etc.* [16]* :245 There was even a diagnosis of qigong syndromewhich was used reecting on the exercises practiced by Falung Gong.* [16]* :245 It was the unfair game aiming to avoid the political abuse of psychiatry from
dominating the WPA agenda.* [16]* :245
In August 2002, the General Assembly was to take place during the next WPA World Congress in Yokohama.* [16]* :247
The issue of Chinese political abuse of psychiatry had been placed as one of the nal items on the agenda of the General
Assembly.* [16]* :251 When the issue was broached during the General Assembly, the exact nature of compromise came
to light.* [16]* :252 In order to investigate the political abuse of psychiatry, the WPA would send an investigative mission
to China.* [16]* :252 The visit was projected for the spring of 2003 in order to assure that one could present a report
during the annual meeting of the British Royal College of Psychiatrists in June/July of that year and the Annual Meeting
of the American Psychiatric Association in May of the same year.* [16]* :252 After the 2002 World Congress, the WPA
Executive Committees half-hearted attitude in Yokohama came to light: it was an omen of a longstanding policy of
diversion and postponement.* [16]* :252 The 2003 investigative mission never took place, and when nally a visit to China
did take place, this visit was more of scientic exchange.* [16]* :252 In the meantime, the political abuse of psychiatry
persisted unabatedly, nevertheless the WPA did not seem to care.* [16]* :252
1.1.3
Cuba
See also: Political abuse of psychiatry in Cuba

Although Cuba has been politically connected to the Soviet Union since the United States broke o relations with Cuba
shortly after the dictator Fidel Castro came to power in 1959, few considerable allegations regarding the political abuse of
psychiatry in this country emerged before the late 1980s.* [8]* :74 Americas Watch and Amnesty International published
reports alluding to cases of possible unwarranted hospitalization and ill-treatment of political prisoners.* [8]* :75 These
reports concerned the Gustavo Machin hospital in Santiago de Cuba in the southeast of the country and the major mental
hospital in Havana.* [8]* :75 In 1977, a report on alleged abuse of psychiatry in Cuba presenting cases of ill-treatment in
mental hospitals going back to the 1970s came out in the United States.* [8]* :75 It presents grave allegations that prisoners
end up in the forensic ward of mental hospitals in Santiago de Cuba and Havana where they undergo ill-treatment including
electroconvulsive therapy without muscle relaxants or anaesthesia.* [8]* :75 The reported application of ECT in the forensic
wards seems, at least in many of the cited cases, not to be an adequate clinical treatment for the diagnosed state of the
prisoner in some cases the prisoners seem not to have been diagnosed at all.* [8]* :75 Conditions in the forensic wards
have been described in repulsive terms and apparently are in striking contrast to the other parts of the mental hospitals
that are said to be well-kept and modern.* [8]* :75
In August 1981, the Marxist historian Ariel Hidalgo was apprehended and accused ofincitement against the social order,
international solidarity and the Socialist Stateand sentenced to eight yearsimprisonment.* [8]* :75 In September 1981,
he was transported from State Security Headquarters to the Carb-Servi (forensic) ward of Havana Psychiatric Hospital
where he stayed for several weeks.* [8]* :76
1.1.4
India
It was reported in June, 2012, that the Indian Government has approached NIMHANS, a well known mental health
establishment in South India, to assist in suppressing anti-nuclear protests regards to building of the Kudankulam Nuclear
Power Plant. The government was in talks with NIMHANS representatives to chalk up a plan to dispatch psychiatrists to
Kudankulam, for counselling protesters opposed to the building of the plant. To fulll this, NIMHANS developed a team
of 6 members, all of them, from the Department of Social Psychiatry. The psychiatrists were sent to get apeek a into the
protesters' mindsand help them learn the importance of the plant according to one news source.* [21]* [22]* [23]* [24]* [25]
In July, 2013, the same institution, NIMHANS, was involved in a controversy where it was alleged that it provided
assistance to the Central Bureau of Investigation relating to some interrogation techninques.
1.1.5
Japan
Japanese mental institutions during the country's imperial era reported an abnormally large number of patient deaths,
peaking in 1945 after the surrender of Japan to Allied forces.* [26] The patients of these institutions were mistreated
mainly because they were a hindrance to society. Under the oppressive Imperial Japanese government, citizens were
expected to contribute in one way or another to the war eort, and the mentally ill were unable to do so, and as such
were looked down upon and abused. The main cause of death for these patients was starvation, as caretakers did not
supply the patients with adequate food, likely as a form of torture and a method of sedation. Because mentally ill patients
were kept secluded from the outside world, the large number of deaths went unnoticed by the general public. After the
end of Allied occupation, the National Diet of Japan passed the Mental Hygiene Act (, Seishin Eisei H)
in 1950, which improved the status of the mentally ill and prohibited the domestic containment of mental patients in
medical institutions. However, the Mental Hygiene Act had unforeseen consequences. Along with many other reforms,
the law prevented the mentally ill from being charged with any sort of crime in Japanese courts. Anyone who was found
to be mentally unstable by a qualied psychiatrist was required to be hospitalized rather than incarcerated, regardless of
the severity of any crime that person may have committed. The Ministry of Justice tried several times to amend the law,
but was met with opposition from those who believed the legal system should not interfere with medical science.* [26]
After almost four decades, the Mental Health Act (, Seishin Hoken H) was nally passed in 1987. The new
law corrected the aws of the Mental Hygiene Act by allowing the Ministry of Health and Welfare to set regulations on
the treatment of mental patients in both medical and legal settings. With the new law, the mentally ill have the right to
voluntary hospitalization, the ability to be charged with a crime, and right to use the insanity defense in court, and the
right to pursue legal action in the event of abuse or negligence on the part of medical professionals.
1.1.6
Nazi Germany
Main article: Action T4

By 1936, killing of the physically and socially untbecame accepted practice.* [27] In Nazi Germany in the 1940s,
the abuse of psychiatry was the abuse of the 'duty to care' in enormous scale: 300,000 individuals were sterilized and
100,000 killed in Germany alone and many thousands further aeld, mainly in eastern Europe.* [28] For the rst time
in history, during the Nazi era, psychiatrists sought to systematically destroy their patients and were instrumental in
establishing a system of identifying, notifying, transporting, and killing hundreds of thousands ofracially and cognitively
compromisedpersons and mentally ill in settings that ranged from centralized mental hospitals to jails and death camps.
Psychiatrists played a central and prominent role in sterilization and euthanasia constituting two categories of the crimes
against humanity.* [29] The taking of thousands of brains from euthanasia victims demonstrated the way medical research
was connected to the psychiatric killings.* [30] There were six psychiatric extermination centers: Bernburg, Brandenburg,
Grafeneck, Hadamar, Hartheim, and Sonnenstein.* [31]* [32] They played a crucial role in developments leading to the
Holocaust.* [31]
1.1.7
Norway
There have been a few accusations about abuse of psychiatry in Norway. See Arnold Juklerd.
1.1. BY COUNTRY
1.1.8
Romania
In Romania, there have been allegations of some particular cases of psychiatric abuse during over a decade.* [8]* :73 In
addition to particular cases, there is evidence that mental hospitals were utilized as short-term detainment centers.* [8]* :73
For instance, before the 1982 International University Sports Olympiad, over 600 dissidents were detained and kept
out of public view in mental hospitals.* [8]* :73 Like in the Soviet Union, on the eve of Communist holidays, potential
troublemakerswere sent to mental hospitals by busloads and discharged when the holidays had passed.* [1]
1.1.9
Russia
Main article: Political abuse of psychiatry in Russia

Reports on particular cases continue to come from Russia where the worsening political climate appears to make an
atmosphere in which local authorities feel able to again use psychiatry as a means of frightening.* [1] In modern Russia,
the fact that a person is a human rights defender again means that the person risks receiving a psychiatric diagnosis.* [33]
1.1.10
South Africa
Amental health genocidereminiscent of the Nazi aberrations has been located in the history of South African oppression
during the apartheid era.* [34]
1.1.11
Soviet Union
Main article: Political abuse of psychiatry in the Soviet Union

From the early 1970s, during Leonid Brezhnev's rule of the Soviet Union, reports started reaching the West that religious and political dissenters were being detained in maximum-security mental hospitals in the USSR without medical
justication.* [7] In 1977, the World Psychiatric Association condemned the USSR for this practice, and six years later,
the All-Union Society of Neuropathologists and Psychiatrists seceded from the WPA rather than face almost denite
expulsion.* [7] During this period, while reports of continuous repression multiplied, Soviet psychiatric ocials refused
to allow international bodies to see the hospitals and patients in question and denied the charges of abuse.* [7] In 1989,
however, the stonewalling of Soviet psychiatry was overcome by perestroika and glasnost.* [7] Over the objection of the
psychiatric establishment, the Soviet government permitted a delegation of psychiatrists from the USA, representing the
U.S. Government, to carry out extensive interviews of suspected victims of abuse.* [7]
In February 1989, a delegation of US psychiatrists and other experts visited the Soviet Union on the invitation of the
Soviet government.* [8]* :69 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.* [8]* :69 Whereas the delegation
originally sought interviews with 48 persons, it eventually saw 15 hospitalized and 12 discharged patients.* [8]* :69 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.* [8]* :69 The delegation came
to the conclusion that nine of the 15 hospitalized patients had disorders which would be classied in the United States
as serious psychoses, diagnoses corresponding broadly with those used by the Soviet psychiatrists.* [8]* :69 One of the
hospitalized patients had been diagnosed as having schizophrenia although the US team saw no evidence of mental disorder.* [8]* :70 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.* [8]* :70 According to medical record, all these patients had diagnoses of
psychopathology or schizophrenia.* [8]* :70
When returned home after a visit of more than two weeks, the delegation wrote its report which was pretty damaging to
the Soviet authorities.* [16]* :125 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.* [16]* :125
1.1.12
United States
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that
caused black slaves to ee captivity.* [35]* :41 In addition to identifying drapetomania, Cartwright prescribed a
remedy. His feeling was that with proper medical advice, strictly followed, this troublesome practice that many
Negroes have of running away can be almost entirely prevented.* [36] In the case of slavessulky and dissatised
without causea warning sign of imminent ight Cartwright prescribed "whipping the devil out of themas
a preventative measure.* [37]* [38]* [39] As a remedy for this disease, doctors also made running a physical
impossibility by prescribing the removal of both big toes.* [35]* :42
In the United States, political dissenters have been involuntarily committed. For example, in 1927 a demonstrator
named Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a
rally in support of Sacco and Vanzetti.* [40]
When Clennon W. King, Jr., a black pastor and civil rights activist attempted to enroll at the all-white University
of Mississippi for summer graduate courses in 1958, the Mississippi police arrested him on the grounds that any
nigger who tried to enter Ole Miss must be crazy.* [41] Keeping King's whereabouts secret for 48 hours, the
Mississippi authorities kept him conned to a mental hospital for twelve days before a panel of doctors established
the activist's sanity.* [42]
In the 1964 election, Fact magazine polled American Psychiatric Association members on whether Barry Goldwater
was t to be president and published The Unconscious of a Conservative: A Special Issue on the Mind of Barry
Goldwater.This led to the banning of diagnosing public gures when you have not performed an examination or
been authorized to release information by the patient. This became the Goldwater rule.* [43]* [44]
In the 1970s, Martha Beall Mitchell, wife of U.S. Attorney General John Mitchell, was diagnosed with a paranoid
mental disorder for claiming that the administration of President Richard M. Nixon was engaged in illegal activities.
Many of her claims were later proved correct, and the term "Martha Mitchell eect" was coined to describe mental
health misdiagnoses when accurate claims are dismissed as delusional.
In 1972 Thomas Eagleton was forced to withdraw as a vice presidential candidate for being treated for depression.* [45]
In 2006, Canadian psychiatrist Colin A. Ross's book was published, titled The C.I.A. Doctors: Human Rights Violations by American Psychiatrists.* [46] The book presents evidence based on 15,000 pages of documents received
from the CIA via the Freedom of Information Act that there have been systematic, pervasive violations of human
rights by American psychiatrists during the recent 65 years.* [46]
In 2010, the book The Protest Psychosis: How Schizophrenia Became a Black Disease by psychiatrist Jonathan Metzl
(who also has a Ph.D. in American studies) was published.* [5] The book covers the history of the 1960s Ionia State
Hospital located in Ionia, Michigan and now converted to a prison and focuses on exposing the trend of this hospital
to diagnose African Americans with schizophrenia because of their civil rights ideas.* [5] The book suggests that
in part the sudden inux of such diagnoses could traced to a change in wording in the DSM-II, which compared to
the previous edition added hostilityand aggressionas signs of the disorder.* [5]
Some people, notably clinical psychologist Bruce E. Levine, argue that Oppositional Deant Disorder, which can
be easily used to pathologize anti-authoritarianism, is an abuse of psychiatry.
1.2. PSYCHIATRIC REPRISALS
In 1973, the American Psychiatric Association declassied homosexuality as a mental disorder and The American
Psychological Association Council of Representatives followed in 1975.
In 2014, Mercury News published a series of articles detailing questionable use of psychotropic drugs within California's foster care system where bad behavior is attributed to various mental conditions, and little care is provided
besides drugs. Likewise, many experts questioned the long-term eects of high dosages on developing brains, and
some former patients reported permanent side eects even after stopping the meds. * [47]
According to journalist Johnathan Turley and Newsweek Magazine, in June 2015, U.S. District Judge Richard M.
Berman ordered conservative lm maker and activist Dinesh DSouza to continue Psychological Counseling for a
four year period despite numerous recommendations to the contrary by well respected private and court appointed
mental health personnel. DSouza pleaded guilty to a single count of making illegal contributions in the name of
others as part of the campaign of Wendy Long for New York Senate. This occurred during a post connenment
hearing. DSouza was seeking to reduce the four year community service sentence by reference to his home
connement period. Berman balked and said that he said the two periods as distinct a position that courts would
likely take in similar cases. In referring to the pschological counseling aspect, DSouzas counsel submitted
evidence that the court-ordered psychiatrist found no indication of depression or reason for medication. His own
retained psychologist also provided a written statement concluding there was no need to continue the consultation.
However, Judge Berman simply disagreed and said that he thinks more counseling will help while noting that this
is not punishment: I only insisted on psychological counseling as part of Mr. DSouzas sentence because
I wanted to be helpful. I am requiring Mr. DSouza to see a new psychological counselor and to continue the
weekly psychological consultation not as part of his punishment or to be retributive.The court insisted Im
not singling out Mr. DSouza to pick on him. A requirement for psychological counseling often comes up in my
hearings in cases where I nd it hard to understand why someone did what they did.* [48]* [49]
1.2 Psychiatric reprisals

Whistle-blowers who part ranks with their organizations have had their mental stability questioned, such as, for example, the NYPD veteran who alleged falsied crime statistics in his department and was forcibly committed to a mental
institution.* [50]
1.3 See also

Antipsychiatry
The Protest Psychosis: How Schizophrenia Became a Black Disease
Global Initiative on Psychiatry
1.4 References
[1] van Voren, Robert (January 2010). Political Abuse of PsychiatryAn Historical Overview. Schizophrenia Bulletin 36 (1):
3335. doi:10.1093/schbul/sbp119. PMC 2800147. PMID 19892821.
[2] Helmchen, Hanfried; Sartorius, Norman (2010). Ethics in Psychiatry: European Contributions. Springer. p. 491. ISBN 90481-8720-6.
[3] , (January 2010). : .
news: (in Russian) ( 1 (20)).
[4] Semple, David; Smyth, Roger; Burns, Jonathan (2005). Oxford handbook of psychiatry. Oxford: Oxford University Press. p.
6. ISBN 0-19-852783-7.
[5] Metzl, Jonathan (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press. ISBN 0-8070-85928.
[6] Noll, Richard (2007). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing. p. 3. ISBN
0-8160-6405-9.
[7] Bonnie, Richard (2002). Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies
(PDF). Journal of the American Academy of Psychiatry and the Law 30 (1): 136144. PMID 11931362. Retrieved 12
December 2010.
[8] Medicine betrayed: the participation of doctors in human rights abuses. Zed Books. 1992. p. 65. ISBN 1-85649-104-8.
[9] Malterud, Kirsti; Hunskaar, Steinar (2002). Chronic myofascial pain: a patient-centered approach. Radclie Publishing. p. 94.
ISBN 1-85775-947-8.
[10] Veenhoven, Willem; Ewing, Winifred; Samenlevingen, Stichting (1975). Case studies on human rights and fundamental freedoms: a world survey. Martinus Nijho Publishers. p. 29. ISBN 90-247-1780-9.
[11] Shah, Ruchita; Basu, Debasish (JulySeptember 2010).Coercion in psychiatric care: Global and Indian perspective. Indian
Journal of Psychiatry 52 (3): 203206. doi:10.4103/0019-5545.70971. PMC 2990818. PMID 21180403. Retrieved 22 March
2012.
[12] Declan, Lyons; Art, O'Malley (2002). The labelling of dissent politics and psychiatry behind the Great Wall. The
Psychiatrist 26 (12): 443444. doi:10.1192/pb.26.12.443.
[13] Katona, Cornelius; Robertson, Mary (2005). Psychiatry at a glance. Wiley-Blackwell. p. 77. ISBN 1-4051-2404-0.
[14] Munro, Robin (2002). Dangerous minds: political psychiatry in China today and its origins in the Mao era. Human Rights
Watch. ISBN 1-56432-278-5. (Google Books)
[15] Munro, Robin (2002). Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era. Human Rights
Watch. ISBN 1-56432-278-5. (HTML)
[16] van Voren, Robert (2009). On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the Soviet Unionof
Vladimir Putin. AmsterdamNew York: Rodopi. p. 242. ISBN 978-90-420-2585-1.
[17] Freedman, M (October 2003). Dangerous Minds: Political Psychiatry in China Today and Its Origin in the Mao Era.
Psychiatric Services 54 (10): 14181419. doi:10.1176/appi.ps.54.10.1418-a. Retrieved 10 December 2010.
[18] Contortions of Psychiatry in China. The New York Times. 25 March 2001. Retrieved 6 April 2012.
[19] Demick, Barbara (16 March 2012). China poised to limit use of mental hospitals to curb dissent. Los Angeles Times.
Retrieved 6 April 2012.
[20] LaFraniere, Sharon; Levin, Dan (11 November 2010). Assertive Chinese Held in Mental Wards. The New York Times.
Retrieved 22 March 2012.
[21] Centre to deal anti-nuke mind-set with NIMHANS. http://ibnlive.in.com/''. Retrieved 15 June 2015.
[22] No margin for error. http://www.hindustantimes.com/''. Retrieved 15 June 2015.
[23] Demonising anti-nuclear protests. Retrieved 15 June 2015.
[24] Koodankulam counselling for protestors ayed. The New Indian Express. Retrieved 15 June 2015.
[25] Plan to counsel anti-nuclear protesters draws ak. The New Indian Express. Retrieved 15 June 2015.
[26] Totsuka, Etsuro (1990). The history of Japanese psychiatry and the rights of mental patients (PDF). The Psychiatrist 14
(4): 193200. Retrieved 19 March 2012.
[27] Holder, Elizabeth (1977). The abuse of psychiatry for political purposes. Journal of Child Psychotherapy 4 (3): 108110.
doi:10.1080/00754177708254978.
[28] Birley, J. L. T. (January 2000).Political abuse of psychiatry
. Acta Psychiatrica Scandinavica 101 (399): 1315. doi:10.1111/j.09024441.2000.007s020[dash]3.x. PMID 10794019.
1.5. EXTERNAL LINKS
[29] Strous, Rael (February 2007).Psychiatry during the Nazi era: ethical lessons for the modern professional. Annals of General
Psychiatry 6 (1): 8. doi:10.1186/1744-859X-6-8. PMC 1828151. PMID 17326822. Retrieved 21 March 2012.
[30] Weindling, Paul Julian (2006). Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent.
Palgrave Macmillan. p. 6. ISBN 0-230-50700-X.
[31] Breggin, Peter (1993). Psychiatry's role in the holocaust (PDF). International Journal of Risk & Safety in Medicine 4 (2):
133148. doi:10.3233/JRS-1993-4204. PMID 23511221.
[32] Fuller Torrey, Edwin; Yolken, Robert (January 2010). Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia
. Schizophrenia Bulletin 36 (1): 2632. doi:10.1093/schbul/sbp097. PMC 2800142. PMID 19759092. Retrieved 28 March
2012.
[33] 15 ". Nezavisimiy Psikhiatricheskiy Zhurnal (in Russian) ( 4). 2005. ISSN
1028-8554. Retrieved 24 July 2011.
[34] Press conference exposes mental health genocide during apartheid. South African Government Information. 14 June 1997.
Retrieved 16 January 2012.
[35] White, Kevin (2002). An introduction to the sociology of health and illness. SAGE. pp. 41, 42. ISBN 0-7619-6400-2.
[36] Cartwright, Samuel A. (1851). Diseases and Peculiarities of the Negro Race. DeBow's Review XI. Retrieved 16 November
2011.
[37] Caplan, Arthur; McCartney, James; Sisti, Dominic (2004). Health, disease, and illness: concepts in medicine. Georgetown
University Press. p. 35. ISBN 1-58901-014-0.
[38] Paul Finkelman (1997). Slavery & the Law. Rowman & Littleeld. p. 305. ISBN 0-7425-2119-2.
[39] Rick Halpern, Enrico Dal Lago (2002). Slavery and Emancipation. Blackwell Publishing. p. 273. ISBN 0-631-21735-5.
[40] Moshik, Temkin (2009). The Sacco-Vanzetti Aair. Yale University Press Publishers. p. 316. ISBN 978-0-300-12484-2.
[41] Tucker, William H. (2002). The Funding of Scientic Racism: Wicklie Draper and the Pioneer Fund. University of Illinois
Press. p. 119. ISBN 0-252-02762-0.
[42] Negro Pastor Pronounced Sane; Demands Mississippi Apologize. UPI. Sarasota Journal 20 June 1958: 3.
[43] Richard A. Friedman (May 23, 2011). How a Telescopic Lens Muddles Psychiatric Insights. New York Times. Retrieved
2011-05-24.
[44] LBJ Fit to Serve. Associated Press. May 23, 1968. Retrieved 2011-05-24. Publisher Ralph Ginzburg, defendant in a libel
suit for an article on a poll of psychiatrists on Barry Goldwater that he conducted in 1964 says ...
[45] George McGovern (May 11, 1983). Trashing' Candidates. New York Times. Retrieved 2013-10-18.
[46] Ross, Colin (2006). The C.I.A. Doctors: Human Rights Violations by American Psychiatrists. Manitou Communications. ISBN
0-9765508-0-6.
[47] Drugging Our Kids - San Jose Mercury News. Drugging our kids - San Jose Mercury News. Retrieved 15 June 2015.
[48] Turley, Jonathan (15 July 2015). Federal Judge Orders Dinesh DSouza To Continue Psychological Counseling Despite
Contrary Expert Recommendation.
[49] Walker, Lauren (14 July 2015).Judge Orders Anti-Obama Filmmaker D'Souza Receive Psychological Counseling
. Newsweek.
[50] Cop hauled o to psych ward after alleging fake crime stats. Retrieved 15 June 2015.
1.5 External links

Adler, Nanci; Mueller, Gerard; Ayat, Mohammed (1993). Psychiatry under tyranny: a report on the political
abuse of Romanian psychiatry during the Ceausescu years
. Current Psychology 12 (1): 317. doi:10.1007/BF02737088.
PMID 11652327.
van Voren, Robert (2002). Comparing Soviet and Chinese Political Psychiatry (PDF). The Journal of the
American Academy of Psychiatry and the Law 30 (1): 131135. PMID 11931361. Retrieved 27 February 2011.
Chapter 2
Political abuse of psychiatry in the Soviet

Union
In the Soviet Union, a systematic political abuse of psychiatry took place* [1] and was based on the interpretation of
political dissent as a psychiatric problem.* [2] It was called psychopathological mechanismsof dissent.* [3]
During the leadership of General Secretary Leonid Brezhnev, psychiatry was used as a tool to eliminate political opponents
(dissidents) who openly expressed beliefs that contradicted ocial dogma.* [4] The termphilosophical intoxication
was widely used to diagnose mental disorders in cases where people disagreed with leaders and made them the target
of criticism that used the writings by Karl Marx, Friedrich Engels, and Vladimir Lenin.* [5] Article 5810 of the Stalin
Criminal Codewhich as Article 70 had been shifted into the RSFSR Criminal Code of 1962and Article 190-1 of the
RSFSR Criminal Code along with the system of diagnosing mental illness, developed by academician Andrei Snezhnevsky,
created the very preconditions under which non-standard beliefs could easily be transformed into a criminal case, and it,
in its turn, into a psychiatric diagnosis.* [6] Anti-Soviet political behavior, in particular, being outspoken in opposition to
the authorities, demonstrating for reform, writing books were dened in some persons as being simultaneously a criminal
act (e.g., violation of Articles 70 or 190-1), a symptom (e.g., delusion of reformism), and a diagnosis (e.g., "sluggish
schizophrenia").* [7] Within the boundaries of the diagnostic category, the symptoms of pessimism, poor social adaptation
and conict with authorities were themselves sucient for a formal diagnosis of sluggish schizophrenia.* [8]
The process of psychiatric incarceration was instigated by attempts to emigrate; distribution or possession of prohibited
documents or books; participation in civil rights actions and demonstrations, and involvement in forbidden religious activity.* [9] The religious faith of prisoners, including well-educated former atheists who adopted a religion, was determined
to be a form of mental illness that needed to be cured.* [10] Formerly highly classied government documents published
after the dissolution of the Soviet Union demonstrate that the authorities used psychiatry as a tool to suppress dissent.* [11]
According to the Commentary on the Russian Federation Law on Psychiatric Care, persons who were subjected to repressions in the form of commitment for compulsory treatment to psychiatric medical institutions and were rehabilitated in
accordance with the established procedure receive compensation. The Russian Federation acknowledged that psychiatry
was used for political purposes and took responsibility for the victims of political psychiatry.* [12]
Political abuse of psychiatry in Russia continues after the fall of the Soviet Union* [13] and threatens human rights activists
with a psychiatric diagnosis.* [14]
2.1 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.* [15] It entails the exculpation and committal of citizens to psychiatric facilities based upon political rather than mental health-based criteria.* [16] Many authors,
including psychiatrists, also use the terms Soviet political psychiatry* [17] or punitive psychiatryto refer to this
10
2.1. BACKGROUND
11
The Serbsky Central Research Institute for Forensic Psychiatry, also briey called the Serbsky Institute (the part of its building in Moscow)
12
CHAPTER 2. POLITICAL ABUSE OF PSYCHIATRY IN THE SOVIET UNION
phenomenon.* [18]
In the book Punitive Medicine by Alexander Podrabinek, the termpunitive medicine, which is identied withpunitive
psychiatry,is dened as a tool in the struggle against dissidents who cannot be punished by legal means.* [19]
Punitive psychiatry is neither a discrete subject nor a psychiatric specialty but, rather, it is an emergency arising within
many applied sciences in totalitarian countries where members of a profession may feel themselves compelled to service
the diktats of power.* [20] Psychiatric connement of sane people is uniformly considered a particularly pernicious form
of repression* [21] and Soviet punitive psychiatry was one of the key weapons of both illegal and legal repression.* [22]
As Vladimir Bukovsky and Semyon Gluzman wrote in their joint A Manual on Psychiatry for Dissenters,the Soviet use
of psychiatry as a punitive means is based upon the deliberate interpretation of dissent... as a psychiatric problem.* [23]
Psychiatry possesses an inherent capacity for abuse that is greater than in other areas of medicine.* [24] 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.* [24] In addition, receiving a psychiatric diagnosis can in
itself be regarded as oppressive.* [25] 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.* [24] 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.* [26] 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.* [27] Psychiatrists have been involved in human rights abuses in states across
the world when the denitions of mental disease were expanded to include political disobedience.* [28] 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.* [29] Nowadays, in many countries, political prisoners are still sometimes
conned and abused in mental institutions.* [30]
In the Soviet Union dissidents were often conned in the so-called psikhushka, or psychiatric wards.* [31] Psikhushka is the
Russian ironic diminutive formental hospital.* [32] One of the rst 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.* [33] 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.* [29] Western scholars examined no aspect of Soviet psychiatry as thoroughly as its
involvement in the social control of political dissenters.* [34]
As early as 1948, the Soviet secret service took an interest in this area of medicine.* [35] It was one of the superiors of
the Soviet secret police, Andrey Vyshinsky, who rst ordered the use of psychiatry as a tool of repression.* [36] Russian
psychiatrist Pyotr Gannushkin also believed that in a class society, especially during the most severe class struggle, psychiatry was incapable of not being repressive.* [37] A system of political abuse of psychiatry was developed at the end of
Joseph Stalin's regime.* [38] However, according to Alexander Etkind, punitive psychiatry was not simply an inheritance
from the Stalin era as the GULAG (the acronym for Chief Administration for Corrective Labor Camps, the penitentiary
system in the Stalin years) was an eective instrument of political repression and there was no compelling requirement
to develop an alternative and expensive psychiatric substitute.* [39] The abuse of psychiatry was a natural product of the
later Soviet era.* [39] 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 conicts between them:
1. the rst 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.* [39]
The hundreds of hospitals in the provinces combined components of both systems.* [39]
What was the abuse of psychiatry under the dictatorship of Stalin?* [40] If a person was mentally ill, he was sent to a
psychiatric hospital until his dying day.* [40] If he was not quite mentally healthy but not quite ill, with his character traits,
he was sent to a prison camp or shot.* [40] When some allusions to the so-called socialist legality appeared, it was decided
these people must be tried.* [40] But soon it became realized that bringing the people who gave anti-Soviet speeches to
2.2. JOINT SESSION
13
trial made matters worse, they began not to be admitted to the court by being attributed with psychiatric diagnoses and
declared insane.* [40]
2.2 Joint Session

Main article: Pavlovian session
In the 1950s, psychiatrists of the Soviet Union disgracefully organized themselves into the medical arm of the Gulag
state.* [41] A precursor of later abuses in psychiatry in the Soviet Union was the so-called Joint Sessionof 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] reactionaryscience that was damaging to Soviet
psychiatry.* [42] During the Joint Session these eminent psychiatrists, motivated by fear, had to publicly admit that their
scientic positions were in error and they also had to promise to conform Pavlovian doctrines.* [42] However, these public
declarations of obedience proved insucient as in the closing speech of the congress, the lead author of the event's
policy report, Snezhnevsky stated that they have not disarmed themselves and continue to remain in the old antiPavlovian positions, thereby causing grave damage to the Soviet scientic 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.* [43] The congressional members who articulated these accusations, among them Irina
Strelchuk, Vasily Banshchikov, Oleg Kerbikov, and Snezhnevsky, were characterized by careerist ambition and fears for
their own positions.* [42] Not surprisingly, many of them were advanced and appointed to leadership positions shortly
after the session.* [42]
The Joint Session also had a negative 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.* [42] In addition to losing their laboratories
some of these scientists were subjected to torture in prison.* [42] The Moscow, Leningrad, Ukrainian, Georgian, and
Armenian schools of neuroscience and neurophysiology were damaged for a period due to this loss of personnel.* [42] The
Joint Session ravaged productive research in neurosciences and psychiatry for years to come.* [42] It was pseudoscience
that took over.* [42]
After the joint session of the USSR Academy of Sciences and the USSR Academy of Medical Sciences on 28 June
4 July 1950 and during the session of the Presidium of the Academy of Medical Sciences and the Board of the AllUnion Society of Neuropathologists and Psychiatrists on 1115 October 1951, the leading role was given to Snezhnevky's
school.* [44] 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.* [45] The Soviet doctors, under the incentive of Snezhnevsky, devised a
Pavlovian theory of schizophreniaand increasingly applied this diagnostic category to political dissidents.* [46]
2.3 Sluggish schizophrenia

Main article: 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.* [47] (Alexander Solzhenitsyn)
Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used
for political purposes.* [48] It was the diagnosis of sluggish schizophreniathat was most prominently used in cases
of dissidents.* [49] Sluggish schizophrenia as one of new diagnostic categories was created to facilitate the stiing of
14
dissidents and was a root of self-deception among psychiatrists to placate their consciences when the doctors acted as a
tool of oppression in the name of a political system.* [50] According to the Global Initiative on Psychiatry chief executive
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.* [51] The diagnosissluggish schizophrenia,a longstanding concept further developed
by the Moscow School of Psychiatry and particularly by its chief Snezhnevsky, furnished a very handy framework for
explaining this behavior.* [51] 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
psychiatristssluggish schizophreniaappeared 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.* [51]
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 classication of mental disorders postulating an original set of diagnostic
criteria.* [8] A carefully crafted description of sluggish schizophrenia established that psychotic symptoms were nonessential for the diagnosis, but symptoms of psychopathy, hypochondria, depersonalization or anxiety were central to
it.* [8] Symptoms referred to as part of thenegative axisincluded pessimism, poor social adaptation, and conict with
authorities, and were themselves sucient for a formal diagnosis of sluggish schizophrenia with scanty symptoms.
*
[8] 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.* [8] 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.* [8] Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for
the psychiatric incarceration of dissenters.* [8] 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.* [51] 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.* [51] The
city with the highest prevalence of schizophrenia in the world was Moscow.* [52] 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.* [51] Their symptoms could be like those of a neurosis or could assume a
paranoid character.* [51] The patients with paranoid symptoms retained some insight into their condition but overestimated
their own signicance and could manifest grandiose ideas of reforming society.* [51] Thereby, sluggish schizophrenia could
have such symptoms as reform delusions,perseverance,and struggle for the truth.* [51] As Viktor Styazhkin
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 benet of mankind.* [53]
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 classications, but Soviet psychiatry,
proceeding from ideological conceptions, referred critique of the political system and proposals to reform this system to
the delusional construct.* [54] 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.* [55]
On the covert orders of the KGB, thousands of social and political reformersSoviet dissidentswere incarcerated
in mental hospitals after being labelled with diagnoses ofsluggish schizophrenia, a disease fabricated by Snezhnevsky
and Moscow schoolof psychiatry.* [56] American psychiatrist Alan A. Stone stated that Western criticism of Soviet
psychiatry aimed at Snezhnevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia
with a sluggish typemanifestation by reformerismincluding other symptoms.* [57] One can readily apply this
diagnostic scheme to dissenters.* [57] Snezhnevsky was long attacked in the West as an exemplar of psychiatric abuse
in the USSR.* [49] The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and
this diagnosis to make political dissent into a mental disease.* [58] 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,* [49] and, in dozens of cases, he personally signed a commission decision on legal insanity of mentally
healthy dissidents including Vladimir Bukovsky, Natalya Gorbanevskaya, Leonid Plyushch, Mikola Plakhotnyuk,* [59]
and Pyotr Grigorenko.* [60]
2.4. POLITICAL TREND TOWARD MASS ABUSE ONSET
15
2.4 Political trend toward 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.* [35] 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 justied as a provocation of world imperialism or a legacy
of the past, they were merely the product of mental disease.* [35] 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 oences, 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.* [35]
Yuri Andropov (19141984), a KGB Chairman and General Secretary of the CPSU
The now available evidence supports the conclusion that the system of political abuse of psychiatry was carefully designed
by the KGB to rid the USSR of undesirable elements.* [61] According to several available documents and a message by a
16
former general of the Fifth (dissident) Directorate of the Ukrainian KGB to Robert van Voren, political abuse of psychiatry
as a systematic method of repression was developed by Yuri Andropov along with a selected group of associates.* [62]
Andropov was in charge of the wide-ranging deployment of psychiatric repression since he has headed the KGB.* [63]
He became the KGB Chairman on 18 May 1967.* [64] On 3 July 1967, he made a proposal to establish for dealing with
the political opposition the KGB's Fifth Directorate* [65] (ideological counterintelligence).* [66] At the end of July, the
directorate was established and entered in its les cases of all Soviet dissidents including Andrei Sakharov and Alexander
Solzhenitsyn.* [65] 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.* [67] He aimed to achieve the destruction of dissent in all its formsand 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.* [67]
Similar ideas can be found in the 1983 book Speeches and Writings by Yuri Andropov:* [68]
[w]hen analyzing the main trend in present-day bourgeois criticism of [Soviet] human rights policies one
is bound to draw the conclusion that although this criticism is camouaged with concernfor freedom,
democracy, and human rights, it is directed in fact against the socialist essence of Soviet society
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 orderfrom
dissenters.* [69] In this connection, a secret resolution of the USSR Council of Ministers was adopted.* [70] The proposal
by Andropov to use psychiatry for struggle against dissenters was implemented.* [71]
The USSR had 70 psychiatric hospitals and 21,103 psychiatric beds by 1926, 102 psychiatric hospitals and 33,772 psychiatric beds by 1935, 200 psychiatric hospitals and 116,000 psychiatric beds by 1955.* [72] The Soviet authorities built
psychiatric hospitals at a rapid pace and increased the quantity of beds for patients with nervous and mental illnesses
from 222,600 to 390,000 between 1962 and 1974, and the expansion in the number of psychiatric beds was expected to
continue in the years up to 1980.* [73] In this period, Soviet psychiatry was dominated by a tendency dierent from the
vigorous trend in Western countries to treat as many persons as possible as out-patients rather than in-patients.* [73]
On 15 May 1969, there was issued Decree No. 345209 on measures for preventing dangerous behavior (acts) on
the part of mentally ill persons.* [74] This Decree ratied the practice of having undesirables hauled into detention
by psychiatrists.* [74] Under this practice, the psychiatrists were told whom they should examine, and they might fetch
these individuals with the assistance of the police or entrap them into coming to the hospital.* [74] The psychiatrists
doubled as interrogators and as arresting ocers.* [74] The doctors fabricated a diagnosis requiring internment, and no
court judgment was required for conning the individual indenitely.* [74]
By the end of the 1950s, the most commonly used method of punishing leaders of the political opposition became psychiatric commitment.* [8] In the 1960s and 1970s, the trials of dissenters and their referral for treatmentto special
psychiatric hospitals of the system of MVD came out into the open before the world public, and information about
psychiatric terror,which the leadership of the Serbsky Institute was atly denying, began to appear.* [75] The bulk
of psychiatric repression date from the late 1960s to the early 1980s.* [76] Andropov demonstrated little patience with
domestic dissatisfaction as exposed by his continuation of the Brezhnev Era policy of conning dissenters in mental hospitals.* [77] The use of mental hospitals to conne dissenters was indicative of Soviet thinking; a person who dared to
challenge the blissful Soviet view of Marxism must have been mentally ill.* [77]
2.5 Examination and hospitalization

Political dissidents were usually charged under article 70 (agitation and propaganda against the Soviet state) and 1901 (dissemination of false fabrications defaming the Soviet state and social system) of the Criminal Code.* [8] Forensic
psychiatrists were asked to examine those transgressors whose mental state the investigating ocers had considered abnormal.* [8]
Practically in all cases, dissidents were examined in the Serbsky Central Research Institute for Forensic Psychiatry* [78]
which conducted forensic-psychiatric expert evaluation of persons brought to justice under political articles.* [76] Certied, the persons were sent for involuntary treatment to special hospitals of the system of the Ministry of Internal Aairs
(MVD) of the Russian Soviet Federative Socialist Republic.* [76]
2.6. STRUGGLE AGAINST ABUSE
17
The accused had no right of appeal.* [8] The right was given to their relatives or other interested persons but they were not
allowed to nominate psychiatrists to take part in the evaluation, because all psychiatrists were considered fully independent
and equally credible before the law.* [8]
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.* [35] Previously, psychiatric departments had been regarded as a 'refuge' against being dispatched to the Gulag, but thenceforth that
policy altered.* [35] The rst 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.* [35] Both Morozov and Lunts were personally involved in numerous well-known cases and were notorious abusers of psychiatry for political purposes.* [35]
Most prisoners, in Viktor Nekipelov's words, characterized Daniil Lunts as no better than the criminal doctors who
performed inhuman experiments on the prisoners in Nazi concentration camps.* [79]
There was well-documented practice of using psychiatric hospitals as temporary prisons within two or three weeks around
October Revolution Day and May Day to lock up socially dangerouspersons who otherwise might protest in public
or manifest other deviant behavior.* [80]
2.6 Struggle against abuse

Main article: Struggle against political abuse of psychiatry in the Soviet Union
In the 1960s, a vigorous movement grew up protesting against abuse of psychiatry in the USSR.* [81] Political abuse of
psychiatry in the Soviet Union was denounced in the course of the Congresses of the World Psychiatric Association in
Mexico City (1971), Hawaii (1977), Vienna (1983) and Athens (1989).* [8] The campaign to terminate political abuse of
psychiatry in the USSR was a key episode in the Cold War, inicting irretrievable damage on the prestige of medicine in
the Soviet Union.* [56]
2.7 Classication of the victims

Main article: Cases of political abuse of psychiatry in the Soviet Union
Upon analysis of over 200 well-authenticated cases covering the period 19621976, Sidney Bloch and Peter Reddaway
developed a classication of the victims of Soviet psychiatric abuse. They were classied as:* [82]
1. advocates of human rights or democratization;
2. nationalists;
3. would-be emigrants;
4. religious believers;
5. citizens inconvenient to the authorities.
The advocates of human rights and democratization, according to Bloch and Reddaway, made up about half the dissidents
repressed by means of psychiatry.* [82] Nationalists made up about one-tenth of the dissident population dealt with psychiatrically.* [83] Would-be emigrants constituted about one-fth of dissidents victimized by means of psychiatry.* [84]
People, detained only because of their religious activity, made up about fteen per cent of dissident-patients.* [84] Citizens inconvenient to the authorities because of their obduratecomplaints about bureaucratic excesses and abuses
accounted for about ve per cent of dissidents subject to psychiatric abuse.* [85]
18
2.8 Incomplete gures estimated due to some archival documents

In 1985, Peter Reddaway and Sidney Bloch in their book Soviet Psychiatric Abuse have provided documented data on
some 500 cases.* [86]
According to the 1993 book by Russian psychiatrist Mikhail Buyanov, the harm inicted by Soviet punitive psychiatry
on the image of domestic medicine is, of course, great, but bears no comparison to the crimes of the Nazi doctors.* [87]
Now, when all the passions have cooled, one can say that the zeal of Soviet psychiatrists inicted suering on up to 100 or
120 people of all 280 million citizens of the former Soviet Union, Buyanov writes.* [87] He adds that among the persons
were many fanatical nationalists, religious sectarians, and political paranoiacs who after escaping to freedom corrupted
the masses, rammed their heads with nonsense, carried away immature people with their ideas through the connivance
of the so-called progressive intelligentsia, and a result of it is wars, blood, and reciprocal hatred.* [87]
On basis of the available data and materials accumulated in the archives of the International Association on the Political
Use of Psychiatry, one can condently conclude that thousands of dissenters were hospitalized for political reasons.* [51]
From 1994 to 1995, an investigative commission of Moscow psychiatrists explored the records of ve prison psychiatric
hospitals in Russia and discovered about two thousand cases of political abuse of psychiatry in these hospitals alone.* [51]
In 2004, Anatoly Prokopenko said he was surprised at the facts obtained by him from the ocial classied top secret
documents by the Central Committee of the CPSU, by the KGB, and MVD.* [88] According to his calculations based
on what he found in the documents, about 15 thousand people were conned for political crimes in psychiatric prison
hospitals of the MVD system.* [88] In 2005, 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.* [89] 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.* [89] The gure of fteen or twenty thousand political prisoners in psychiatric hospitals of the MVD of the
USSR was presented in the book Bezumnaya Psikhiatriya (Mad Psychiatry) by Prokopenko published in 1997* [90] and
republished in 2005.* [91]
An evidence of political abuse psychiatry in the USSR is based on Semyon Gluzman's calculation indicating that the
percentage ofthe mentally illamong those accused of the so-called anti-Soviet activity proved to be many times higher
than among criminal oenders.* [92]* [16] The attention to political prisoners paid by Soviet psychiatrists exceeded by at
least 40 times their attention to ordinary criminal oenders.* [92] 12 % of all the forensic psychiatric examinations carried
out by the Serbsky Institute targeted those accused of anti-Soviet activity.* [92]* [16] The gure of convicted dissidents in
penal institutions was 0.05% of the total of convicts.* [92]* [16] 12 % is greater than 0.05% by 40 times.* [92]* [16]
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.* [93] No objective counting
of repressed persons is possible without fundamental analysis of archival documents.* [94] The diculty of this method
is that the required data are very diverse and are not in one archive.* [94] 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 Oce 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.* [94]
According to Russian psychiatrist Emmanuil Gushansky, the scale of psychiatric abuses in the past, the use of psychiatric
doctrines by the totalitarian state are thoroughly concealed.* [95] Archives of the MVD, the USSR Health Ministry, the
Serbsky Institute for Forensic Psychiatry that store evidences of psychiatric expansion and regulations, on which this
expansion was based, still remain closed to researchers like a tomb, he says.* [95] Dan Healey has the same opinion that the
abuses of Soviet psychiatry during the leadership of Stalin and more drastically after his decease in the 1960s-80s remain
under-researched and main archives are still classied.* [96] Hundreds of les on people who passed through forensic
psychiatric examinations during the time of Stalin's rule at the Serbsky Institute are on the shelves of the highly classied
archive in its basement* [97] where Gluzman saw the les in 1989.* [98] All of them marked only by numbers without
names, surnames, any biographical data on the examinees* [97] are unresearched and inaccessible to researchers.* [98]
2.8. INCOMPLETE FIGURES ESTIMATED DUE TO SOME ARCHIVAL DOCUMENTS
19
Mayor of Saint Petersburg legal scholar Anatoly Sobchak wrote:

The scale of the application of methods of repressive psychiatry in the USSR is testied by inexorable
gures and facts. The work by the commission of the top party leadership headed by Alexei Kosygin in
1978 resulted in the decision to build 80 psychiatric hospitals and 8 special ones in addition to existing
ones. Their construction was to be completed by 1990. They were being built in Krasnoyarsk, Khabarovsk,
Kemerovo, Kuibyshev, Novosibirsk, and other parts of the Soviet Union. In the course of the changes the
country underwent in 1988, 5 prison hospitals were transferred to the jurisdiction of the Ministry of Health
from the MVD system, and other 5 ones were shut down. Hurried covering of tracks began through mass
rehabilitation of patients, a part of them was mentally crippled (only in the same year 800,000 patients were
removed from the psychiatric registry). Only in Leningrad 60,000 people were rehabilitated in 1991 and
1992. In 1978, 4.5 million people through the country were on the psychiatric registry. Its scale was equal
to the population of many civilized countries.* [99]
In Ukraine, a study of the origins of the political abuse of psychiatry was conducted for ve years on the basis of the state
archives.* [100] A total of 60 people were again surveyed.* [100] All they were citizens of Ukraine, convicted of political
crimes and hospitalized on the territory of Ukraine. As it turned out, none of them was in need of any psychiatric
treatment.* [100]
Alexander Yakovlev (19232005), the head of the Commission for Rehabilitation of the Victims of Political Repression, a politician and
historian
In the Commission for Rehabilitation of the Victims of Political Repression from 1993 to 1995, the Decree of the President
of the Russian Federation on measures for preventing abuse of psychiatry was being prepared.* [101] For this purpose,
Anatoly Prokopenko selected suitable archival documents, and Emmanuil Gushansky at the request of the head of a
department of the Commission Vladimir Naumov drew up the report.* [101] It colligated both the archival data presented
to Gushansky and materials received during the visit by the commission of the Independent Psychiatric Association of
Russia jointly with him to several psychiatric hospitals with strict observation (former special hospitals of the MVD
system).* [101] When materials for discussion in the Commission for Rehabilitation of the Victims of Political Repression
20
have been prepared, the work has come to a standstill.* [101] The documents failed to reach the head of the Commission
Alexander Yakovlev.* [101] The report on political abuse of psychiatry prepared by Gushansky with the aid of Prokopenko
at the request of the Commission for Rehabilitation of the Victims of Political Repression has been unclaimed and denied
publication even by the Nezavisimiy Psikhiatricheskiy Zhurnal.* [95] The Moscow Research Center for Human Rights
headed by Boris Altshuler and Alexei Smirnov and the Independent Psychiatric Association of Russia whose president
is Yuri Savenko were asked by Gushansky to publish the materials and archival documents on punitive psychiatry but
showed no interest in doing so.* [101] Publishing such documents is dictated by the needs of present life and by fears that
use of psychiatry for non-medical purposes can be repeated.* [102]
In 2000, the Commission for Rehabilitation of the Victims of Political Repression included in its report only the following
four phrases of political abuse of psychiatry:* [103]
The Commission has also considered such a complex, socially relevant issue, as the use of psychiatry for
political purposes. The collected documents and materials allow us to say that the extrajudicial procedure of
admission to psychiatric hospitals was used for compulsory hospitalization of persons whose behavior was
viewed by the authorities assuspiciousfrom the political point of view. According to the incomplete data,
hundreds of thousands of people have been illegally placed to psychiatric institutions of the country over the
years of Soviet power. The rehabilitation of these people at best was, and are usually today due to gaps in
legislation, limited to removing them from the psychiatric registry.
In the 1988 and 1989, about two million people were removed from the psychiatric registry at the request of Western
psychiatrists that was one of their conditions for the admission of Soviet psychiatrists to the World Psychiatric Association.* [104] Yuri Savenko provided dierent gures in dierent publications: about one million,* [105] up to one and a
half million,* [106] about one and a half million people removed from the psychiatric registry.* [107] Mikhail Buyanov
provided the gure of over two million people removed from the psychiatric registry.* [108]
2.9 Theoretical analysis

In 1990, Psychiatric Bulletin of the Royal College of Psychiatrists published the articleCompulsion in psychiatry: blessing
or curse?" by 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 cn 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 inicting 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 dierent 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.* [109]
According to American psychiatrist Oleg Lapshin, Russia until 1993 did not have any specic legislation in the eld 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 of that made the abuse of psychiatry
possible to suppress those who opposed the political regime, and that created the vicious practice of ignoring the rights
of the mentally ill.* [110]
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:* [111]
2.9. THEORETICAL ANALYSIS
21
1. The ideologizing of science, its breakaway from the achievements of world psychiatry, the party orientation of
Soviet forensic psychiatry.
2. The lack of legal basis.
3. The total nationalization of mental health service.
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.* [20] Thus, it is not
psychiatry itself that is punitive, but the totalitarian state uses psychiatry for punitive purposes with ease.* [20]
According to Larry Gostin, the root cause of the problem was the State itself.* [112] The denition of danger was radically
extended by the Soviet criminal system to cover politicalas well as customary physical types of danger.* [112]
As Bloch and Reddaway note, there are no objective reliable criteria to determine whether the person's behavior will be
dangerous, and approaches to the denition of dangerousness greatly dier among psychiatrists.* [113]
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.* [114]
According to Norman Sartorius, a former president of the World Psychiatric Association, political abuse of psychiatry
in the former Soviet Union was facilitated by the fact that the national classication included categories that could be
employed to label dissenters, who could then be forcibly incarcerated and kept in psychiatric hospitals for treatment
.* [115] Darrel Regier, vice-chair of the DSM-5 task force, has a similar opinion that the political abuse of psychiatry in
the USSR was sustained by the existence of a classication developed in the Soviet Union and used to organize psychiatric
treatment and care.* [116] In this classication, there were categories with diagnoses that could be given to political
dissenters and led to the harmful involuntary medication.* [116]
According to Moscow psychiatrist Alexander Danilin, the so-called nosologicalapproach in the Moscow psychiatric
school established by Snezhnevsky boiles down to the ability to make the only diagnosis, schizophrenia; psychiatry is
not science but such a system of opinions and people by the thousands are falling victims to these opinionsmillions of
lives were crippled by virtue of the concept sluggish schizophreniaintroduced some time once by an academician
Snezhnevsky, whom Danilin called a state criminal.* [117]
St Petersburg academic psychiatrist professor Yuri Nuller notes that the concept of Snezhnevsky's school allowed psychiatrists to consider, for example, schizoid psychopathy and even schizoid character traits as early, delayed in their
development, stages of the inevitable progredient process, rather than as personality traits inherent to the individual, the
dynamics of which might depend on various external factors.* [118] The same also applied to a number of other personality disorders.* [118] It entailed the extremely broadened diagnostics of sluggish (neurosis-like, psychopathy-like)
schizophrenia.* [118] Despite a number of its controversial premises and in line with the traditions of then Soviet science,
Snezhnevsky's hypothesis has immediately acquired the status of dogma which was later overcome in other disciplines
but rmly stuck in psychiatry.* [119] Snezhnevsky's concept, with its dogmatism, proved to be psychologically comfortable for many psychiatrists, relieving them from doubt when making a diagnosis.* [119] That carried a great danger:
any deviation from a norm evaluated by a doctor could be regarded as an early phase of schizophrenia, with all ensuing
consequences.* [119] It resulted in the broad opportunity for voluntary and involuntary abuses of psychiatry.* [119] But
Snezhnevsky did not take civil and scientic courage to reconsider his concept which clearly reached a deadlock.* [119]
According to American psychiatrist Walter Reich, the misdiagnoses of dissidents resulted from some characteristics of
Soviet psychiatry that were distortions of standard psychiatric logic, theory, and practice.* [49]
According to Semyon Gluzman, abuse of psychiatry to suppress dissent is based on condition of psychiatry in a totalitarian
state.* [16] Psychiatric paradigm of a totalitarian state is culpable for its expansion into spheres which are not initially
those of psychiatric competence.* [16] Psychiatry as a social institution, formed and functioning in the totalitarian state, is
incapable of not being totalitarian.* [16] Such psychiatry is forced to serve the two dierently directed principles: care and
treatment of mentally ill citizens, on the one hand, and psychiatric repression of people showing political or ideological
dissent, on the other hand.* [16] In the conditions of the totalitarian state, independent-minded psychiatrists appeared and
may again appear, but these few people cannot change the situation in which thousands of others, who were brought up
on incorrect pseudoscientic concepts and fear of the state, will sincerely believe that the uninhibited, free thinking of a
22
citizen is a symptom of madness.* [16] Gluzman species the following six premises for the unintentional participation of
doctors in abuses:* [16]
1. The specicity, in the totalitarian state, of the psychiatric paradigm tightly sealed from foreign inuences.
2. The lack of legal conscience in most citizens including doctors.
3. Disregard for fundamental human rights on the part of the lawmaker and law enforcement agencies.
4. Declaratory nature or the absence of legislative acts that regulate providing psychiatric care in the country. The
USSR, for example, adopted such an act only in 1988.
5. The absolute state paternalism of totalitarian regimes, which naturally gives rise to the dominance of the archaic
paternalistic ethical concept in medical practice. Professional consciousness of the doctor is based on the almost
absolute right to make decisions without the patient's consent (i.e. there is disregard for the principle of informed
consent to treatment or withdrawal from it).
6. The fact, in psychiatric hospitals, of frustratingly bad conditions, which refer primarily to the poverty of health care
and inevitably lead to the dehumanization of the personnel including doctors.
Gluzman says that there, of course, may be a dierent approach to the issue expressed by Michel Foucault.* [120] According to Michael Perlin, Foucault in his book Madness and Civilization documented the history of using institutional
psychiatry as a political tool, researched the expanded use of the public hospitals in the 17th century in France and came
to the conclusion thatconnement [was an] answer to an economic crisis... reduction of wages, unemployment, scarcity
of coinand, by the 18th century, the psychiatric hospitals satised the indissociably economic and moral demand for
connement.* [121]
In 1977, British psychiatrist David Cooper asked Foucault the same question which Claude Bourdet had formerly asked
Viktor Fainberg during a press conference given by Fainberg and Leonid 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.* [122]
In the discussion Connement, Psychiatry, Prison, Foucault states the cooperation of psychiatrists with the KGB in the
Soviet Union was not abuse of medicine, but an evident case and condensationof psychiatry's inheritance, an
intensication, the ossication of a kinship structure that has never ceased to function.* [123] Foucault believed that
the abuse of psychiatry in the USSR of the 1960s was a logical extension of the invasion of psychiatry into the legal system.* [124] In the discussion with Jean Laplanche and Robert Badinter, Foucault says that criminologists of the 1880
1900s started speaking surprisingly modern language:The crime cannot be, for the criminal, but an abnormal, disturbed
behavior. If he upsets society, it's because he himself is upset.* [125] This led to the twofold conclusions.* [125] First,
the judicial apparatus is no longer useful.The judges, as men of law, understand such complex, alien legal issues, purely
psychological matters no better than the criminal. So commissions of psychiatrists and physicians should be substituted
for the judicial apparatus.* [125] And in this vein, concrete projects were proposed.* [125] Second, We must certainly
treat this individual who is dangerous only because he is sick. But, at the same time, we must protect society against him.
*
[125] Hence comes the idea of mental isolation with a mixed function: therapeutic and prophylactic.* [125] In the 1900s,
these projects have given rise to very lively responses from European judicial and political bodies.* [126] However, they
found a wide eld of applications when the Soviet Union became one of the most common but by no means exceptional
cases.* [126]
According to American psychiatrist Jonas Robitscher, psychiatry has been playing a part in controlling deviant behavior
for three hundred years.* [127] Vagrants, originals,eccentrics, and homeless wanderers who did little harm but were
vexatious to the society they lived in were, and sometimes still are, conned to psychiatric hospitals or deprived of their
legal rights.* [127] Some critics of psychiatry consider the practice as a political use of psychiatry and regard psychiatry
as promoting timeserving.* [127]
As Vladimir Bukovsky and Semyon Gluzman point out, it is dicult for the average Soviet psychiatrist to understand the
dissident's poor adjustment to Soviet society.* [128] This view of dissidence has nothing surprising about itconformity
reigned in Soviet consciousness; a public intolerance of non-conformist behavior always penetrated Soviet culture; and
the threshold for deviance from custom was similarly low.* [128]
2.9. THEORETICAL ANALYSIS
23
An example of the low threshold is a point of Donetsk psychiatrist Valentine Pekhterev, who argues that psychiatrists
speak of the necessity of adapting oneself to society, estimate the level of man's social functioning, his ability to adequately test the reality and so forth.* [129] In Pekhterev's words, these speeches hit point-blank on the dissidents and
revolutionaries, because all of them are poorly functioning in society, are hardly adapting to it either initially or after
increasing requirements.* [129] They turn their inability to adapt themselves to society into the view that the company
breaks step and only they know how to help the company restructure itself.* [129] The dissidents regard the cases of
personal maladjustment as a proof of public ill-being.* [129] The more such cases, the easier it is to present their personal
ill-being as public one.* [129] They bite the society's hand that feed them only because they are not given a right place
in society.* [129] Unlike the dissidents, the psychiatrists destroy the hardly formed defense attitude in the dissidents by
regardingpublic well-beingas personal one.* [129] The psychiatrists extract teeth from the dissidents, stating that they
should not bite the feeding hand of society only because the tiny group of the dissidents feel bad being at their place.* [129]
The psychiatrists claim the need to treat not society but the dissidents and seek to improve society by preserving and improving the mental health of its members.* [129] After reading the book Institute of Fools by Viktor Nekipelov, Pekhterev
concluded that allegations against the psychiatrists sounded from the lips of a negligible but vociferous part of inmates
who when surfeiting themselves with cakes pretended to be suerers.* [129]
According to the response by Robert van Voren, Pekhterev in his article condescendingly argues that the Serbsky Institute
was not so bad place and that Nekipelov exaggerates and slanders it, but Pekhterev, by doing so, misses the main point:
living conditions in the Serbsky Institute were not bad, those who passed through psychiatric examination there were in a
certain senseon holidayin comparison with the living conditions of the Gulag; and all the same, everyone was aware that
the Serbsky Institute was more than the gates of hellfrom where people were sent to specialized psychiatric hospitals
in Chernyakhovsk, Dnepropetrovsk, Kazan, Blagoveshchensk, and that is not all.* [130] Their life was transformed to
unimaginable horror with daily tortures by forced administration of drugs, beatings and other forms of punishment.* [130]
Many went crazy, could not endure what was happening to them, some even died during thetreatment(for example, a
miner from Donetsk Alexey Nikitin).* [130] Many books and memoirs are written about the life in the psychiatric Gulag
and every time when reading them a shiver seizes us.* [130] The Soviet psychiatric terror in its brutality and targeting the
mentally ill as the most vulnerable group of society had nothing on the Nazi euthanasia programs.* [131] The punishment
by placement in a mental hospital was as eective as imprisonment in Mordovian concentration camps in breaking persons
psychologically and physically.* [131] The recent history of the USSR should be given a wide publicity to immunize
society against possible repetitions of the Soviet practice of political abuse of psychiatry.* [131] The issue remains highly
relevant.* [131]
According to Fedor Kondratev, an expert of the Serbsky Center and supporter of Snezhnevsky and his colleagues who
developed the concept of sluggish schizophrenia in the 1960s,* [132] those arrested by the KGB under RSFSR Criminal
Code Article 70 (anti-Soviet agitation and propaganda), 190-1 (dissemination of knowingly false fabrications that
defame the Soviet state and social system) made up, in those years, the main group targeted by the period of using
psychiatry for political purposes.* [133] It was they who began to be searched for psychopathological mechanisms
and, therefore, mental illness which gave the grounds to recognize an accused person as mentally incompetent, to debar
him from appearance and defence in court, and then to send him for compulsory treatment to a special psychiatric hospital of the Ministry of Internal Aairs.* [133] The trouble (not guilt) of Soviet psychiatric science was its theoretical
overideologization as a result of the strict demand to severely preclude any deviations from the exclusively scientic
concept of MarxismLeninism.* [3] This showed, in particular, in the fact that Soviet psychiatry under the totalitarian
regime considered that penetrating the inner life of an ill person was awed psychologization, existentionalization.* [3]
In this connection, one did not admit the possibility that an individual can behave in a dierent way than others do
not only because of his mental illness but on the ground alone of his moral sets consistently with his conscience.* [3] It
entailed the consequence: if a person dierent from all others opposes the political system, one needs to search forpsychopathological mechanismsof his dissent.* [3] Even in cases when catamnesis conrmed the correctness of a diagnosis
of schizophrenia, it did not always mean that mental disorders were the cause of dissent and, all the more, that one needed
to administer compulsory treatmentfor itin special psychiatric hospitals.* [3] What seems essential is another fact that
the mentally ill could oppose the totalitarianism as well, by no means due to their psychopathological mechanisms,
but as persons who, despite having the diagnosis of schizophrenia, retained moral civic landmarks.* [134] Any ill person
with schizophrenia could be a dissident if his conscience could not keep silent, Kondratev says.* [135]
According to St Petersburg psychiatrist Vladimir Pshizov, with regard to punitive psychiatry, the nature of psychiatry
is of such a sort that using psychiatrists against opponents of authorities is always tempting for the authorities, because
it is seemingly possible not to take into account an opinion by the person who received a diagnosis.* [136] Therefore,
24
the issue will always remain relevant.* [136] While we do not have government policy of using psychiatry for repression,
psychiatrists and former psychiatric nomenklatura retained the same on-the-spot reexes.* [136]
As Ukrainian psychiatrist Ada Korotenko notes, the use of punitive psychiatry allowed of avoiding the judicial procedure
during which the accused might declare the impossibility to speak publicly and the violation of their civil rights.* [137]
Making a psychiatric diagnosis is insecure and can be based on a preconception.* [138] Moreover, while diagnosing mental
illness, subjective fuzzy diagnostic criteria are involved as arguments.* [138] The lack of clear diagnostic criteria and clearly
dened standards of diagnostics contributes to applying punitive psychiatry to vigorous and gifted citizens who disagree
with authorities.* [138] At the same time, most psychiatrists incline to believe that such a misdiagnosis is less dangerous
than not diagnosing mental illness.* [138]
German psychiattist Hanfried Helmchen says the uncertainty of diagnosis is prone to other than medical inuence, e.g.,
political inuence, as was the case with Soviet dissenters who were stied by a psychiatric diagnosis, especially that of
sluggish schizophrenia,in order to take them away from society in special psychiatric hospitals.* [139]
According to Russian psychologist Dmitry Leontev, punitive psychiatry in the Soviet Union was based on the assumption
that only a madman can go against public dogma and seek for truth and justice.* [140]
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.* [141] The concerns
about political abuse of psychiatry as a tactic of controlling dissent have been regularly voiced by American psychiatrist
Thomas Szasz,* [142] and he mentioned that these authors, who correctly emphasized the value-laden nature of psychiatric
diagnoses and the subjective character of psychiatric classications, failed to accept the role of psychiatric power.* [143]
Musicologists, drama critics, art historians, and many other scholars also create their own subjective classications; however, lacking state-legitimated power over persons, their classications do not lead to anyone's being deprived of property,
liberty, or life.* [143] For instance, plastic surgeon's classication 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.* [143]
The bedrock of political medicine is coercion masquerading as medical treatment.* [144] What transforms coercion into
therapy are physicians diagnosing the person's condition aillness,declaring the intervention they impose on the victim
a treatment,and legislators and judges legitimating these categorizations as illnessesand treatments.* [144] 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.* [144] 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.* [145]
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 into the social role of the psychiatrist in democratic and
totalitarian societies alike.* [145] Psychiatrically and legally t subjects for involuntary mental hospitalization had always
been dissidents.* [146] It is the contents and contours of dissent that has changed.* [146] Before the American Civil
War, dissent was constituted by being a Negro and wanting to escape from slavery.* [146] In Soviet Russia, dissent was
constituted by wanting toreformMarxism or emigrate to escape from it.* [146] As Szasz put it,the classication by
slave owners and slave traders of certain individuals as Negroes was scientic, in the sense that whites were rarely classied as blacks. But that did not prevent the abuseof such racial classication, because (what we call) its abuse was,
in fact, its use.* [143] 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.* [147] 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.* [147]
As Michael Robertson and Garry Walter suppose, psychiatric power in practically all societies expands on the grounds of
public safety, which, in the view of the leaders of the USSR, was best maintained by the repression of dissidence.* [148]
According to Gwen Adshead, a British forensic psychotherapist at the Broadmoor Hospital, the question is what is meant
by the wordabnormal.* [149] Evidently it is possible for abnormal to be identied associally inappropriate.* [149]
If that is the case, social and political dissent is turned into a symptom by the medical terminology, and thereby becomes
an individual's personal problem, not a social matter.* [149]
According to Russian psychiatrist Emmanuil Gushansky, psychiatry is the only medical specialty in which the doctor is
given the right to violence for the benet of the patient.* [150] The application of violence must be based on the mental
health law, must be as much as possible transparent and monitored by representatives of the interests of persons who
2.10. RESIDUAL PROBLEMS
25
are in need of involuntary examination and treatment.* [150] While being hospitalized in a psychiatric hospital for urgent
indications, the patient should be accompanied by his relatives, witnesses, or other persons authorized to control the actions
of doctors and law-enforcement agencies.* [150] Otherwise, psychiatry becomes an obedient maid for administrative and
governmental agencies and is deprived of its medical function.* [150] It is the police that must come to the aid of citizens
and is responsible for their security.* [95] Only later, after the appropriate legal measures for social protection have been
taken, the psychiatrist must respond to the queries of law enforcement and judicial authorities by solving the issues of
involuntary hospitalization, sanity, etc.* [95] In Russia, all that goes by opposites.* [95] The psychiatrist is vested with
punitive functions, is involved in involuntary hospitalization, the state machine hides behind his back, actually manipulating
the doctor.* [95] The police are reluctant to investigate oences committed by the mentally ill.* [95] After receiving the
information about their disease, the bodies of inquiry very often stop the investigation and do not bring it to the level of
investigative actions.* [95] Thereby psychiatry becomes a cloak for the course of justice and, by doing so, serves as a source
for the rightlessness and stigmatization of both psychiatrists and persons with mental disorders.* [95] The negative attitude
to psychiatrists is thereby supported by the state machine and is accompanied by the aggression against the doctors, which
increases during the periods of social unrest.* [95]
Vladimir Bukovsky, well known for his struggle against political abuse of psychiatry in the Soviet Union, explained that
using psychiatry against dissidents was usable to the KGB because hospitalization did not have an end date, and, as a
result, there were cases when dissidents were kept in psychiatric prison hospitals for 10 or even 15 years.* [151] Once
they pump you with drugs, they can forget about you, he said and added, I saw people who basically were asleep for
years.* [152]
2.10 Residual problems

In the opinion of the Moscow Helsinki Group chairwoman Lyudmila Alexeyeva, the attribution of a mental illness to
a prominent gure who came out with a political declaration or action is the most signicant factor in the assessment
of psychiatry during the 19601980s.* [153] The practice of forced connement of political dissidents in psychiatric
facilities in the former USSR and Eastern Europe destroyed the credibility of psychiatric practice in these countries.* [27]
When psychiatric profession is discredited in one part of the world, psychiatry is discredited throughout the world.* [154]
Psychiatry lost its professional basis entirely with its abuse to stie dissidence in the former USSR and in the so-called
euthanasia program in Nazi Germany.* [155] There is little doubt that the capacity for using psychiatry to enforce social
norms and even political interests is immense.* [27] Now psychiatry is vulnerable because many of its notions have been
questioned, and the sustainable pattern of mental life, of boundaries of mental norm and abnormality has been lost,
director of the Moscow Research Institute for Psychiatry Valery Krasnov says, adding that psychiatrists have to seek new
reference points to make clinical assessments and new reference points to justify old therapeutical interventions.* [153]
As Emmanuil Gushansky states, today subjective position of a Russian patient toward a medical psychologist and psychiatrist is defensive in nature and prevents the attempt to understand the patient and help him assess his condition.* [156]
Such a position is related to constant, subconscious fear of psychiatrists and psychiatry.* [156] This fear is caused by not
only abuse of psychiatry, but also constant violence in the totalitarian and post-totalitarian society.* [156] The psychiatric violence and psychiatric arrogance as one of manifestations of such violence is related to the primary emphasis on
symptomatology and biological causes of a disease, while ignoring psychological, existential, and psychodynamic factors.* [156] Gushainsky notices that the modern Russian psychiatry and the structure of providing mental health care are
aimed not at protecting the patient's right to an own place in life, but at discrediting such a right, revealing symptoms and
isolating the patient.* [95]
The psychiatrist became a scarecrow attaching psychiatric labels.* [95] He is feared, is not conded, is not taken into
condence in the secrets of one's soul and is asked to provide only medications.* [95] Psychiatric labels, or stigmas, have
spread so widely that there is no such thing as the media that does not call a disliked person schizo and does not generalize
psychiatric assessments to phenomena of public life.* [95] The word psikhushka entered everyday vocabulary.* [95] All
persons who deviate from the usual standards of thought and behavior are declared mentally ill, with an approving giggling of public.* [95] Not surprisingly, during such a stigmatization, people with real mental disorders fear publicity like
the plague.* [95] Vilnius psychologist Oleg Lapin has the same point that politicians and the press attach psychological,
psychiatric and medical labels; he adds that psychiatry has acquired the new status of normalizing life that was previously
possessed by religion.* [157] Formerly, one could say: you are going against God or God is with us; now one can say: I
26
behave reasonably, adequately, and you do not behave in that way.* [157] In 2007, Alexander Dugin, a professor at the
Moscow State University and adviser to State Duma speaker Sergei Naryshkin, presented opponents of Vladimir Putin's
policy as mentally ill by saying, There are no longer opponents of Putin's policy, and if there are, they are mentally ill
and should be sent to prophylactic health examination.* [158] In The Moscow Regional Psychiatric Newspaper of 2012,
psychiatrist Dilya Enikeyeva in violation of medical privacy and ethics publicized the diagnosis of histrionic personality
disorder, which she in absentia gave Kseniya Sobchak, a Russian TV anchor and a member of political opposition, and
stated that Sobchak was harmful to society.* [159]
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.* [160] 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.* [160] It demonstrated that the actual situation was much sorer
and that many individuals had been aected.* [160] Millions of individuals were treated and stigmatized by an outdated
biologically oriented and hospital-based mental health service.* [160] Living conditions in clinics were bad, sometimes
even terrible, and violations of human rights were rampant.* [160] According to the data of a census published in 1992,
the mortality of the ill with schizophrenia exceeded that of the general population by 46 times for the age of 2039 years,
by 34 times for the age of 3039 years, by 1.52 times for the age over 40 years (larger values are for women).* [161]
According to Robert van Voren, although for several years, especially after the implosion of the USSR and during the
rst years of Boris Yeltsin's rule, the positions of the Soviet psychiatric leaders were in jeopardy, now one can rmly
conclude that they succeeded in riding out the storm and retaining their powerful positions.* [162] In addition, they also
succeeded in avoiding an inow of modern concepts of delivering mental health care and a fundamental change in the
structure of psychiatric services in Russia.* [162] On the whole, in Russia, the impact of mental health reformers has been
the least.* [162] Even the reform eorts made in such places as St. Petersburg, Tomsk, and Kaliningrad have faltered or
were encapsulated as centrist policies under Putin brought them back under control.* [162]
Throughout the post-communist period, the pharmaceutical industry has mainly been an obstacle to reform.* [163] Aiming
to explore the vast market of the former USSR, they used the situation to make professionals and services totally dependent
on their nancial sustenance, turned the major attention to the availability of medicines rather than that of psycho-social
rehabilitation services, and stimulated corruption within the mental health sector very much.* [163]
At the turn of the century, the psychiatric reform that had been implemented by Franco Basaglia in Italy became known
and was publicly declared to be implemented in Russia, with the view of retrenchment of expenditures.* [164] But when
it became clear that even more money was needed for the reform, it got bogged down in the same way the reform
of the army and many other undertakings did.* [164] Russia is decades behind the countries of the European Union in
mental health reform, which has already been implemented or is being implemented in them.* [165] Until Russian society,
Gushansky says, is aware of the need for mental health reform, we will live in the atmosphere of animosity, mistrust and
violence.* [165] Many experts believe that problems spread beyond psychiatry to society as a whole.* [166] As Robert
van Voren supposes, the Russians want to have their compatriots with mental disorders locked up outside the city and do
not want to have them in community.* [166] Despite the 1992 Russian Mental Health Law, coercive psychiatry in Russia
remains generally unregulated and fashioned by the same trends toward hyperdiagnosis and overreliance on institutional
care characteristic of the Soviet period.* [167] In the Soviet Union, there had been an increase of the bed numbers because
psychiatric services had been used to treat dissidents.* [168]
In 2005, the Russian Federation had one of the highest levels of psychiatric beds per capita in Europe at 113.2 per 100,000
population, or more than 161,000 beds.* [169] In 2014, Russia has 104.8 beds per 100,000 population and no actions
have been taken to arrange new facilities for outpatient services.* [170] Persons who do not respond well to treatment
at dispensaries can be sent to long-term social care institutions (internats) wherein they remain indenitely.* [169] The
internats are managed by oblast Social Protection ministries.* [169] Russia had 442 psychoneurologic internats by 1999,
and their number amounted to 505 by 2013.* [171] The internats provided places for approximately 125,000 people in
2007.* [169] In 2013, Russian psychoneurologic internats accommodated 146,000 people, according to the consolidated
data of the Department of Social Protection of Moscow and the Ministry of Labour and Social Protection of the Russian
Federation.* [171] It is supposed that the number of beds in internats is increasing at the same rate with which the number
of beds is decreasing in psychiatric hospitals.* [172] Lyubov Vinogradova of the Independent Psychiatric Association
of Russia provides the dierent gure of 122,091 or 85.5 places in psychoneurologic institutions of social protection
(internats) per 100,000 population in 2013 and says that Russia is high on Europe's list of the number of places in the
institutions.* [173] Vinogradova states that many regions have the catastrophic shortage of places in psychoneurological
27
internats, her words point out to the need to increase the number of places there and to the fact that the Independent
Psychiatric Association of Russia is forcing transinstitutionalizationrelocating the mentally ill from their homes and
psychiatric hospitals to psychoneurological internats.* [173]
One of the buildings of the Pavlov Psychiatric Hospital in Kiev
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 in its children's
unit alone were more than in the whole of Great Britain.* [174] In Ukraine, public opinion did not contribute to the
protection of citizens against possible recurrence of political abuse of psychiatry.* [175] There were no demonstrations
and rallies in support of the mental health law.* [175] But there was a public campaign against developing the civilized law
and against liberalizing the provision of psychiatric care in the country.* [175] The campaign was initiated and conducted
by relatives of psychiatric patients.* [175] They wrote to newspapers, yelled in busy places and around them, behaved in
the unbridled way in ministerial oces and corridors.* [175] Once Gluzman saw through a trolleybus window a group of
20-30 people standing by a window of the Cabinet of Ministers of Ukraine with red ags, portraits of Lenin and Stalin and
the slogan coarsely written on the white cardboard: Get the Gluzman psychiatry o Ukraine!"* [175] Activists of the
dissident movement far from the nostalgia for the past also participated in the actions against changes in the mental health
system.* [175] But in general, it should be remembered that all these protest actions have been activated by nomenklatura
psychiatrists.* [175] The whole Ukrainian psychiatric system actually consists of the two units: hospital for treatment of
acute psychiatric conditions and internat-hospice for helpless chronic patientsunable to live on their own.* [176] And
between hospital and internat-hospice is desert.* [176] That is why about 40 percent of patients in any Ukrainian psychiatric
hospital are so-called social patients whose stay in the psychiatric hospital is not due to medical indications.* [176] A similar
pattern is in internats.* [176] A signicant part of their lifelong customers could have lived long enough in society despite
their mental illnesses.* [176] They could have lived quite comfortably and safely for themselves and others in special
dorms, nursing homes, halfway houses.* [176] Ukraine does not have anything like that.* [176]
In the Soviet times, mental hospitals were frequently created in former monasteries, barracks, and even concentration
28
A barrack of a concentration camp seen from outside is of a type of buildings in which Russian psychiatric hospitals have often been
located
camps.* [170] Soa Dorinskaya, a human rights activist and psychiatrist, says she saw former convicts who have been
living in a Russian mental hospital for ten years and will have been staying there until their dying day because of having
no home.* [177] Deinstitutionalization has not touched many of the hospitals, and persons still die inside them.* [170] In
2013, 70 persons died in a re just outside Novgorod and Moscow.* [170] Living conditions are often insucient and
sometimes horrible: 12 to 15 patients in a big room with bars on the windows, no bedside tables, often no partitions,
not enough toilets.* [170] The number of outpatient clinics designed for the primary care of the mentally disordered
stopped increasing in 2005 and was reduced to 277 in 2012 as against 318 in 2005.* [170] Stigma linked to mental disease
is at the level of xenophobia.* [170] The Russian public perceive the mentally sick as harmful, useless, incurable, and
dangerous.* [170] The social stigma is maintained not only by the general public but also by psychiatrists.* [170]
Soviet mentality has endured into the present day.* [170] For instance, in spite of the removal of homosexuality from the
nomenclature of mental disorders, 62.5% of 450 surveyed psychiatrists in the Rostov Region view it as an illness, and up
to three quarters view it as immoral behavior.* [170] The psychiatrists sustain the ban on gay parades and the use of veiled
schemes to lay o openly lesbian and gay persons from schools, child care centers, and other public institutions.* [170] The
chief psychiatrist of Russia Zurab Kekelidze in his 2013 interview to Dozhd says that a part of the cases of homosexuality
is a mental disorder, he counters the remark that the World Health Organization removed homosexuality from the list
of mental disorders by stating that it is not true.* [178] The trend to consider homosexuality as a mental disorder was
supported by the Independent Psychiatric Association of Russia in 2005 when its president Savenko expressed their joint
surprise at the proposal by the Executive Committee of the American Psychiatric Association to exclude homosexuality as
a mental disorder from manuals on psychiatry, referred the proposal to antipsychiatric actions, and stated that ideological,
social and liberal reasoning for the proposal was substituted for scientic one.* [179] In 2014, Savenko changed his mind
about homosexuality, and he along with Alexei Perekhov in their joint paper criticized and referred the trend to consider
homosexuality as a mental disorder to Soviet mentality.* [170]
In 1994, there was organized a conference concerned with the theme of political abuse of psychiatry and attended by
representatives from dierent former Soviet Republics from Russia, Belarus, the Baltics, the Caucasus, and some
of the Central Asian Republics.* [180] Dainius Puras made a report on the situation within the Lithuanian Psychiatric
Association, where discussion had been held but no resolution had been passed.* [180] 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 hyperdiagnosisor scientic disagreement.* [180] It was particularly noteworthy that
29
A barrack of a concentration camp seen from inside
Tatyana Dmitrieva, the then Director of the Serbsky Institute, was a proponent of such belittlement.* [180] This was not
so queer, because she was a close friend of the key architects of political psychiatry.* [180]
In the early 1990s, she spoke the required words of repentance for political abuse of psychiatry* [181] 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.* [182] Her words were widely broadcast abroad but were published only in
the St. Petersburg newspaper Chas Pik within the country.* [183] However, in her 2001 book Aliyans Prava i Milosediya
(The Alliance of Law and Mercy), Dmitrieva wrote that there were no psychiatric abuses and certainly no more than in
Western countries.* [182] Moreover, the book makes the charge that professor Vladimir Serbsky and other intellectuals
were wrong not to cooperate with the police department in preventing revolution and bloodsheds and that the current
generation is wrong to oppose the regime.* [184] In 2007, Dmitrieva asserted that the practice of punitive psychiatry
had been grossly exaggerated, while nothing wrong had been done by the Serbsky Institute.* [185] After that an ocial at
the Serbsky Institute declaredpatientVladimir Bukovsky, who was then going to run for the President of the Russian
Federation, undoubtedly psychopathic.* [185]
While speaking of the Serbsky Center, Yuri Savenko alleges thatpractically 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.
*
[186] According to human rights activist and former psychiatrist Soa Dorinskaya, the system of Soviet psychiatry has
not been destroyed, the Serbsky Institute is standing where it did, the same people who worked in the Soviet system are
working there.* [187] She says we have a situation like after the defeat of fascism in Germany, when fascism ocially
collapsed, but all governors of acres, judges and all people remained after the fascist regime.* [187]
In his article of 2002, Alan A. Stone, who as a member of team had examined Pyotr Grigorenko and found him mentally
30
healthy in 1979,* [188] disregarded the ndings of the World Psychiatric Association and the later avowal of Soviet
psychiatrists themselves and put forward the academically revisionist theory that there was no political abuse of psychiatry
as a tool against pacic dissidence in the former USSR.* [189] He asserted that it was time for psychiatry in the Western
countries to reconsider the supposedly documented accounts of political abuse of psychiatry in the USSR in the hope
of discovering that Soviet psychiatrists were more deserving of sympathy than condemnation.* [58] In Stone's words,
he believes that Snezhnevsky was wrongly condemned by critics.* [58] According to Stone, one of the rst points the
Soviet psychiatrists who have been condemned for unethical political abuse of psychiatry make is that the revolution is
the greatest good for the greatest number, the greatest piece of social justice, and the greatest benecence imaginable in
the twentieth century.* [190] In the Western view, the ethical compass of the Soviet psychiatrists begins to wander when
they act in the service of this greatest benecence.* [190]
According to St Petersburg psychiatrist Vladimir Pshizov, a disastrous factor for domestic psychiatry is that those who
had committed the crime against humanity were allowed to stay on their positions until they can leave this world in a
natural way.* [191] Those who retained their positions and inuence turned domestic psychiatry from politically motivated
one to criminally motivated one because the sphere of interests of this public has been reduced to making a business
of psychopharmacologic drugs and taking possession of the homes of the ill.* [191] In Soviet times, all the heads of
departments of psychiatry, all the directors of psychiatric research institutes, all the head doctors of psychiatric hospitals
were the CPSU nomenklatura, which they remained so far.* [191] The representative of nomenklatura in psychiatry had
the scheme of career that is simple and often stereotyped: for one to two years, he run errands as a resident, then joined the
party and became a partgrouporg.* [192]* [191] His junior colleagues (usually non-partisan ones) collected and processed
material for his dissertation.* [191] Its review of literature, particularly in a research institute for psychiatry, was often
written by patients, because only they knew foreign languages, and their party comrades were not up to it, the natural
habitat did not stimulate learning a foreign language.* [191]
Robert van Voren also says Russian psychiatry is now being headed by the same psychiatrists who was heading psychiatry
in Soviet times.* [193] Since then Russian psychiatric system has not almost changed.* [193] In reality, we still see a sort
of the Soviet psychiatry that was in the late 1980s.* [193] Russian psychiatrists do not have access to specialized literature
published in other countries and do not understand what is world psychiatry.* [193] Sta training has not changed, literature
is inaccessible, the same psychiatrists teach new generations of specialists.* [193] Those of them who know what is world
psychiatry and know it is not the same as what is happening in Russia are silent and afraid.* [193] The powerful core of the
old nomenklatura in psychiatry was concentrated in Moscow, and it was clear that the struggle inside their fortress would be
not only dicult, but also it would be a waste of time, energy and resources, so the Global Initiative on Psychiatry has been
avoiding Moscow almost completely for all the years.* [194] Instead, the Global Initiative on Psychiatry took active part
in projects for reforming the mental health service in Ukraine, donated a printing plant to Ukrainian public, organized
a publishing house, helped print a huge amount of medical and legal literature distributed for free, but the Ukrainian
tax police accused the publishing house of manufacturing counterfeit dollars, and a signicant part of humanitarian aid
that the Global Initiative on Psychiatry had gathered in the Netherlands for Ukrainian psychiatric hospitals was stolen in
Kiev.* [194]
Many of the current leaders of Russian psychiatry, especially those who were related to the establishment in Soviet
period, have resiled from their avowal read at the 1989 General Assembly of the WPA that Soviet psychiatry had been
systematically abused for political purposes.* [195] Among such leaders who did so is Aleksandr Tiganov, a pupil of
Snezhnevsky, full member of the Russian Academy of Medical Sciences, the director of its Mental Health Research
Center, and the chief psychiatrist of the Ministry of Health of the Russian Federation. In 2011, when asked whether ill or
healthy were those examined because of their disagreements with authority, Tiganov answered, These people suered
from sluggish schizophrenia and were on the psychiatric registry.* [196] According to Tiganov, it was rumored that
Snezhnevsky took pity on dissenters and gave them a diagnosis required for placing in a special hospital to save them
from a prison, but it is not true, he honestly did his medical duty.* [196] The same ideas are voiced in the 2014 interview
by Anatoly Smulevich, a pupil of Snezhnevsky, full member of the Russian Academy of Medical Sciences; he says what
was attributed to Snesnevsky was that he recognized the healthy as the ill, it did not happen and is pure slander, it is
completely ruled out for him to give a diagnosis to a healthy person.* [197]
In 2007, Mikhail Vinogradov, one of the leading sta members of the Serbsky Center, strongly degraded the human
rights movement of the Soviet era in every possible way and tried to convince that all political dissidents who had been to
his institution were indeed mentally ill.* [198] In his opinion,now it is clear that all of them are deeply aected people.
*
[198] In 2012, Vinogradov said the same, Do you talk about human rights activists? Most of them are just unhealthy
31
people, I talked with them. As for the dissident General Grigorenko, I too saw him, kept him under observation, and
noted oddities of his thinking. But he was eventually allowed to go abroad, as you know... Who? Bukovsky? I talked
with him, and he is a completely crazy character. But he too was allowed to go abroad! You see, human rights activists
are people who, due to their mental pathology, are unable to restrain themselves within the standards of society, and the
West encourages their inability to do so.* [199] In the same year, he oered to restore Soviet mental health law and said
ithas never been used for political persecution.Human rights activists who claim it did, in Vinogradov's words, are
not very mentally healthy.* [200]
Russian psychiatrist Fedor Kondratev not only denied accusations that he was ever personally engaged in Soviet abuses of
psychiatry; he stated publicly that the very conception of the existence of Soviet-era punitive psychiatrywas nothing
more than:the fantasy [vymysel] of the very same people who are now defending totalitarian sects. This is slander, which
was [previously] used for anti-Soviet ends, but is now being used for anti-Russian ends.* [201] He says that there were
attempts to use of psychiatry for political purposes but there was no mass psychiatric terror, he calls allegations about the
terror a propagandistic weapon of activists of the Cold War.* [3] As Alexander Podrabinek writes, psychiatrists of punitive
conscription and namely Kondratev are relatively indierent to the public's indignation over illegal use of psychiatry both
in Soviet times and now, they do not notice this public, allowing themselves to ignore any unprofessional opinion.* [202] In
response to the article by Podrabinek, Kondratev instituted a suit against Podrabinek under Russian Civil Code Article 152
on protecting one's honor, dignity and business reputation.* [203] According to Valery Krasnov and Isaak Gurovich, ocial
representatives of psychiatry involved in its political abuse never acknowledged the groundlessness of their diagnostics
and actions.* [204] The absence of the acknowledgement and the absence of an analysis of made errors cast a shadow
upon all psychiatrists in the USSR and, especially, in Russia.* [204] As Russian-American historian Georgi Chernyavsky
writes, after the fall of the communist regime, no matter how some psychiatrists lean over backwards, foaming at the
mouth to this day when stating that they were slandered, that they did not give dissidents diagnoses-sentences, or that, at
least, these cases were isolated and not at all related to their personal activities, no matter how the doctors, if one may call
them so, try to rebut hundreds if not thousands of real facts, it is undoable.* [205]
In 2004, Savenko stated that the passed law on the state expert activity and the introduction of the profession of forensic
expert psychiatrist actually destroyed adversary-based examinations and that the Serbsky Center turned into the complete
monopolist of forensic examination, which it had never been under Soviet rule.* [206] Formerly, the court could include
any psychiatrist in a commission of experts, but now the court only chooses an expert institution.* [206] The expert has
the right to participate only in commissions that he is included in by the head of his expert institution, and can receive the
certicate of qualication as an expert only after having worked in a state expert institution for three years.* [206] The
Director of the Serbsky Center Dmitrieva was, at the same time, the head of the forensic psychiatry department which is
the only one in the country and is located in her Center.* [206] No one had ever had such a monopoly.* [206]
According to Savenko, the Serbsky Center has long labored to legalize its monopolistic position of the Main expert
institution of the country.* [207] The ambition and permissivenesswhich, due to proximity to power, allow the Serbsky
Center to get in touch over the telephone with the judges and explain to them who is who and what is the guideline, although
the judges themselves have already learned ithave turned out to be a considerable drop in the level of the expert reports
on many positions.* [207] Such a drop was inevitable and foreseeable in the context of the Serbsky Center eorts to
eliminate adversary character of the expert reports of the parties, then to maximally degrade the role of the specialist as a
reviewer and critic of the presented expert report, and to legalize the state of aairs.* [207] Lyubov Vinogradova believes
there has been a continuous diminution in patients' rights as independent experts are now excluded from processes, cannot
speak in court and can do nothing against the State experts.* [166]
On 28 May 2009, Yuri Savenko wrote to the then 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 the sharp drop in the level of forensic psychiatric examinations, which Savenko attributed
to the lack of competition within the sector and its increasing nationalization.* [208] 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 the
report, even such as the substantiation of its ndings, and not only the gross contradiction of its ndings to the descriptive
section of the report, but it is often a matter of concrete statements which are so contrary to generally accepted scientic
terms that doubts about the disinterestedness of the experts arise.* [208] According to the letter, courts, in violation of
procedural rules, do not analyze the expert report, its coherence and consistency in all its parts, do not check experts'
ndings for their accuracy, completeness, and objectivity.* [208]
On 15 June 2009, the working group chaired by the Director of the Serbsky Center Tatyana Dmitrieva sent the Supreme
32
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 led to appeal against the reports.* [207]
The reason put forward for the proposal was that the appeals against the expert reports were allegedly led without
regard for the scope of the caseand that one must appeal against the expert report only together with the sentence.
*
[207] In other words, according to Yuri Savenko, all professional errors and omissions are presented as untouchable by
virtue of the fact that they were inltrated into the sentence.* [207] That is cynicism of administrative resources, cynicism
of power, he says.* [207]
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 evaluationby Elena Shchukina and Sergei Shishkov* [209] focusing on
the inadmissibility of appealing against the expert report without regard for the scope of the evaluated case.* [207] While
talking about appealing againstthe reports, the authors of the paper, according to lawyer Dmitry Bartenev, mistakenly
identify the reports with actions of the experts (or an expert institution) and justify the impossibility of the parallel
examination and evaluation of the actions of the experts without regard for the scope of the evaluated case.* [207] Such a
conclusion made by the authors appears clearly erroneous because abuse by the experts of rights and legitimate interests
of citizens including trial participants, of course, may be a subject for a separate appeal.* [207]
According to the warning made in 2010 by Yuri Savenko at the same Congress, prof. Anatoly Smulevich, author of the
monographs Problema Paranoyi (The Problem of Paranoia) (1972) and Maloprogredientnaya Shizofreniya (Continuous
Sluggish Schizophrenia) (1987), which had contributed to the hyperdiagnosis of sluggish schizophrenia, again began
to play the same role he played before.* [164] Recently, under his inuence therapists began to widely use antidepressants
and antipsychotics but often in inadequate cases and in inappropriate doses, without consulting psychiatrists.* [210] This
situation has opened up a huge new market for pharmaceutical rms, with their unlimited capabilities, and the ow of
the mentally ill to internists.* [164] Smulevich bases the diagnosis of continuous sluggish schizophrenia, in particular, on
appearance and lifestyle and stresses that the forefront in the picture of negative changes is given to the contrast between
retaining mental activity (and sometimes quite high capacity for work) and mannerism, unusualness of one's appearance
and entire lifestyle.* [211]
According to the commentary by the Independent Psychiatric Association of Russia on the 2007 text by Vladimir Rotstein,
a doctrinist of Snezhnevsky's school, there are sucient patients with delusion of reformism in psychiatric inpatient
facilities for involuntary treatment.* [105] In 2012, delusion of reformism was mentioned as a symptom of mental disorder
in Psychiatry. National Manual edited by Tatyana Dmitrieva, Valery Krasnov, Nikolai Neznanov, Valentin Semke, and
Alexander Tiganov.* [212] In the same year, Vladimir Pashkovsky in his paper reported that he diagnosed 4.7 percent
of 300 patients with delusion of reform.* [213] As Russian sociologist Alexander Tarasov notes, you will be treated in a
hospital so that you and all your acquaintances get to learn forever that only such people as Anatoly Chubais or German
Gref can be occupied with reforming in our country; and you are suering fromsyndrome of litigiousnessif in addition
you wrote to the capital city complaints, which can be written only by a reviewing authority or lawyer.* [214]
According to Doctor of Legal Sciences Vladimir Ovchinsky, regional dierences in forensic psychiatric expert reports
are striking.* [215] For example, in some regions of Russia, 8 or 9 percent of all examinees are pronounced sane; in other
regions up to 75 percent of all examinees are pronounced sane.* [215] In some regions less than 2 percent of examinees
are declared schizophrenics; in other regions up to 80 percent of examinees are declared schizophrenics.* [215]
In April 1995, the State Duma considered the rst draft of a law that would have established a State Medical Commission
with a psychiatrist to certify the competence of the President, the Prime Minister, and high federal political ocials to
fulll the responsibilities of their positions.* [216] In 2002, Ukrainian psychiatrist Ada Korotenko stated that today the
question was raised about the use of psychiatry to settle political accounts and establish psychiatric control over people
competing for power in the country.* [217] Obviously, one will nd supporters of the feasibility of such a lter, she said,
though is it worthwhile to substitute experts' medical reports for elections?* [217] In 2003, the suggestion of using psychiatry to prevent and dismiss ocials from their positions was supported by Alexander Podrabinek, author of the book
Punitive Medicine,* [218] a 265-page monograph covering political abuses of psychiatry in the Soviet Union.* [219] He
suggested that people who seek high positions or run for the legislature should bring from the psychiatric dispensary a
reference that they are not on the psychiatric registry and should be subjected to psychiatric examination in the event of
inappropriate behavior.* [220] Concerned about the problem, authorities ruled that the Russian Mental Health Law should
not be applied to senior ocials and the judiciary on the ground that they are vested with parliamentary or judicial immunity.* [221] A psychiatrist who violates this rule can be deprived of his diploma and sentenced to imprisonment.* [222] In
2011, Russian psychiatrists again tried to promote the idea that one's marked aspiration in itself for power can be referred
2.11. DOCUMENTS AND MEMOIRS
33
to psychopathic symptoms and that there are statistics about 60 percent of current leaders of states suering from various
forms of mental abnormalities.* [223]
2.11 Documents and memoirs

The evidence for the misuse of psychiatry for political purposes in the Soviet Union was documented in a number of
articles and books.* [224] Several national psychiatric associations examined and acted upon this documentation.* [224]
The United States Government Printing Oce published documents on political abuse of psychiatry in the Soviet Union
in 1972, 1975, 1976, 1984, and 1988.* [225] 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* [226]archived
by the Columbia University Libraries in archival collection Human Rights Watch Records: Helsinki Watch, 19522003,
Series VII: Chris Panico Files, 19791992, USSR, Psychiatry, International Association on the Political Use of Psychiatry,
Box 16, Folder 58 (English version) and Box 16, Folder 911 (Russian version).* [227] In 1992, the British Medical
Association published some documents on the subject in the book Medicine Betrayed: The Participation of Doctors in
Human Rights Abuses.* [228] 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* [229] and in the books Punitive Medicine by Podrabinek,* [230] Bezumnaya Psikhiatriya (Mad
Psychiatry) by Anatoly Prokopenko,* [231] Reckoning With Moscow: A Nuremberg Trial for Soviet Agents and Western Fellow Travelers by Vladimir Bukovsky,* [232] Sovietskaya PsikhiatriyaZabluzhdeniya i Umysel (Soviet Psychiatry:
Fallacies and Wilfulness) by Ada Korotenko and Natalia Alikina,* [233] and Kaznimye Sumasshestviem (The Executed by
Madness).* [234]
The widely known sources including published and written memoirs by victims of psychiatric arbitrariness convey moral
and physical suerings experienced by the victims in special psychiatric hospitals of the USSR.* [235] In 1965, Valery
Tarsis published in the West his book Ward 7: An Autobiographical Novel* [236] based upon his own experiences in
19631964 when he was detained in the Moscow Kashchenko psychiatric hospital for political reasons.* [237] The book
was the rst literary work to deal with the Soviet authorities' abuse of psychiatry.* [238] 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.* [239] The topics vary from the taste of the cabbage served for supper to the meaning of life and Russia's
destiny.* [239] The poem was translated into English by Harry Thomas.* [239] The experience underlying Gorbunov and
Gorchakov was formed by two stints of Brodsky at psychiatric establishments.* [240] In 1970, Natalya Gorbanevskaya
published her book Polden: Delo o Demonstratsii 24 Avgusta 1968 Goda na Krasnoy Ploshchadi (Noon: The Case on
the Demonstration of 25 August 1968 at the Red Square)* [241] translated into English under the title Red Square at
Noon.* [242] Some parts of the book describe special psychiatric hospitals and psychiatric examinations of dissidents. In
Gorbanevskaya's book, On Special Psychiatric Hospitals (Madhouses), a work by Pyotr Grigorenko written in 1968,
was published.* [243] 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.* [244] In 1974, Yuri Maltsev published his
memoirs Reportazh iz Sumasshedshego Doma (Reportage from Madhouse).* [245] 1975 saw the article My Five Years
in Mental Hospitals by Viktor Fainberg.* [246] In 1976, Viktor Nekipelov published in samizdat his book Institute of
Fools: Notes on the Serbsky Institute* [247] documenting his personal experience at Psychiatric Hospital of the Serbsky
Institute.* [248] In 1980, the book was translated and published in English.* [249] Only in 2005, the book was published
in Russia.* [250]
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.* [251] The play is dedicated to Viktor Fainberg and
Vladimir Bukovsky, two Soviet dissidents expelled to the West.* [252] In 1978, the book I Vozvrashchaetsa Veter
(And the Wind Returns ) 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* [253] and later translated into English under the title To Build a Castle: My Life as a Dissenter.* [254] In
1979, Leonid Plyushch published his book Na Karnavale Istorii (At History's arnival) in which he described how he and
other dissidents were committed to psychiatric hospitals.* [255] At the same year, the book was translated into English
under the title History's Carnival: A Dissident's Autobiography.* [256] In 1980, the book by Yuri Belov Razmyshlenia ne
34
tolko o Sychovke: Roslavl 1978 (Reections not only on Sychovka: Roslavl 1978) was published.* [257] In 1981, Pyotr
Grigorenko published his memoirs V Podpolye Mozhno Vstretit Tolko Krys (In Underground One Can Meet Only Rats),
which included the story of his psychiatric examinations and hospitalizations.* [258] In 1982, the book was translated into
English under the title Memoirs.* [259] In 1982, Soviet philosopher Pyotr Abovin-Yegides published his article Paralogizmy politseyskoy psikhiatrii i ikh sootnoshenie s meditsinskoy etikoy (Paralogisms of police psychiatry and their
relation to medical ethics).* [260] In 1983, Evgeny Nikolaev's book Predavshie Gippokrata (Betrayers of Hippocrates),
when translated from Russian into German under the title Gehirnwsche in Moskau (Brainwashing in Moscow), rst came
out in Mnchen and told about psychiatric detention of its author for political reasons.* [261] In 1984, the book under its
original title was rst published in Russian which the book had originally been written in.* [262] In 1983, Yuri Vetokhin
published his memoirs Sklonen k Pobegu* [263] translated into English under the title Inclined to Escape in 1986.* [264] 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 own out of Russia.* [265] 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.* [266] In 1988, Reportazh iz Niotkuda (Reportage from Nowhere) by Viktor Rafalsky
was published.* [267] In the publication, he described his connement in Soviet psychiatric hospitals.* [268] In 1993,
Valeriya 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.* [269] In 1996, Vladimir Bukovsky published his
book Moskovsky Protsess (Moscow trial) 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.* [270] The book was translated into English in 1998 under the title Reckoning With Moscow: A Nuremberg
Trial for Soviet Agents and Western Fellow Travelers.* [232] In 2001, Nikolay Kupriyanov published his book GULAG2-SN * [271] 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.* [272] In 2002, St. Petersburg forensic psychiatrist Vladimir Pshizov published his book Sindrom
Zamknutogo Prostranstva (Syndrome of Closed Space) describing the hospitalization of Viktor Fainberg.* [273] 2003 saw
the book Moy Sudba i Moy Borba protiv Psikhiatrov (My Destiny and My Struggle against Psychiatrists) by Anatoly
Serov who worked as a lead design engineer before he was committed to a psychiatric hospital.* [274] In 2010, Alexander
Shatravka published his book Pobeg iz Raya (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 conned to Soviet psychiatric hospitals and prisons.* [275] In his book, he also described methods
of brutal treatment of prisoners in the institutions.* [275] In 2012, Soviet dissident and believer Vladimir Khailo's wife
published her book Subjected to Intense Persecution.* [276] 2014 saw the book Zha Zholtoy Stenoy (Behind the Yellow
Wall) by Alexander Avgust, a former inmate of Soviet psychiatric hospitals who in his book describes the wider circle of
their inhabitants than literature on the issue usually does.* [277]
The use of psychiatry for political purposes in the USSR was discussed in three television documentariesThey Chose
Freedom produced by Vladimir V. Kara-Murza in 2005,* [278] Prison Psychiatry produced by Anatoly Yaroshevsky of
NTV in the same year,* [279] Parallels, Events, People (an episode Punitive Psychiatry) produced by Natella Boltyanskaya
for the Voice of America in 2014* [280]and in the TV interview Psychiatric Practices in the Soviet Union produced by
C-SPAN on 17 July 1989 with the participation of William Farrand, Peter Reddaway, Darrel Regier, who were members
of the US delegation during its visit to Soviet psychiatric facilities in February 1989.* [281]
2.12 See also

Struggle against political abuse of psychiatry in the Soviet Union
2.13 References
[1] BMA 1992, p. 66; Bonnie 2002; Finckenauer 1995, p. 52; Gershman 1984; Helmchen & Sartorius 2010, p. 490; Knapp 2007,
2.13. REFERENCES
35
p. 406; Kutchins & Kirk 1997, p. 293; Lisle 2010, p. 47; Merskey 1978; Society for International Development 1984, p. 19;
US GPO (1972, 1975, 1976, 1984, 1988); Voren (2002, 2010a, 2013a)
[2] Bloch & Reddaway 1977, p. 425; UPA Herald 2013
[3] Kondratev 2010, p. 181.
[4] Korolenko & Dmitrieva 2000, p. 17.
[6] Kovalyov 2007.
[7] US Delegation Report 1989, p. 26; US Delegation Report (Russian translation) 2009, p. 93
[8] Ougrin, Gluzman & Dratcu 2006.
[9] Chodo 1985.
[10] Pospielovsky 1988, pp. 36, 140, 156, 178181.
[11] Gluzman (2009a, 2013a); Voren 2013a, p. 8; Fedenko 2009; see some documents in Pozharov 1999; Soviet Archives 1970
[12] Dmitrieva 2002; Pshizov 2006, p. 73
[13] Voren 2013a, pp. 1618; Pietikinen 2015, p. 280
[14] NPZ 2005.
[15] Voren 2010a; Helmchen & Sartorius 2010, p. 491
[16] Gluzman (2009b, 2010a)
[17] Bloch & Reddaway 1985, p. 189; Kadarkay 1982, p. 205; Korotenko & Alikina 2002, p. 260; Laqueur 1980, p. 26; Munro
2002a, p. 179; Pietikinen 2015, p. 280; Rejali 2009, p. 395; Smythies 1973; Voren (2010b, p. 95, 2013b); Working Group
on the Internment of Dissenters in Mental Hospitals 1983, p. 1
[18] Adler & Gluzman 1993; Ball & Farr 1984, p. 258; Bebtschuk, Smirnova & Khayretdinov 2012; Brintlinger & Vinitsky 2007,
pp. 292, 293, 294; Dmitrieva 2001, pp. 84, 108; Faraone 1982; Fedor 2011, p. 177; Grigorenko, Ruzgis & Sternberg 1997,
p. 72; Gushansky 2005, p. 35; Horvath 2014; Kekelidze 2013b; Korotenko & Alikina 2002, pp. 7, 47, 60, 67, 77, 259, 291;
Koryagin (1988, 1989); Magalif 2010; Podrabinek 1980, pp. 10, 57, 136; Pukhovsky 2001, pp. 243, 252; Savenko (2005a,
2005b); Schmidt & Shchurko 2014; Szasz (2004, 2006); Vitaliev 1991, p. 148; Voren & Bloch 1989, pp. 92, 95, 98; West &
Green 1997, p. 226
[19] Podrabinek 1980, p. 63.
[20] Savenko 2005a.
[21] Bonnie 2002; US GPO 1984, p. 5; Faraone 1982
[22] West & Green 1997, p. 226; Alexye 1976; US GPO 1984, p. 101
[23] Bloch & Reddaway 1977, p. 425.
[24] BMA 1992, p. 65.
[25] Malterud & Hunskaar 2002, p. 94.
[26] BMA 1992, p. 66.
[27] Lyons & O'Malley 2002.
[28] Semple & Smyth 2013, p. 6.
[29] Metzl 2010, p. 14.
[30] Noll 2007, p. 3.
36
[31] Matvejevi 2004, p. 32.

[32] Hunt 1998, p. xii.
[33] Birstein 2004.
[34] Brintlinger & Vinitsky 2007, p. 292.
[35] Knapp 2007, p. 402.
[36] Helmchen & Sartorius 2010, p. 495.
[37] Vasilenko 2004, p. 29; Chernosvitov 2002, p. 50
[38] Keukens & Voren 2007.
[39] Grigorenko, Ruzgis & Sternberg 1997, p. 72.
[40] Demina 2008.
[41] Lakritz 2009.
[42] Lavretsky 1998, p. 540.
[43] Savenko 2009a.
[44] Voren 2010b, p. 101.
[46] Veenhoven, Ewing & Samenlevingen 1975, p. 30.
[47] Sagan & Jonsen 1976.
[48] Katona & Robertson 2005, p. 77.
[49] Reich 1983.
[50] Tobin 2013.
[51] Voren 2010a.
[52] Park et al. 2014.
[53] Styazhkin 1992, p. 66.
[54] Korotenko & Alikina 2002, p. 19.
[56] Healey 2011.
[57] Stone 1985, p. 8.
[58] Stone 2002.
[59] Gluzman 2013c.
[60] Stone 1985, p. 11.
[61] Voren 2013a, p. 4.
[62] Voren 2013a, p. 8.
[63] Bloch & Reddaway 1985, pp. 187188.
[64] Rhoer 1983, p. 52.
[65] Nuti 2009, p. 29.
2.13. REFERENCES
[66] Albats 1995, p. 177.

[67] Andrew & Mitrokhin 1999, p. 7.
[68] Lambelet 1989.
[69] Albats 1995, p. 177; Luty 2014
[70] Kondratev 2010, p. 176.
[72] Tiganov 1999, p. 333.
[74] Veenhoven, Ewing & Samenlevingen 1975, p. 28.
[77] Schultz 2011, p. 19.
[79] Applebaum 2003, p. 549.
[80] Bloch 1978.
[81] Fernando 2003, p. 160.
[86] Finlayson 1987.
[87] Buyanov 1993, p. 192.
[88] Baburin 2004.
[89] Agamirov 2005.
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Mishina, Irina [ ]. : 60
[In the power of a diagnosis: 60 percent of current leaders are suering from
various forms of mental abnormalities]. [Our Version]. 26 December 2011 [Retrieved 3 March
2014]. Russian.
Mishina, Irina [ ]. : ,
? [Dual personalities: Why are criminals considered healthy, while public
gures are considered complete madmen?]. [Our Version]. 17 December 2012 [Retrieved 3 March
2014]. Russian.
Reich, Walter. The world of Soviet psychiatry. The New York Times. 30 January 1983 [Retrieved 12 January
2014]. Russian text: Reich, Walter [ ]. inoSMI. [The world of Soviet
psychiatry] [archived 2012-02-11; Retrieved 12 January 2014]. Russian.
Rodriguez, Alex. Russian dissidents called mentally ill. Chicago Tribune. 7 August 2007 [Retrieved 2 May 2011].
Schodolski, Vincent. Soviet Psychiatric Practices Inspected by U.S. Delegation. Chicago Tribune. 28 February
1989 [Retrieved 22 June 2014].
58

Smulevich, Anatoly; Morozov, Pyotr [ , ].
[Psychiatry cannot be invented in mind or textbooks]. [The
Psychiatrist's Diary]. 2014 [archived 24 April 2012]:14. Russian.
Sokolov, Maxim [ ]. [Putin is absolute]. Izvestia. 5 October 2007 [Retrieved
1 April 2014]. Russian.
Spencer, Charles. Every Good Boy Deserves Favour at the National Theatre, review. The Telegraph. 14 January
2010 [Retrieved 21 April 2011].
Trehub, Hanna. Political Madness: Dutch Sovietologist Robert van Voren speaks about Soviet repressive psychiatry
and its surviving oshoots. The Ukrainian Week. 22 February 2013 [Retrieved 6 January 2014].
Vyzhutovich, Valeri [ ]. [When the soul hurts]. Rossiyskaya Gazeta [Russian Newspaper]. 3 November 2011 [Retrieved 4 January 2013]:Week number 5624 (248). Russian.
Websites
The Complete Review. Every Good Boy Deserves Favour by Tom Stoppard; 2009 [Retrieved 21 April 2011].
National Theatre of Great Britain. Every good boy deserves favour; January 2010 [archived 20 March 2012;
Retrieved 21 April 2011].
Ukrainian Independent Information Agency. : - .
[There are too many psychiatric hospitals in Ukraine: S. Gluzman's press conference]; 4 October 2008
[Retrieved 27 July 2011]. Russian.
Russian News Service [ ].
[Doctors oer to restore Soviet mental health law]; 15 November 2012 [Retrieved 14 December 2013]. Russian.
Agamirov, Karen [ ]. Radio Liberty. . :
, 1983 ,
? [Man has the right. Punitive psychiatry: will China suer the same fate as the
Soviet Union expelled from members of the World Psychiatric Association in 1983, and is Russia moving closer
up to them?]; 25 January 2005 [Retrieved 18 February 2014]. Russian.
Agamirov, Karen [ ]. Radio Liberty. .
[Man has the right. The right to defence against punitive psychiatry]; 17 July 2007 [Retrieved 18
February 2014]. Russian.
Baburin, Vladimir [ ]. Radio Liberty. .
. , 70- ,
, [Man has the right. The trial in the case
of Igor Sutyagin has resumed. Engineer Vadim Lashkin, who in the 70s wrote the letter in defense of Solzhenitsyn
and was taken to a psychiatric hospital, cannot today get rehabilitation]; 31 October 2001 [Retrieved 16 December
2012]. Russian.
Baburin, Vladimir [ ]. Radio Liberty. .
. [Man has the right. The exhibitionDestroyed lives. Psychiatry exposed."];
10 August 2004 [Retrieved 22 January 2014]. Russian.
Demina, Nataliya [ ]. Polit.ru. , ,
[The circle of persons who try to bribe an expert is very broad]; 15 January 2008 [Retrieved 13 February 2014].
Russian.
Fedenko, Pavel [ ]. The BBC Russian Service. , [A diagnosis
is quickly found to attribute a person with]; 9 October 2009.
2.14. SOURCES
59
Gorelik, Kristina [ ]. Radio Liberty. .

[Man has the right. On abuses in psychiatry]; 17 September 2003 [Retrieved 24 January 2014].
Russian.
Kekelidze, Zurab [ ]. Dozhd. : ,
[The chief psychiatrist of Russia: Gays were previously beaten on the sly, and now their being beaten
is discussed]; 26 January 2013a [Retrieved 31 January 2014]. Russian.
Kekelidze, Zurab [ ]. Independent Psychiatric Association of Russia.
? (- . ..
) [For whom is the myth of punitive psychiatry protable? (Press
conference of prof. Z.I. Kekelidze in connection with sending oppositionist Mikhail Kosenko to compulsory treatment]; 22 October 2013b [Retrieved 9 August 2014]. Russian.
Kondratev, Fedor [ ]. [Pereprava]. .
. . [Savenko under the roof of Podrabinek. Actual interview of Prof. F. Kondratev]; 26 March 2014 [Retrieved 27 April 2014]. Russian.
Ovchinsky, Vladimir [ ]. Radio Liberty. : ? [Russian psychiatry: how may I serve you?]; 29 June 2010 [Retrieved 29 December 2012]. Russian.
Peters, Irina [ ]. Radio Liberty. [Lithuania lives, trusting in
NATO]; 28 March 2014 [Retrieved 29 March 2014]. Russian.
Podrabinek, Alexander [ ]. Grani.ru. [Kondratev's syndrome]; 3
March 2014 [Retrieved 10 March 2014]. Russian.
Polyakovskaya, Elena; Gorelik, Kristina [ , ]. Radio Liberty.
[Psychiatry as a tool of coercion]; 10 October 2013 [Retrieved 10 October 2013].
Russian.
Reiter, Svetlana [ ]. Lenta.ru. [Below the hopelessness line]; 29
October 2013. Russian.
Schultz, Frederick. The University of Toledo Digital Repository. Andropov and the U.S. media: a comparative
study of Yuri Andropov's premiership of the USSR as viewed through the New York Times and the Chicago
Tribune. In: Theses and Dissertations. Paper 710.; 2011 [archived 1 July 2015].
Valovich, Tatiana [ ]. Radio Liberty. [Vladimir Pshizov]; 13 March 2003
[Retrieved 10 March 2014]. Russian.
Audio-visual material
Russia: [TV documentary], [Prison Psychiatry]; 2005 [Retrieved 21 April 2011]; p. duration 00.43.11. Russian.
Institute of Modern Russia, USA: [TV documentary], They Chose Freedom: The Story of Soviet Dissidents [Retrieved 20 February 2014]; p. duration 00.22.21 (part 1), 00.22.38 (part 2), 00.21.10 (part 3), 00.22.31 (part 4).
English. Rissian version: Institute of Modern Russia, USA: [TV documentary], :
[They Chose Freedom: The Story of Soviet Dissidents] [Retrieved 20 February 2014];
p. duration 00.21.18 (part 1), 00.22.32 (part 2), 00.21.12 (part 3), 00.22.40 (part 4). Russian.
C-SPAN, USA: [TV interview], Psychiatric Practices in the Soviet Union. Guests were members of the delegation which visited Soviet psychiatric facilities and patients in February of 1989 [Retrieved 20 February 2014]; p.
duration 01.01.05. English.
Boltyanskaya, Natella [ ]. Voice of America. , , :
[Parallels, Events, People: Punitive Psychiatry]; 25 April 2014 [Retrieved 10 May 2014]; p. duration
00.15.21 (part 1). Russian.
60

[Parallels, Events, People: Punitive Psychiatry]; 9 May 2014 [Retrieved 10 May 2014]; p. duration
2.15 Further reading

Alexeyeva, Ludmilla (1987). Soviet dissent: contemporary movements for national, religious, and human rights.
Wesleyan University Press. ISBN 0-8195-6176-2.
Alexeyeva, Ludmilla [ ] (1992). : [History
of dissent in the USSR: contemporary period] (in Russian). VilniusMoscow: [News]. (The Russian text of
the book)
Antbi, Elizabeth (1977). Droit d'asiles en Union Sovitique. Paris: Editions Julliard. ISBN 2-260-00065-7.
Bloch, Sidney; Reddaway, Peter (1977). Russia's political hospitals: The abuse of psychiatry in the Soviet Union.
Victor Gollancz Ltd. ISBN 0-575-02318-X.
Bloch, Sidney; Reddaway, Peter (1985). Soviet psychiatric abuse: the shadow over world psychiatry. Westview
Press. ISBN 0-8133-0209-9.
Bloch, Sidney; Reddaway, Peter [ , ] (1996). : [Diagnosis:
dissent] (PDF). : [Karta: Russian
Independent Historical and Human Rights Defending Journal] (in Russian) (1314): 5667. Retrieved 1 January
2013.
Fireside, Harvey (1982). Soviet Psychoprisons. W. W. Norton & Company. ISBN 0-393-00065-6.
Gluzman, Semyon (1989). On Soviet totalitarian psychiatry. Amsterdam: International Association on the Political
Use of Psychiatry. ISBN 90-72657-02-0.
Korotenko, Ada; Alikina, Natalia [ , ] (2002). : [Soviet psychiatry: fallacies and wilfulness] (in Russian). Kiev:
[Publishing house Sphere"]. ISBN 966-7841-36-7.
Medvedev, Zhores; Medvedev, Roy (1979). A Question of Madness: Repression by Psychiatry in the Soviet Union.
Norton. ISBN 0-393-00921-1.
Podrabinek, Alexander (1980). Punitive medicine. Ann Arbor: Karoma Publishers. ISBN 0-89720-022-5. Russian
text: Podrabinek, Alexander [ ] (1979). [Punitive medicine] (in
Russian). New York: [Khronika Press]. Archived from the original on 24 March 2014.
Prokopenko, Anatoly [ ] (1997). : [Mad psychiatry: classied materials on the use of psychiatry in
the USSR for punitive purposes] (in Russian). Moscow: " " ["Top Secret"]. ISBN 5-85275145-6.
Smith, Theresa; Oleszczuk, Thomas (1996). No Asylum: State Psychiatric Repression in the Former U.S.S.R. New
York City: New York University Press. ISBN 0-8147-8061-X.
Soviet Political Psychiatry: The Story of the Opposition. London: International Association on the Political Use of
Psychiatry, Working Group on the Internment of Dissenters in Mental Hospitals. 1983.
Voren, Robert van (2009). On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the Soviet
Unionof Vladimir Putin. AmsterdamNew York: Rodopi Publishers. ISBN 978-90-420-2585-1.
Chapter 3
Struggle against political abuse of psychiatry

in the Soviet Union
In the Soviet Union, systematic political abuse of psychiatry took place* [1] and was based on the interpretation of political
dissent as a psychiatric problem.* [2] It was called psychopathological mechanismsof dissent.* [3]
During the leadership of General Secretary Leonid Brezhnev, psychiatry was used as a tool to eliminate political opponents
(dissidents) who openly expressed beliefs that contradicted ocial dogma.* [4] The termphilosophical intoxication
was widely used to diagnose mental disorders in cases where people disagreed with leaders and made them the target
of criticism that used the writings by Karl Marx, Friedrich Engels, and Vladimir Lenin.* [5] Article 5810 of the Stalin
Criminal Codewhich as Article 70 had been shifted into the RSFSR Criminal Code of 1962and Article 190-1 of the
RSFSR Criminal Code along with the system of diagnosing mental illness, developed by academician Andrei Snezhnevsky,
created the very preconditions under which non-standard beliefs could easily be transformed into a criminal case, and it,
in its turn, into a psychiatric diagnosis.* [6] Anti-Soviet political behavior, in particular, being outspoken in opposition to
the authorities, demonstrating for reform, writing books were dened in some persons as being simultaneously a criminal
act (e.g., violation of Articles 70 or 190-1), a symptom (e.g., delusion of reformism), and a diagnosis (e.g., "sluggish
schizophrenia").* [7] Within the boundaries of the diagnostic category, the symptoms of pessimism, poor social adaptation
and conict with authorities were themselves sucient for a formal diagnosis of sluggish schizophrenia.* [8]
The process of psychiatric incarceration was instigated by attempts to emigrate; distribution or possession of prohibited
documents or books; participation in civil rights actions and demonstrations, and involvement in forbidden religious activity.* [9] The religious faith of prisoners, including well-educated former atheists who adopted a religion, was determined
to be a form of mental illness that needed to be cured.* [10] Formerly highly classied extant documents from Special
leof 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.* [11]
In the 1960s, a vigorous movement grew up protesting against abuse of psychiatry in the USSR.* [12] Political abuse of
psychiatry in the Soviet Union was denounced in the course of the Congresses of the World Psychiatric Association in
Mexico City (1971), Hawaii (1977), Vienna (1983) and Athens (1989).* [8] The campaign to terminate political abuse
of psychiatry in the USSR was a key episode in the Cold War, inicting irretrievable damage on the prestige of Soviet
medicine.* [13] In 1971, Vladimir Bukovsky smuggled to the West a le of 150 pages documenting the political abuse of
psychiatry, which he sent to The Times.* [14] The documents were photocopies of forensic reports on prominent Soviet
dissidents.* [15] In January 1972, Bukovsky was convicted of spreading anti-Soviet propaganda under Criminal Code,
mainly on the ground that he had, with anti-Soviet intention, circulated false reports about political dissenters.* [16] Action
Group for the Defence of Human Rights stated that Bukosky was arrested as a direct result of his appeal to worlds
psychiatrists, thereby suggesting that now they held his destiny in their hands.* [17] In 1974, Bukovsky and the incarcerated
psychiatrist Semyon Gluzman wrote A Manual on Psychiatry for Dissidents,* [18] which provided potential future victims
of political psychiatry with instructions on how to behave during inquest in order to avoid being diagnosed as mentally
sick.* [14]
Political abuse of psychiatry in Russia continues after the fall of the Soviet Union* [19] and threatens human rights activists
61
62
CHAPTER 3. STRUGGLE AGAINST POLITICAL ABUSE OF PSYCHIATRY IN THE SOVIET UNION
The Serbsky Central Research Institute for Forensic Psychiatry, also briey called the Serbsky Institute (the part of its building in Moscow)
3.1. BACKGROUND
63
with a psychiatric diagnosis.* [20]
3.1 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.* [21] It entails the exculpation and committal of citizens to psychiatric facilities based upon political rather than mental health-based criteria.* [22] Many authors,
including psychiatrists, also use the terms Soviet political psychiatry* [23] or punitive psychiatryto refer to this
phenomenon.* [24]
In the book Punitive Medicine by Alexander Podrabinek, the termpunitive medicine, which is identied withpunitive
psychiatry,is dened as a tool in the struggle against dissidents who cannot be punished by legal means.* [25]
Punitive psychiatry is neither a discrete subject nor a psychiatric specialty but, rather, it is an emergency arising within
many applied sciences in totalitarian countries where members of a profession may feel themselves compelled to service
the diktats of power.* [26] Psychiatric connement of sane people is uniformly considered a particularly pernicious form
of repression* [27] and Soviet punitive psychiatry was one of the key weapons of both illegal and legal repression.* [28]
In the Soviet Union dissidents were often conned in the so-called psikhushka, or psychiatric wards.* [29] Psikhushka is the
Russian ironic diminutive formental hospital.* [30] One of the rst 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.* [31] 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.* [32] Western scholars examined no aspect of Soviet psychiatry as thoroughly as its
involvement in the social control of political dissenters.* [33]
As early as 1948, the Soviet secret service took an interest in this area of medicine.* [34] It was one of the superiors of
the Soviet secret police, Andrey Vyshinsky, who rst ordered the use of psychiatry as a tool of repression.* [35] Russian
psychiatrist Pyotr Gannushkin also believed that in a class society, especially during the most severe class struggle, psychiatry was incapable of not being repressive.* [36] A system of political abuse of psychiatry was developed at the end of
Joseph Stalin's regime.* [37] However, according to Alexander Etkind, punitive psychiatry was not simply an inheritance
from the Stalin era as the GULAG (the acronym for Chief Administration for Corrective Labor Camps, the penitentiary
system in the Stalin years) was an eective instrument of political repression and there was no compelling requirement
to develop an alternative and expensive psychiatric substitute.* [38] The abuse of psychiatry was a natural product of the
later Soviet era.* [38] 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 conicts between them:
1. the rst 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.* [38]
The hundreds of hospitals in the provinces combined components of both systems.* [38]
3.2 Soviet psychiatric abuse exposed

In recent years in our country a number of court orders have been made involving the placing in psychiatric hospitals
( of
special typeand otherwise) of people who in the opinion of their relatives and close friends are mentally healthy. These
people are: Grigorenko, Rips, Gorbanevskaya, Novodvorskaya, Yakhimovich, Gershuni, Fainberg, Victor Kuznetsov,
Iofe, V. Borisov and others people well known for their initiative in defence of civil rights in the U.S.S.R.
This phenomenon arouses justied anxiety, especially in view of the widely publicized placing of the biologist Zhores
Medvedev in a psychiatric hospital by extrajudical means.
64
Vladimir Bukovsky (b. 1942), a British neurophysiologist and former Soviet human rights activist, and political prisoner
The diagnoses of the psychiatrists who have served as expert witnesses in court, and on whose diagnoses the court orders
are based, provoke many doubts as regards their content. However, only specialists in psychiatry can express authoritative
opinions about the degree of legitimacy of these diagnoses.
Taking advantage of the fact that I have managed to obtain exact copies of the diagnostic reports made by the forensicpsychiatric groups who examined Grigorenko, Fainberg, Gorbanevskaya, Borisov and Yakhimovich, and also extracts
from the diagnosis on V. Kuznetsov, I am sending you these documents, and also various letters and other material which
reveal the character of these people. I will be very grateful to you if you can study this material and express your opinion
on it.
I realize that at a distance and without the essential clinical information it is very dicult to determine the mental condition
of a person and either to diagnose an illness or assert the absence of any illness. Therefore I ask you to express your opinion
on only this point: do the above-mentioned diagnoses contain enough scientically-based evidence not only to indicate
the mental illnesses described in the diagnoses, but also to indicate the necessity of isolating these people completely from
society?
I will be very happy if you can interest your colleagues in this matter and if you consider it possible to place it on the
agenda for discussion at the next International Congress of Psychiatrists.
For a healthy person there is no fate more terrible than indenite internment in a mental hospital. I believe that you will
not remain indierent to this problem and will devote a portion of your time to it just as physicists nd time to combat
the use of the achievements of their science in ways harmful to mankind.
Thanking you in advance,
V. Bukovsky
3.3. CONGRESS IN MEXICO CITY
65
Bukovsky's 1971 letter addressed to Western psychiatrists* [39]

In the 1960s, a vigorous movement grew up protesting against abuse of psychiatry in the USSR.* [12] President of the
Independent Psychiatric Association of Russia Yuri Savenko says psychiatric repression was obvious to his circle as early as
1968,* [40] and president of the Ukrainian Psychiatric Association Semyon Gluzman states no one of Soviet psychiatrists
was going to reveal psychiatric repression until Gluzman revealed it in his report.* [41] He was the author of An In Absentia
Psychiatric Opinion on the Case of P.G. Grigorenko* [42] otherwise known as An In Absentia Forensic-psychiatric Report on
P.G. Grigorenko; this document started circulating in samizdat form in 1971* [43] and was based on the medical record
of Pyotr Grigorenko* [44] who spoke against the human rights abuses in the Soviet Union.* [45] Gluzman came to the
conclusion that Grigorenko was mentally sane and had been taken to mental hospitals for political reasons.* [46] 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.* [45]
In 1971, Vladimir Bukovsky smuggled to the West a le of 150 pages documenting the political abuse of psychiatry.* [14]
The documents were photocopies of forensic reports on prominent Soviet dissidents.* [15] These documents were attended
with a letter by Bukovsky requesting Western psychiatrists to explore the six cases documented in the le and tell whether
these persons should be hospitalized or not.* [47] 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, Sheeld University.* [48] The psychiatrists described the documents in British Journal
of Psychiatry of August 1971* [49] and wrote a letter to The Times.* [48] 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.* [48] 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....* [47] They recommended discussing the issue in the course of
the forthcoming World Psychiatric Association (WPA) World Congress in Mexico in November 1971.* [47]
3.3 Congress in Mexico City

The Congress in Mexico City was held on 28 November 4 December 1971. The statement of the forty-four British
psychiatrists was circulated to the 7000 delegates in English, Spanish, and French.* [50] 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.* [50] When speakers demanded that the Congress go on record against the connement of dissidents in
psychiatric hospitals, the Soviet delegation and Snezhnevsky instantly walked out.* [50] They said that they could not talk
about the issue since the Congress lacked ocial interpretation into Russian.* [50] At this Congress, Western psychiatrists
tried to censure their Soviet colleagues for the rst time.* [51] But the charges of psychiatric abuse were new, the campaign
was disorganized, and Snezhnevsky, who headed the Soviet delegation, remained unscathed.* [51] He said in rebuttal that
the accusations were acold-war maneuver carried out at the hands of experts.* [51] 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.* [47] 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.* [47]
One of the key apologists of Soviet psychiatric abuse, Soviet psychiatrist Marat Vartanyan, was chosen as associate secretary of the Executive Committee.* [47] A day after the Mexico Congress Vartanyan announced publicly that the nature
of Soviet system was such that this could not possibly happen.* [47] 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.* [52] He was masterful in his dealings
with the WPA and continued to represent the Soviet Union at symposiums and congresses of the WPA.* [52] Being in
grain hospitable, amboyant, full of humor and with a Western style, Vartanyan managed to fool one after another.* [52]
In the end, no action was taken by the Congress.* [50] 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 outand sever communications for some time to come.* [50]
66
3.4 First responses

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.* [47] 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.* [53] Action Group for the Defence of Human Rights stated that Bukosky was arrested as a direct
result of his appeal to worlds psychiatrists, thereby suggesting that now they held his destiny in their hands.* [17] In one
of his books, Bukovsky attributed his punishment to the timorousness of the WPA Congress in Mexico City in 1972: "
as a result of the timorousness of the Congress, I was given 12 years of punishment for slandering Soviet psychiatry
."* [54]
In 1973, the council of the Royal College of Psychiatrists passed the following resolution:
The Royal College of Psychiatrists rmly opposes the use of psychiatric facilities for the detention of
persons solely on the basis of their political dissent no matter where it occurs.* [55]
In the same year, the Representative Body of the British Medical Association at its annual meeting at Folkestone passed
the following motion:
The British Medical Association condemns the practice of using medical men to certify political and
religious dissenters as insane and to submit them to unnecessary investigation and treatment.* [55]
In 1973, Ruben Nadzharov, the Deputy Director of the Institute of Psychiatry of the USSR Academy of Medical Sciences,
stated that talk in the West of the forced commitment of certain dissident representatives of the intelligentsia to psychiatric
hospitals wasa component part of the anti-Soviet propaganda campaign that certain circles are trying to stir up in pursuit
of highly improper political aims.* [56] In 2013, Robert van Voren, who participated in the struggle against abuse of
Soviet psychiatry, conrmed that supporting Soviet dissidents was part of anti-Soviet policy.* [57]
In 1974, Bukovsky and the incarcerated psychiatrist Semyon Gluzman wrote A Manual on Psychiatry for Dissidents,* [18]
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.* [14] 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.* [58]
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 Corvaln* [59] at Zrich 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.* [60] 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.* [61]
The appeal made by Bukovsky in 1971 caused the formation of the rst groups to campaign against the political abuse
of psychiatry in the Soviet Union.* [62] 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 Hospitalswas created.* [62] 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.* [62] In
September 1975, there was formed the "Campaign Against Psychiatric Abuse" (CAPA),* [63] 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.* [58] In July 1976 in Trafalgar Square, CAPA held a rally against the abuse of
psychiatry in the USSR.* [58] In 1978, Royal College of Psychiatrists established the Special Committee on abuse of
psychiatry.* [64] 20 December 1980 saw the formation in Paris of the International Association on the Political Use of
Psychiatry (IAPUP) whose rst secretary was Grard Bles of France.* [65]
3.5. HONOLULU CONGRESS
67
3.5 Honolulu Congress

In 1975, the American Psychiatric Association agreed to host the WPA's sixth World Congress of Psychiatry during
28 August 3 September 1977, in Honolulu.* [66] 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.* [67]
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'.* [67] 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 inuence of pro-Zionist elements and that the KGB was undertaking measures through operational
channels to counter hostile attacks.* [68] In October 1976, the Ministry of Health constituted a special working group to
develop a plan of action for a counter campaign.* [68] 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.* [68] 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.* [68] 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.* [68] 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.* [68] 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.* [69] 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.* [69] 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.* [69]
However, all this activity of the Soviets could not prevent the issue from dominating the Congress from the very outset.* [69] At the rst plenary session of the Congress, the introduction of the Declaration of Hawaii* [70] took place.* [69]
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.* [69] 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.* [69] The General Assembly accepted the Declaration
of Hawaii without diculty, and without opposition by the Delegation of the Soviets.* [69] 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 growthwithout referring to mental illnesswere formulated as the direct aim of psychiatry, the
menace of vast expansion of psychiatry would 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.* [71] 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.* [69]
The Soviet issue passed the General Assembly less easily.* [69] 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 materialsfrom being
spread in the main congress hall.* [69] In 1977 at the World Congress in Honolulu, Snezhnevsky again defended psychiatric
practices used in his country.* [51] 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.* [72] The British resolution passed with 90 to 88
votes* [72] and only because the Poles did not come and the Russians, having been tardy in their dues payments, were not
68
allowed to cast all votes allocated to them.* [51] Some regarded the resolution as a Pyrrhic victory.* [73]
On 31 August 1977, the General Assembly of the World Psychiatric Association during its meeting in Honolulu for the
VI World Congress of Psychiatry adopted the following resolution:* [74]
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 rst instance in reference to the extensive evidence of the systematic abuse of psychiatry
for political purposes in the USSR.* [75]
This resolution of the WPA is unprecedented in that it was the rst time that an international professional association
specically condemned a great power.* [74] 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.* [76] The allegations,
conrmed by some Soviet psychiatrists who had ed or emigrated to the West, induced the World Psychiatric Association
to condemn the USSR for thesystematic abuse of psychiatry for political purposes.* [77] Kremlin spokesmen ignored
the action as a provocation by a handful of antipsychiatric and antisocial elementsand began a propaganda campaign
to contradict the accusations.* [77] The American resolution requesting to set up a Review Committee received a larger
majority of votes, 121 votes against 66.* [72] Snezhnevsky returned to Moscow wounded, with members of his delegation
putting the blame for their defeat on the "Zionists.* [51]
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 rst secretary of the Association of Soviet Psychiatrists until he left the Soviet Union in June
1977.* [78] 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.* [78]
3.6 UN Principles for the Protection of Persons with Mental Illness

Main article: Principles for the Protection of Persons with Mental Illness
Political abuse of psychiatry in the Soviet Union catalyzed a more general investigation into international psychiatric
practices by the UN Commission on Human Rights. In 1977, the Commission created a Sub-Commission to study,
with a view to formulating guidelines, if possible, the question of the protection of those detained on the grounds of
mental ill-health against treatment that might adversely aect the human personality and its physical and intellectual
integrity.The Sub-Commission subsequently appointed its two Special Rapporteurs the primary task to determine
whether adequate grounds existed for detaining persons on the grounds of mental ill-health.* [79]
The UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care was
published more than a decade later. The nal version of the Principles had been so repeatedly massaged and rewritten
by numerous committees dominated by psychiatrists that cross-referencing and other priorities extensively buried the
primary tasks of attending to the risks of treatment and involuntary detention. In 1991, the United Nations General
Assembly adopted the nal document. In the view of Richard Gosden, it is principally designed to protect the rights of
voluntary patients, not involuntary patients. The problems of involuntary patients are addressed by the document in a
way that tends to undermine their rights rather than protect them.* [79] However, Michael Perlin believes the divulgation
of the Principles has the potential to be a barrier against the type of governmental malfeasance that is epitomized by
the Soviet experience.* [80] According to George Alexander, the Principles are far better than other work of the United
Nations on the issue but it is unclear what eect they will have.* [81] Brendan Kelly says the Principles is a non-binding
declaration.* [82]
3.7 Review Committee

In August 1978, Americans donated $50,000 for the establishment of the Review Committee and, by doing so, showed
their commitment to the project.* [83] The President Jules Masserman, when submitting the donation, asked that the
3.8. WORKING COMMISSION TO INVESTIGATE THE USE OF PSYCHIATRY FOR POLITICAL PURPOSES
69
Review Committee be established without delay for the sake of many political dissidents at risk.* [83] In December
1978, the Review Committee was set up under the chairmanship of Canadian psychiatrist Jean-Yves Gosselin* [72] and,
in August 1979, received the rst complaints submitted by the British Royal College of Psychiatrists.* [84]
The proposed statute read, The Committee to Review the Abuse of Psychiatry will be appointed by the Executive
Committee and shall have the responsibility to review individual complaints. Its activities will not be limited in time.
*
[85]
From the very rst day, the Soviets refused to recognize its existence.* [72] Originally they attempted to prevent its establishment, maintaining that it would divert the WPA from its major function, namely the exchange of scientic ideas.* [72]
When the Review Committee was constituted, the Soviet society asserted overtly that they would not collaborate with
the Review Committee, and they conrmed their stance in three letters, in which they claimed that the Review Committee was an illegal formation,that they would continue not to acknowledge its existence and that no cooperation
could be expected.* [72] That stance would remain unaltered over the years to come.* [72] 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.* [72]
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.* [86] The General
Assembly resolved further to change the Committee scope towards complaints about not only political but any abuse of
psychiatry.* [86] As it was emphasized, the WPA is not a human rights organization and the Review Committee should
only examine complaints about specic acts of abuse carried out by specic psychiatrists against specic persons.* [86]
The 1999 General Assembly modied 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.* [86]
3.8 Working Commission to Investigate the Use of Psychiatry For Political

Purposes
Main article: Moscow Helsinki Group
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.* [87] The Commission was formally linked to the Moscow Helsinki Group* [87]
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.* [88] The commission was composed of ve 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.* [89] The leader of the commission was Alexandr
Podrabinek.* [89] In 1977, he completed a book titled Punitive Medicine,* [90] a 265-page monograph covering political
abuses of psychiatry in the Soviet Union* [91] and containing photographs of hospitals and former inmates, many quotations from ex-inmates,* [92] a white listof two hundred of prisoners of conscience in Soviet mental hospitals and a
black listof over one hundred medical sta and doctors who took part in committing people to psychiatric facilities
for political reasons.* [93]
The psychiatric consultants to the Commission were Alexander Voloshanovich and Anatoly Koryagin.* [94] The task
stated by the Commission was not primarily to diagnose persons or to declare people who sought help mentally ill or
mentally healthy.* [95] 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.* [95] At rst
it was psychiatrist Alexander Voloshanovich from the Moscow suburb of Dolgoprudny, who made these diagnoses.* [62]
But when he had been compelled to emigrate on 7 February 1980,* [96] his work was continued by the Kharkov psychiatrist Anatoly Koryagin.* [62] 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 suering from any mental
disease.* [97] 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.* [97] Also some
70
foreign psychiatrists including the Swedish psychiatrist Harald Blomberg and British psychiatrist Gery Low-Beer helped
in examining former or potential victims of psychiatric abuse.* [62] The Commission used those reports in its work and
publicly referred to them when it was essential.* [62]
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.* [98] 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.* [87] Summaries of the Information Bulletins were published in the key
samizdat publication, the Chronicle of Current Events.* [87] The Information Bulletins were sent to the Soviet ocials,
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.* [87] The Information Bulletins were also used to provide the dissident movement with information about Western protests against the political abuse.* [87] Peter Reddaway said that after
he had studied ocial 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 ocials 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 signicant part and the more foreign pressure the better.* [99] Over fty victims examined by psychiatrists of
the Moscow Working Commission between 1977 and 1981 and the les smuggled to the West by Vladimir Bukovsky
in 1971 were the material that convinced most psychiatric associations that there was distinctly something wrong in the
USSR.* [100]
The Soviet authorities responded aggressively.* [98] Members of the group were being threatened, followed, subjected to
house searches and interrogations.* [98] 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.* [94]
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.* [101] 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* [64] 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.* [102] Instead Snezhnevsky chose to
resign his Fellowship.* [102]
3.9 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.* [103] 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 eect its whole activity in question and that for this reason, All-Union Society took the decision to
withdraw from the WPA.* [104] 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.* [105] On 31 January 1983, the All-Union Society ocially resigned from the World Psychiatric Association* [104]
under threat of expulsion.* [15] 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
3.10. VIENNA CONGRESS
71
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.* [106]
According to the reports on hearing before the Subcommittee on Human Rights and International Organizations of the
Committee on Foreign Aairs 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 ocial psychiatrists had produced no signicant change in the level of Soviet abuses, and that this
approach had, thereby, failed.* [107] 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.* [107] 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.* [108]
According to the statement made by the chairman of the APA Committee on International Abuse of Psychiatry and
Psychiatrists Harold Visotsky 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.* [109] 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 clarication 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:* [110]
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.
3.10 Vienna Congress

The Seventh World Congress of the WPA was scheduled to meet on 10 16 July 1983, at Vienna where heated discussion
and a close vote on the resolutions were anticipated.* [111] The General Assembly of the World Psychiatric Association in
Vienna was likely one of the most tense and disorganized meetings in its existence.* [112] 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.* [112] The debate was preceded by a discussion of various resolutions which had
been submitted, but the state of aairs was so perplexing that some delegates did not even know which resolution they
were asked to vote upon.* [112] Finally a resolution drafted by the British delegate Kenneth Rawnsley,* [112] who served
as the fourth president of the Royal College of Psychiatrists from 1981 to 1984,* [113] was carried by 174 votes to 18,
with 27 abstentions.* [114] The resolution was strikingly conciliatory in tone:* [115]
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.
3.11 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.* [116] 1986 saw the discharge of nineteen political prisoners from mental hospitals.* [117]
In 1987, sixty-four political prisoners were discharged from mental hospitals.* [117]
72
In 1988, hundreds of thousands of persons with mental disorders were removed from the psychiatric register at psychoneurological dispensaries and discharged from psychiatric hospitals to the satisfaction of world public and the World
Psychiatric Association.* [118]
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.* [119] However, a year later the journal Ogoniok published a gure of 10.2 million provided by the state statistics
committee.* [120] In 1990, Zhurnal Nevropatologii i Psikhiatrii Imeni S S Korsakova published almost the same gure of
10 million people registered at psychoneurological dispensaries and 335,200 hospital beds used in the Soviet Union by
1987.* [121] 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.* [122]
3.12 Visit of the US delegation

In 1989, the stonewalling of Soviet psychiatry was overcome by perestroika and glasnost (meaning policy of transparencyin Russian).* [123] 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.* [124] They traveled to the Soviet Union on 25 February 1989.* [125] The group consisted of
about 25 people among whom were William Farrand of the State Department; Loren H. Roth as head of the psychiatric
team; psychiatrists of the National Institute of Mental Health, including Scientic Director of the US Delegation Darrel
A. Regier, Harold Visotsky from Chicago as head of the hospital visit team, and four migr Soviet psychiatrists living
in the United States.* [125] There also were State Department interpreters, two attorneys, Ellen Mercer of the American
Psychiatric Association and Peter Reddaway.* [125]
The visit was initiated by Soviet government ocials, including Andrei Kovalyov, on domestic political grounds.* [6]
A powerful external impact was needed to have reasons to give a new spurt to restructuring psychiatry.* [6] The main
thing was to make the decision to develop an eective law that would strictly regulate all aspects of the provision of
psychiatric care and prevent new political abuses of the keepers of ideological purity in Soviet community who wore
white gowns.* [6] No less important task was to release the maximum number of political and religious prisoners from
psychiatric hospitals.* [6] Something that seemed to Soviet psychiatric leaders to be impossible had to be promised to
them so that they agree to conduct such an event.* [6] To that end, the government ocials played up the need for the
visit in every possible way by using the argument that its success, if any, would enable to resume Soviet membership in
the World Psychiatric Association.* [6] The psychiatric leaders swallowed the bait.* [6] Later on, Andrei Kovalyov wrote
about the attempts to intimidate him by psychiatric measures during the preparation of the event.* [6]
The American psychiatrists were primarily interested in patients who had passed through psychiatric examinations at
the Serbsky Institute.* [6] Their clinical charts were classied secrets.* [6] The psychiatric examinations were conducted
by academicians and eminent professors.* [6] In the clinical charts, there were monstrous things: for example, one of
the patients was refused to be discharged from the hospital until he had renounced his religious convictions, for which
he was hospitalized.* [6] During their visit to the USSR, the American psychiatrists acquainted themselves with cases
that included such crimes": human rights activism, the Ukrainian Helsinki Group (an outburst of emotion while being
inside a social security agency; a visit to the apartment of Andrei Sakharov that was formerly human rights activism; having
written a book about poet Vladimir Vysotsky and other anti-Soviet essays; distributing books by Alexander Solzhenitsyn,
Alexander Zinoviev, Zhores Medvedev; defending the rights of persons with disabilities, signing appeals, etc.).* [6] Of
course, among patients surveyed by Americans were also terrorists and murderers.* [6]
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.* [126] Whereas the delegation originally sought interviews
with 48 persons, it eventually saw 15 hospitalized and 12 discharged patients.* [126] 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.* [126] The delegation came to the conclusion that nine of the 15
hospitalized patients had disorders which would be classied in the United States as serious psychoses, diagnoses corresponding broadly with those used by the Soviet psychiatrists.* [126] One of the hospitalized patients had been diagnosed as
having schizophrenia although the US team saw no evidence of mental disorder.* [127] Among the 12 discharged patients
3.13. ESTABLISHING THE IPA
73
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.* [127]
According to medical record, all these patients had diagnoses of psychopathology or schizophrenia.* [127]
When returned home after a visit of more than two weeks, the delegation wrote its report which was pretty damaging to
the Soviet authorities.* [128] 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.* [128] On 17 July 1989, William Farrand, Peter Reddaway, and
Darrel Regier expounded the ndings of their report in the TV interview Psychiatric Practices in the Soviet Union broadcast
by C-SPAN.* [129] The report was published in Schizophrenia Bulletin, Supplement to Vol. 15, No. 4, 1989.* [130] The
report by the American psychiatrists, who inspected a number of Soviet psychiatric hospitals in March 1989, remained
secret for all ordinary psychiatrists of the country.* [131] It reached the point of absurdity when the administration of the
special hospitals visited by the American doctors sent the WPA a request to send them the report from the USA.* [131]
The American part has translated the obtained Soviet reply into Russian but even the action has not made the USSR Health
Ministry declassify the documents.* [131] As far as Robert van Voren could establish, the report was never published in
the USSR.* [132] Only after twenty years, in 2009, the report was traslated into Russian, and its Russian version was
published not in Russia but in the Netherlands, on the website of the Global Initiative on Psychiatry.* [133]
3.13 Establishing the IPA

In 1989, the Independent Psychiatric Association of Russia (IPA) was created as an association publicly opposing itself
to ocial Soviet psychiatry and its ospring, the All-Union Society of Neuropathologists and Psychiatrists, which was
completely under the control of the Soviet government and implemented its political principles.* [134] From the very
beginning, the IPA and its President Yuri Savenko had to take on human rights functions in addition to educational ones:
rst, 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, articially isolated from Western humanistic
trends.* [134]
In Russia, the IPA is the sole non-governmental professional organization that makes non-forensic psychiatric expert
examination at the request of citizens whose rights have been violated with the use of psychiatry.* [26]
3.14 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.* [135] The Eighth World Congress of the World Psychiatric Association was held between 12 and 19 October 1989 in Athens.* [122] The Congress was reminiscent of the previous World
Congress in 1983 in Vienna, and the one before that in 1977 in Honolulu.* [122] The issue of the Soviet political abuse
of psychiatry raised its ugly head, and dominated the WPA proceedings.* [122]
On 16 October, the Soviet delegation convened a press conference.* [122] The panel was uniformly evasive and defensive.* [122] 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.* [122] 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?* [122] Alexander Tiganov, who played a prominent part in the press conference, answered hesitatingly thatsuch
casescould have taken place during the period of stagnation but there was a need to distinguish between psychiatric,
legal and political aspects.* [122] 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.* [122]
74
Koryagin stated that the readmission would oer 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.* [136] He proposed the four
conditions for the readmission:* [136]
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
specic conditions had been satised; these included the release of all dissidents unjustiably detained in psychiatric
hospitals, and the dissociation by the authorities from the past abuse and their obligation to prevent its repetition.* [122]
The WPA Executive Committee decided to organize the Extraordinary General Assembly for the debate between the
Soviet dissident psychiatrist Dr. Semyon Gluzman and the representatives of the Soviet delegation.* [137] After that, it
was said, by the lips of the President of the Congress, a Greek psychiatrist Costas Stefanis, that the debate could not
take place because Gluzman represented nobody, did not ocially work as a psychiatrist and was not a member of the
Independent Psychiatric Association in Moscow.* [131] A few hours later, Gluzman managed to have himself presented
by Yuri Savenko.* [131] The meeting of the General Assembly turned out to be secret, even the press that was ocially
accredited under the WPA General Assembly was removed from the room.* [131] It was followed by something of the trial
against the ocial Soviet psychiatry.* [131] The situation was quite unbalanced, to put it mildly.* [137] The six or seven
members of the Russian delegation were seated in a row on the stage.* [137] As a result, there were no more available seats
on the stage, and, thus, Gluzman and his interpreter had to stand at the foot of the stage, at least a meter below.* [137]
It looked like seven against one and gave the visual impression of a lost battle.* [137] However, many members of the
Congress sympathized with Gluzman, who agreed to participate in the debate with the Soviet delegation.* [137] In addition,
the Soviet representatives made a very bad impression, repeating the standard Soviet propaganda that was completely
opposing what had already been published in the Soviet press.* [137] Gluzman, on his part, was in his best shape.* [137]
His story was not only sharp and clear but also he even showed compassion to the Soviet representatives who sat on the
stage high above him.* [137] Perhaps, the WPA hoped that the debate would make opinions change in favour of the Soviets
but the opposite happened.* [137] It has strengthened the view of their opponents that too few changes occurred in Soviet
psychiatry to allow the return of the Soviet Society and that their statements were still dominated by lies.* [137]
When it came to the climax, almost all Soviet psychiatrists, including Marat Vartanyan, were ignored by the Congress,
and the leading role in the Soviet delegation has been now openly taken by not a psychiatrist but the diplomat Yuri
Reshetov, the Deputy Foreign Aairs Minister of the Soviet Union.* [137] It is clear that the game is now being played
at the highest level with the direct participation of the political elite in Moscow.* [137] On the other part, there has been
formed the small group of negotiators composed of a British delegate and the President of the Royal College Jim Birley, a
Dutch delegate Roelof ten Doesschate, an American delegate Harold Visotsky, and a German delegate Johannes MeyerLindenberg.* [137] The situation was unique: the World Congress is continuing, the press is agog, the WPA Executive
Committee has been moved to the side, and the four delegates are carrying on negotiations with Yuri Reshetov, who is in
constant contact with Moscow, receiving instructions.* [137] In this way, the full independenceof Soviet psychiatry
from the state apparatus has once again been demonstrated.* [131]
The WPA Executive Committee moved the Soviet issue to the end of the agenda.* [137] At rst, they conducted long
debates about the whole range of procedural problems, small amendments to statutes and other issues, then they went
on to the elections of the WPA Executive Committee that led to a stir.* [137] Fini Schulzinger, the incumbent General
Secretary, decided to run for the presidency.* [137] Candidates were asked to submit their nominations and accompany
them by a short speech and explanation why they would be the best choice.* [137] Schulzinger went rst.* [137] His speech
began quietly, but soon he got excited, especially when it came to the issue of the membership of the Soviets.* [137] To the
surprise of delegates, he accused his contestants of being funded by the CIA and led by the Church of Scientology.* [137]
The audience totally went silent, they have never seen anything like this before.* [137] To the contestant of Schulzinger,
the race has been won: Jorge Alberto Costa e Silva has been elected as the WPA President by the overwhelming majority.* [137]
3.14. ATHENS CONGRESS
75
The negotiations with the Soviets continued even during the General Assembly.* [137] They were oered the last chance:
if they want to return, they have to read out the message that they plead guilty; otherwise, they will not have been
admitted.* [137] The intensive communication with Moscow did not stop, the negotiations of the statement started, and
each word was discussed.* [137]
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.* [138] At the Congress, the Soviet
Society's International Secretary Pyotr Morozov on behalf of his delegation made a statement containing the following
ve points, which are quoted in full:* [122]
2.
3.
4.
5.
1. 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.
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.
The All-Union Society unconditionally accepts the WPA review instrument.
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.
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.* [139] In the end, 291 votes were cast for the resolution, 45
against, with 19 abstentions.* [140] The Soviets were readmitted to the WPA under conditions* [140] 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.* [135]
There is no question of the morality of the WPA position.* [131] The hand of friendship was extended to not thousands
of ordinary Soviet psychiatrists but all the same leading specialistswho had doomed healthy people to the torments
of forced treatment.* [131] They have been charitably oered to voluntarily reeducate themselves and to lead a new,
perestroika-oriented psychiatry; however, what morality can be spoken of when among the members of the WPA were
left Romania and the Republic of South Africa, which abused psychiatry for political purposes?* [131] On the other hand,
they voted not for Vartanyan and Zharikov, not for the sad memory of Lunts but for Gorbachev and rather wanted to
help the processes of humanization in the USSR.* [131] They hoped that the membership Soviet psychiatrists in the WPA
would help to keep them under control.* [131]
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, ocially renounced his Honorary Membership
of the WPA by submitting on 8 November 1989 to the WPA General Secretary a short letter:* [141]
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.* [141] At the Moscow airport, they told the press that there have not
been and are no abuses of psychiatry in the Soviet Union and that the USSR has been admitted to the WPA rmly and
unconditionally.* [131] In an interview with a Soviet television crew, Marat Vartanyan replied to the question whether any
conditions had been set to a Soviet return:* [142]
No, that is wrong information, which you received from somewhere. There were no conditions. We
set the conditions. That is, we proposedehthe Executive Committee of the WPA to come to us on an
ocial visit to the Soviet Union within a year.
76
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.* [141] The dissemination of
disinformation on the part of the Soviets had distinctly not yet come to an end.* [141] Only on 27 October 1989, Meditsinskaya Gazeta reported the conditions set by the WPA General Assembly.* [141] When more than a year and a half
has passed since the decision of the Athens Congress to re-admit the Soviets to the WPA, leading psychiatrists in the
USSR continued to deny that abuse took place.* [143]
The 19831989 years with perfect clearness conrmed the fact that psychiatry is politics regardless of whether someone
likes the fact or not.* [137] The WPA leadership expanded that they tried not to admit politics to psychiatry, but for all
that the result of their actions and their secret negotiations with the Moscow psychiatric leadership was exactly opposing:
it has given the green light to carefully organized interventions from the Moscow political leadership supported by the
active participation of the Stasi and the KGB.* [137]
3.15 Visit of the WPA delegation

The WPA team spent three weeks in the Soviet Union,* [135] from 9 to 29 June 1991,* [144]and saw ten cases, all of which
had been diagnosed by Soviet psychiatrists as having schizophrenia.* [145] When reviewed case notes and the results of
their own interviews, the WPA team conrmed 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.* [146] 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.* [147]
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 Jos Lopez Ibor wrote that the All Union Society made in the General Assembly a Statement that
included ve items, several of which was not yet fullled, 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 ocially resigned from the World Psychiatric Association in October
1992.* [148]
3.16 Russian Mental Health Law

Main article: 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 an 80 year delay, after which the Law passed by Russia as against 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.* [149] 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.* [149] An initiator
of creating a serious, detailed mental health law in the USSR was a deputy of the last convocation of the Supreme Soviet
of the USSR, a young engineer from a Uralian town.* [150] When asked why he as an engineer needs it, he replied to
Semyon Gluzman,All this democracy will soon run out, guys who will come to power, will start repression, and you, Dr.
Gluzman, and I will have a hard time. So let's at least get these guys blocked from this possibility and adopt a civilized law
eliminating the possibility of psychiatric repression!"* [150] 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.* [149]
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.* [149] The Law has been
put in force since 1 January 1993.* [149] Adoption of the Law On Psychiatric Care and Guarantees of CitizensRights
3.17. SEE ALSO
77
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, rst of all, mediating all involuntary measures through judicial procedure.* [149] That is
a major 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.* [149] In 1993, when the IPA printed the Law in 50
thousand copies for the general reader, quite a number of heads of the Moscow psychoneurologic dispensaries refused
to circulate the Law. Over time, these diculties were overcome. It became obligatory to know the Law to pass the
certication exam.* [149]
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.* [151]
Over ve years, from 1998 to 2003, the Serbsky Center made three attempts to submit for the Duma readings of amendments and additions to the Law, but the IPA and general public managed to successfully challenge these amendments, and
they were nally tabled.* [152] In 2004, proponents of mental health reform could hardly prevent the eort 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.* [153] In 2004, Pavel Tishchenko said that government, with fright in a sense, copied many provisions
of Western standards concerning the patientsrights into Russian legislation and included the right to get information,
the right to choose a doctor in Fundamentals of Health Legislation.* [154] After the embarrassment of the 1990s, when
Russian Constitution and many laws have been investedmainly from abroadwith very good principles that protect the
rights of individual citizens, including patients, now a reversal is underway.* [154]
In Andrei Kovalyov
s words, the main thing is that sucient success was achieved in stopping the psychiatric oprichnina by
political and legislative means during perestroika.* [6] Can it be reborn?* [6] Certainly.* [6] Those who consider themselves
statists(that is those for whom the state is everything and a person is nothing), at least, would not surely object to this.* [6]
It took years of intense struggle to eliminate punitive psychiatry.* [6] For its rebirth, it is enough to have not even evil will
(which though cannot be ruled out, especially on the part of those who would improve their positions in society and get
more power in that way) but a simple thoughtlessness, error, blunder.* [6]
3.17 See also

Political abuse of psychiatry in the Soviet Union
3.18 References
[1] BMA 1992, p. 66; Bonnie 2002; Finckenauer 1995, p. 52; Gershman 1984; Helmchen & Sartorius 2010, p. 490; Knapp 2007,
p. 406; Kutchins & Kirk 1997, p. 293; Lisle 2010, p. 47; Merskey 1978; Society for International Development 1984, p. 19;
US GPO (1972, 1975, 1976, 1984, 1988); Voren (2002, 2010a, 2013a)
[2] Bloch & Reddaway 1977, p. 425; UPA Herald 2013
[3] Kondratev 2010, p. 181.
[6] Kovalyov 2007.
[7] US Delegation Report 1989, p. 26; US Delegation Report (Russian translation) 2009, p. 93
[9] Chodo 1985.
[10] Pospielovsky 1988, pp. 36, 140, 156, 178181.
78
[11] Gluzman (2009a, 2013); Voren 2013a, p. 8; Fedenko 2009; Soviet Archives 1970
[12] Fernando 2003, p. 160.
[13] Healey 2011.
[15] Psychiatric News 2010.
[16] Berman 1972, p. 11.
[18] Bukovsky and Gluzman (1975, 1977)
[19] Voren 2013a, pp. 1618; Pietikinen 2015, p. 280
[20] NPZ 2005.
[21] Voren 2010a; Helmchen & Sartorius 2010, p. 491
[22] Gluzman (2009b, 2010a)
[23] Bloch & Reddaway 1985, p. 189; Kadarkay 1982, p. 205; Korotenko & Alikina 2002, p. 260; Laqueur 1980, p. 26; Munro
2002, p. 179; Pietikinen 2015, p. 280; Rejali 2009, p. 395; Smythies 1973; Voren (2010b, p. 95, 2013b); Working Group on
the Internment of Dissenters in Mental Hospitals 1983, p. 1
[24] Adler & Gluzman 1993; Ball & Farr 1984, p. 258; Bebtschuk, Smirnova & Khayretdinov 2012; Brintlinger & Vinitsky 2007,
pp. 292, 293, 294; Dmitrieva 2001, pp. 84, 108; Faraone 1982; Fedor 2011, p. 177; Grigorenko, Ruzgis & Sternberg 1997,
p. 72; Gushansky 2005, p. 35; Horvath 2014; Kekelidze 2013; Korotenko & Alikina 2002, pp. 7, 47, 60, 67, 77, 259, 291;
Koryagin (1988, 1989); Magalif 2010; Podrabinek 1980, pp. 10, 57, 136; Pukhovsky 2001, pp. 243, 252; Savenko (2005a,
2005b); Schmidt & Shchurko 2014; Szasz (2004, 2006); Vitaliev 1991, p. 148; Voren & Bloch 1989, pp. 92, 95, 98; West &
Green 1997, p. 226
[25] Podrabinek 1980, p. 63.
[26] Savenko 2005a.
[27] Bonnie 2002; US GPO 1984, p. 5; Faraone 1982
[28] West & Green 1997, p. 226; Alexye 1976; US GPO 1984, p. 101
[29] Matvejevi 2004, p. 32.
[30] Hunt 1998, p. xii.
[31] Birstein 2004.
[32] Metzl 2010, p. 14.
[34] Knapp 2007, p. 402.
[36] Vasilenko 2004, p. 29; Chernosvitov 2002, p. 50
[37] Keukens & Voren 2007.
[38] Grigorenko, Ruzgis & Sternberg 1997, p. 72.
[39] Bukovsky 1971; Reddaway (1971a, 1971b); Richter 1971; Bloch & Reddaway 1977, pp. 8081; see the Russian text of the
letter in: Artyomova, Rar & Slavinsky 1971, p. 470
[40] Savenko 2010.
3.18. REFERENCES
79
[41] Watch from 07.47 Boltyanskaya 2014

[42] Gluzman 2010b; De Boer, Driessen & Verhaar 1982, p. 180; Schroeter 1979, p. 324
[43] BMA 1992, p. 73; Bloch & Reddaway 1977, p. 235; Psychiatric Bulletin 1981
[44] Schroeter 1979, p. 324.
[45] Sabshin 2008, p. 95.
[46] BMA 1992, p. 73.
[48] Spector & Kitsuse 2001, p. 101.
[49] Richter 1971.
[50] Spector & Kitsuse 2001, p. 103.
[51] Reich 1983.
[52] Voren 2009, p. 61.
[53] Berman 1972, p. 11; Bukovsky & Reddaway 1972
[54] Bukovsky (1981, p. 32, 2008, p. 35)
[55] BMJ 1973.
[56] AAASS 1973, p. 5.
[57] Trehub 2013.
[58] New Scientist 1976.
[59] Laird & Homann 1986, p. 79.
[60] Voren 2009, p. 7.
[61] Shlapentokh 1990, p. 194.
[62] Voren 2010b, p. 150.
[64] Calloway 1993, p. 223.
[67] Voren 2010b, p. 194.
[68] Voren 2010b, p. 195.
[69] Voren 2010b, p. 196.
[70] WPA (1977, 1978a, 1978b). The Declaration with minor amendments approved in 1983 was also published in: Bloch &
Reddaway 1985, pp. 233239
[71] Helmchen 1978.
[72] Voren 2010b, p. 197.
[73] Szasz (1978, 1984, p. 222)
[74] Merskey 1978.
80
[75] Merskey 1978; US GPO 1984, p. 71; Amnesty International 1983, p. 1; Bloch & Reddaway 1985, p. 47
[77] Burns 1981.
[78] US GPO 1984, p. 76.
[79] Gosden (1997, 2001, p. 23)
[80] Perlin 2006.
[81] Alexander 1997.
[82] Kelly 2015.
[83] Bloch 1980.
[84] Voren 2010b, p. 199.
[86] Kastrup 2002.
[87] Voren 2010b, p. 148.
[88] Americas Watch 1984, p. 67.
[90] Luty 2014.
[91] Scarnati 1980.
[92] Bernstein 1980.
[94] BMA 1992, p. 153.
[95] Voren & Bloch 1989, p. 26; Voren 2010b, p. 150
[96] Psychiatric Bulletin 1980.
[97] Voren 2010b, p. 179.
[98] Voren 2009, p. 45.
[99] Moran 2010.
[100] Voren 2009, p. 245.
[101] Psychiatric Bulletin 1979.
[102] Levine 1981.
[103] Voren 2010b, p. 201.
[104] Voren 2010b, p. 203.
[105] Wynn 1983.
[106] Voren 2010b, p. 204.
[107] US GPO 1984, p. 44.
[108] US GPO 1984, p. 45.
[109] US GPO 1984, p. 16.
3.18. REFERENCES
[110] US GPO 1984, p. 16; Bloch & Reddaway 1985, p. 185; HRIR 1982, p. 381
[111] Khronika Press 1982, p. 62.
[112] Voren 2010b, p. 211.
[113] Roth 1992.
[114] Voren 2010b, p. 211; US GPO 1984, p. 17; Bloch & Reddaway 1985, p. 218
[115] Voren 2010b, p. 211; Bloch & Reddaway 1985, p. 218; Freedman & Halpern 1989
[116] Johnston 2005, p. 9.
[117] Voren 2010b, p. 318; Fitzpatrick 1988, p. 3
[118] Gushansky 2005, p. 35.
[119] Voren 2010b, p. 322.
[120] Voren 2010b, p. 322; Voevoda, Chugunova & Krivtsov 1989, p. 24
[121] Ougrin, Gluzman & Dratcu 2006; Zharikov & Kiselev 1990, pp. 7074
[122] Bloch 1990.
[123] Bonnie 2002; Merriam-Webster 2013
[124] Bonnie 2002.
[125] Voren 2010b, p. 373.
[126] BMA 1992, p. 69.
[127] BMA 1992, p. 70.
[128] Voren 2009, p. 125.
[129] Psychiatric Practices in the Soviet Union 1989.
[130] Voren 2010b, p. 385; BMA 1992, p. 69; US Delegation Report 1989
[131] Gluzman 2011.
[132] Voren 2010b, p. 385.
[133] US Delegation Report (Russian translation) 2009.
[134] Neprikosnovennyj zapas 2001.
[135] BMA 1992, p. 71.
[136] Appleby 1987.
[137] Voren 2013b.
[138] Munro (2000, 2002, p. 32)
[139] Voren 2010b, p. 435.
[140] Voren 2010b, p. 436.
[141] Voren 2010b, p. 437.
[142] Voren 2010b, p. 437; Human Rights Watch 19522003
[143] Weich 1991.
[144] WPA 1991.
81
82
[145] BMA 1992, p. 72.

[146] BMA 1992, p. 72; WPA 1991, p. 11
[147] Voren 2010b, p. 454; WPA 1991, p. 10
[148] Voren 2010b, p. 455.
[150] Gluzman (2012, 2013)
[151] NPZ 2009, pp. 8586.
[152] Savenko 2007b, pp. 7577; Vinogradova & Savenko 2006
[153] Murphy 2006.
[154] NPZ 2004.
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3.20. FURTHER READING
91

Alexeyeva, Ludmilla (1987). Soviet dissent: contemporary movements for national, religious, and human rights.
Wesleyan University Press. ISBN 0-8195-6176-2.
Alexeyeva, Ludmilla [ ] (1992). : [History
of dissent in the USSR: contemporary period] (in Russian). VilniusMoscow: [News]. (The Russian text of
the book)
Antbi, Elizabeth (1977). Droit d'asiles en Union Sovitique. Paris: Editions Julliard. ISBN 2-260-00065-7.
Bloch, Sidney; Reddaway, Peter (1977). Russia's political hospitals: The abuse of psychiatry in the Soviet Union.
Victor Gollancz Ltd. ISBN 0-575-02318-X.
Bloch, Sidney; Reddaway, Peter (1985). Soviet psychiatric abuse: the shadow over world psychiatry. Westview
Press. ISBN 0-8133-0209-9.
Bloch, Sidney; Reddaway, Peter [ , ] (1996). : [Diagnosis:
dissent] (PDF). : [Karta: Russian
Independent Historical and Human Rights Defending Journal] (in Russian) (1314): 5667. Retrieved 1 January
2013.
Fireside, Harvey (1982). Soviet Psychoprisons. W. W. Norton & Company. ISBN 0-393-00065-6.
Gluzman, Semyon (1989). On Soviet totalitarian psychiatry. Amsterdam: International Association on the Political
Use of Psychiatry. ISBN 90-72657-02-0.
Korotenko, Ada; Alikina, Natalia [ , ] (2002). : [Soviet psychiatry: fallacies and wilfulness] (in Russian). Kiev:
[Publishing house Sphere"]. ISBN 966-7841-36-7.
Medvedev, Zhores; Medvedev, Roy (1979). A Question of Madness: Repression by Psychiatry in the Soviet Union.
Norton. ISBN 0-393-00921-1.
Podrabinek, Alexander (1980). Punitive medicine. Ann Arbor: Karoma Publishers. ISBN 0-89720-022-5. Russian
text: Podrabinek, Alexander [ ] (1979). [Punitive medicine] (in
Russian). New York: [Khronika Press]. Archived from the original on 24 March 2014.
Prokopenko, Anatoly [ ] (1997). : [Mad psychiatry: classied materials on the use of psychiatry in
the USSR for punitive purposes] (in Russian). Moscow: " " ["Top Secret"]. ISBN 5-85275145-6.
Smith, Theresa; Oleszczuk, Thomas (1996). No Asylum: State Psychiatric Repression in the Former U.S.S.R. New
York City: New York University Press. ISBN 0-8147-8061-X.
Soviet Political Psychiatry: The Story of the Opposition. London: International Association on the Political Use of
Psychiatry, Working Group on the Internment of Dissenters in Mental Hospitals. 1983.
Voren, Robert van (2009). On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the Soviet
Unionof Vladimir Putin. AmsterdamNew York: Rodopi Publishers. ISBN 978-90-420-2585-1.
92
Marat Vartanyan (19321993), a key apologist of Soviet psychiatric abuse, a founder and former director of the Mental Health Research
Center of the USSR Academy of Medical Sciences
Semyon Gluzman (b. 1946), a Ukrainian psychiatrist, human rights activist and political prisoner
93
94
Alexandr Podrabinek (b. 1953), a Russian journalist and former Soviet human rights activist and political prisoner
Anatoly Koryagin (b. 1938), a Russian psychiatrist and former Soviet human rights activist and political prisoner
95
96
Royal College of Psychiatrists (building with yellow ag) in Belgrave Square, London
97
Yuri Savenko, the President of the Independent Psychiatric Association of Russia and editor-in-chief of Nezavisimiy Psikhiatricheskiy
Zhurnal
Chapter 4
Anti-psychiatry
Vienna's NarrenturmGerman for fools' towerwas one of the earliest buildings specically designed as a madhouse. It was
built in 1784.
Anti-psychiatry is the view that psychiatric treatments are often more damaging than helpful to patients, and a movement
opposing such treatments for almost two centuries. It considers psychiatry a coercive instrument of oppression due to an
unequal power relationship between doctor and patient, and a highly subjective diagnostic process.* [1]* [2]* [3]
Anti-psychiatry originates in an objection to what some view as dangerous treatments.* [2] Examples include electroconvulsive
therapy, insulin shock therapy, brain lobotomy,* [2] and the over-prescription of potentially dangerous pharmaceutical
drugs.* [4] An immediate concern is the signicant increase in prescribing psychiatric drugs for children.* [1]* [2] There
98
4.1. HISTORY
99
were also concerns about mental health institutions. Every society, including liberal Western society, permits involuntary
treatment or involuntary commitment of mental patients.* [1]
In the 1960s, there were many challenges to psychoanalysis and mainstream psychiatry, where the very basis of psychiatric
practice was characterized as repressive and controlling. Psychiatrists involved in this challenge included Jacques Lacan,
Thomas Szasz, Giorgio Antonucci, R. D. Laing, Franco Basaglia, Theodore Lidz, Silvano Arieti, and David Cooper.
Others involved were Michel Foucault and Erving Goman. Cooper coined the term anti-psychiatryin 1967, and
wrote the book Psychiatry and Anti-psychiatry in 1971.* [1]* [2]* [5] Thomas Szasz introduced the denition of mental
illness as a myth in the book The Myth of Mental Illness (1961), Giorgio Antonucci introduced the denition of psychiatry
as a prejudice in the book I pregiudizi e la conoscenza critica alla psichiatria (1986).
Contemporary issues of anti-psychiatry include freedom versus coercion, mind versus brain, nature versus nurture, and
the right to be dierent. Some ex-patient groups have become anti-psychiatric, often referring to themselves as "survivors"
rather than patients.* [1]
4.1 History
4.1.1
Precursors
The rst widespread challenge to the prevailing medical approach in Western countries occurred in the late 18th century.* [6] Part of the progressive Age of Enlightenment, a "moral treatment" movement challenged the harsh, pessimistic,
somatic (body-based) and restraint-based approaches that prevailed in the system of hospitals and madhousesfor
people considered mentally disturbed, who were generally seen as wild animals without reason.* [6] Alternatives were
developed, led in dierent regions by ex-patient sta, physicians themselves in some cases, and religious and lay philanthropists.* [6] The moral treatment was seen as pioneering more humane psychological and social approaches, whether
or not in medical settings; however, it also involved some use of physical restraints, threats of punishment, and personal
and social methods of control.* [6] And as it became the establishment approach in the 19th century, opposition to its
negative aspects also grew.* [6]
According to Michel Foucault, there was a shift in the perception of madness, whereby it came to be seen as less about
delusion, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behaviour or will.* [7] Foucault
argued that, prior to this, doctors could often prescribe travel, rest, walking, retirement and generally engaging with nature,
seen as the visible form of truth, as a means to break with articialities of the world (and therefore delusions).* [8] Another
form of treatment involved nature's opposite, the theatre, where the patient's madness was acted out for him or her in such
a way that the delusion would reveal itself to the patient.
According to Foucault, the most prominent therapeutic technique instead became to confront patients with a healthy sound
will and orthodox passions, ideally embodied by the physician. The cure then involved a process of opposition, of struggle
and domination, of the patient's troubled will by the healthy will of the physician. It was thought the confrontation would
lead not only to bring the illness into broad daylight by its resistance, but also to the victory of the sound will and the
renunciation of the disturbed will. We must apply a perturbing method, to break the spasm by means of the spasm.... We
must subjugate the whole character of some patients, subdue their transports, break their pride, while we must stimulate and
encourage the others (Esquirol, J.E.D., 1816* [9]). Foucault also argued that the increasing internment of the mentally
ill(the development of more and bigger asylums) had become necessary not just for diagnosis and classication but
because an enclosed place became a requirement for a treatment that was now understood as primarily the contest of
wills, a question of submission and victory.
The techniques and procedures of the asylums at this time includedisolation, private or public interrogations, punishment
techniques such as cold showers, moral talks (encouragements or reprimands), strict discipline, compulsory work, rewards,
preferential relations between the physician and his patients, relations of vassalage, of possession, of domesticity, even of
servitude between patient and physician at times.* [9] Foucault summarised these as designed to make the medical
personage the 'master of madness'"* [9] through the power the physician's will exerts on the patient. The eect of this
shift then served to inate the power of the physician relative to the patient, correlated with the rapid rise of internment
(asylums and forced detention).* [10]
Other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism, including the
100
CHAPTER 4. ANTI-PSYCHIATRY
breakdown of the traditional family structures. And that by the end of the 19th century, psychiatrists often had little
power in the overrun asylum system, acting mainly as administrators who rarely attended to patients, in a system where
therapeutic ideals had turned into mindless institutional routines.* [11] In general, critics point to negative aspects of
the shift toward so-called moral treatments, and the concurrent widespread expansion of asylums, medical power
and involuntary hospitalization laws, in a way that was to play an important conceptual part in the later anti-psychiatry
movement.* [12]
Various 19th-century critiques of the newly emerging eld of psychiatry overlap thematically with 20th-century antipsychiatry, for example in their questioning of the medicalisation of madness. Those critiques occurred at a time
when physicians had not yet achieved hegemony through psychiatry, however, so there was no single, unied force to
oppose.* [12] Nevertheless, there was increasing concern at the ease with which people could be conned, with frequent
reports of abuse and illegal connement (for example, Daniel Defoe, the author of Robinson Crusoe, had previously
argued that husbands used asylum hospitals to incarcerate their disobedient wives.* [13]) There was general concern that
physicians were undermining personhood by medicalizing problems, by claiming they alone had the expertise to judge it,
and by arguing that mental disorder was physical and hereditary. The Alleged Lunatics' Friend Society arose in England
in the mid-19th century to challenge the system and campaign for rights and reforms.* [14] In the United States, Elizabeth
Packard published a series of books and pamphlets describing her experiences in the Illinois insane asylum to which her
husband had had her committed.
Throughout, the class nature of mental hospitals, and their role as agencies of control, were well recognized. And the new
psychiatry was partially challenged by two powerful social institutions the church and the legal system. These trends
have been thematically linked to the later 20th century anti-psychiatry movement.* [15]
As psychiatry became more professionally established during the nineteenth century (the term itself was coined in 1808
in Germany, as Psychiatriein) and developed allegedly more invasive treatments, opposition increased.* [16] In the
Southern US, black slaves and abolitionists encountered Drapetomania, a pseudo-scientic diagnosis for why slaves ran
away from their masters.* [17]
There was some organized challenge to psychiatry in the late 1870s from the new speciality of neurology. Practitioners
criticized mental hospitals for failure to conduct scientic research and adopt the modern therapeutic methods such as
nonrestraint. Together with lay reformers and social workers, neurologists formed the National Association for the Protection of the Insane and the Prevention of Insanity. However, when the lay members questioned the competence of asylum
physicians to even provide proper care at all, the neurologists withdrew their support and the association oundered.* [15]
4.1.2
Early 1900s
It has been noted that the most persistent critics of psychiatry have always been former mental hospital patients, but
that very few were able to tell their stories publicly or to confront the psychiatric establishment openly, and those who did
so were commonly considered so extreme in their charges that they could seldom gain credibility.* [15] In the early 20th
century, ex-patient Cliord W. Beers campaigned to improve the plight of individuals receiving public psychiatric care,
particularly those committed to state institutions, publicizing the issues in his book, A Mind that Found Itself (1908).* [18]
While Beers initially condemned psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient
involvement in the movement, he was inuenced by Adolf Meyer and the psychiatric establishment, and toned down his
hostility since he needed their support for reforms.
His reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped found, the National Committee for Mental Hygiene which eventually became the National Mental Health
Association.* [15] In the UK, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients
who sought justice for abuses committed in psychiatric custody, and were aggrieved that their complaints were patronisingly discounted by the authorities, who were seen to value the availability of medicalized internment as a 'whitewashed'
extrajudicial custodial and punitive process.* [19] In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the
system of neglect and abuse she had suered by publishing The Experiences of an Asylum Patient.* [20] In the US,
We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York, and continued
to meet as an ex-patient group.* [21]
In the 1920s extreme hostility to psychiatrists and psychiatry was expressed by the French playwright and theater director
Antonin Artaud, in particular, in his book on van Gogh. To Artaud, who was himself to spend a fair amount of time in
4.1. HISTORY
101
a straitjacket, imagination was reality. Much inuenced by the Dada and surrealist enthusiasms of the day, he considered
dreams, thoughts and visions no less real than the outsideworld. To Artaud, reality appeared little more than a
convenient consensus, the same kind of consensus an audience accepts when they enter a theater and, for a time, are
happy to pretend what they're seeing is real.
In this era before Penicillin was discovered, eugenics was popular. People believed diseases of the mind could be passed
on so compulsory sterilization of the mentally ill was enacted in many countries.
We do not stand alone": Flags of countries with compulsory sterilization legislation.
In the 1930s several controversial medical practices were introduced, including inducing seizures (by electroshock, insulin
or other drugs) or cutting parts of the brain apart (lobotomy). In the US, between 1939 and 1951, over 50,000 lobotomy
operations were performed in mental hospitals. But lobotomy was ultimately seen as too invasive and brutal.* [22]
Holocaust documenters argued that the medicalization of social problems and systematic euthanasia of people in German
mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder of the
1940s. The Nazi programs were called Action T4 and Action 14f13.* [23]* [24]* [25] The Nuremberg Trials convicted a
102
number of psychiatrists who held key positions in Nazi regimes.
4.1.3
1940s and 1950s
The post-World War II decades saw an enormous growth in psychiatry; many Americans were persuaded that psychiatry
and psychology, particularly psychoanalysis, were a key to happiness. Meanwhile, most hospitalized mental patients
received at best decent custodial care, and at worst, abuse and neglect.
The psychoanalyst Jacques Lacan has been identied as an inuence on later anti-psychiatry theory in the UK, and as
being the rst, in the 1940s and 50s, to professionally challenge psychoanalysis to reexamine its concepts and to appreciate
psychosis as understandable. Other inuences on Lacan included poetry and the surrealist movement, including the poetic
power of patients' experiences. Critics disputed this and questioned how his descriptions linked to his practical work. The
names that came to be associated with the anti-psychiatry movement knew of Lacan and acknowledged his contribution
even if they did not entirely agree.* [26] The psychoanalyst Erich Fromm is also said to have articulated, in the 1950s, the
secular humanistic concern of the coming anti-psychiatry movement. In The Sane Society (1955), Fromm wrote ""An
unhealthy society is one which creates mutual hostility [and] distrust, which transforms man into an instrument of use
and exploitation for others, which deprives him of a sense of self, except inasmuch as he submits to others or becomes an
automaton..."Yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking
in sanity. They hold that the problem of mental health in a society is only that of the number of 'unadjusted' individuals,
and not of a possible unadjustment of the culture itself.* [27]
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, slowly came into use. Although often
accepted as an advance in some ways, there was opposition, partly due to serious adverse eects such as tardive dyskinesia,
and partly due their chemical straitjacketeect and their alleged use to control and intimidate patients.* [22] Patients
often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.* [22] There
was also increasing opposition to the large-scale use of psychiatric hospitals and institutions, and attempts were made to
develop services in the community.
In the 1950s in the United States, a right-wing anti-mental health movement opposed psychiatry, seeing it as liberal, leftwing, subversive and anti-American or pro-Communist. There were widespread fears that it threatened individual rights
and undermined moral responsibility. An early skirmish was over the Alaska Mental Health Bill, where the right wing
protestors were joined by the emerging Scientology movement.
The eld of psychology sometimes came into opposition with psychiatry. Behaviorists argued that mental disorder was a
matter of learning not medicine; for example, Hans Eysenck argued that psychiatry really has no role to play. The
developing eld of clinical psychology in particular came into close contact with psychiatry, often in opposition to its
methods, theories and territories.* [28]
4.1.4
1960s
Coming to the fore in the 1960s, anti-psychiatry(a term rst used by David Cooper in 1967) dened a movement
that vocally challenged the fundamental claims and practices of mainstream psychiatry. While most of its elements had
precedents in earlier decades and centuries, in the 1960s it took on a national and international character, with access to the
mass media and incorporating a wide mixture of grassroots activist organizations and prestigious professional bodies.* [28]
Cooper was a South African psychiatrist working in Britain. A trained Marxist revolutionary, he argued that the political
context of psychiatry and its patients had to be highlighted and radically challenged, and warned that the fog of individualized therapeutic language could take away people's ability to see and challenge the bigger social picture. He spoke of
having a goal ofnon-psychiatryas well as anti-psychiatry. It has been suggested that Cooper may have seen psychiatry
as analogous to apartheid.* [28]
The psychiatrists R D Laing (from Scotland), Theodore Lidz (from America), Silvano Arieti (from Italy) and others,
argued that schizophreniaand psychosis were understandable, and resulted from injuries to the inner self-inicted by
psychologically invasiveschizophrenogenicparents or others. It was sometimes seen as a transformative state involving
an attempt to cope with a sick society. Laing, however, partially dissociated himself from his colleague Cooper's term
anti-psychiatry. Laing had already become a media icon through bestselling books (such as The Divided Self and
4.1. HISTORY
103
The Politics of Experience) discussing mental distress in an interpersonal existential context; Laing was somewhat less
focused than his colleague Cooper on wider social structures and radical left wing politics, and went on to develop more
romanticized or mystical views (as well as equivocating over the use of diagnosis, drugs and commitment). Although the
movement originally described as anti-psychiatry became associated with the general counter-culture movement of the
1960s, Lidz and Arieti never became involved in the latter. Franco Basaglia promoted anti-psychiatry in Italy and secured
reforms to mental health law there.
Laing, through the Philadelphia Association founded with Cooper in 1965, set up over 20 therapeutic communities including Kingsley Hall, where sta and residents theoretically assumed equal status and any medication used was voluntary.
Non-psychiatric Soteria houses, starting in the United States, were also developed* [29] as were various ex-patient-led
services.
Psychiatrist Thomas Szasz argued that "mental illness" is an inherently incoherent combination of a medical and a psychological concept. He opposed the use of psychiatry to forcibly detain, treat, or excuse what he saw as mere deviance
from societal norms or moral conduct. As a libertarian, Szasz was concerned that such usage undermined personal rights
and moral responsibility. Adherents of his views referred to the myth of mental illness, after Szasz's controversial
1961 book of that name (based on a paper of the same name that Szasz had written in 1957 that, following repeated
rejections from psychiatric journals, had been published in the American Psychologist in 1960* [30]). Although widely
described as part of the main anti-psychiatry movement, Szasz actively rejected the term and its adherents; instead, in
1969, he collaborated with Scientology to form the Citizens Commission on Human Rights. It was later noted that the
view that insanity was not in most or even in any instances amedicalentity, but a moral issue, was also held by Christian
Scientists and certain Protestant fundamentalists, as well as Szasz.* [15] Szasz was not a Scientologist himself and was
non-religious; he commented frequently on the parallels between religion and psychiatry.
Erving Goman, Deleuze, Guattari and others criticized the power and role of psychiatry in society, including the use
of "total institutions" and the use of models and terms that were seen as stigmatizing.* [31] The French sociologist and
philosopher Foucault, in his 1961 publication Madness and Civilization: A History of Insanity in the Age of Reason,
analyzed how attitudes towards those deemed insanehad changed as a result of changes in social values. He argued
that psychiatry was primarily a tool of social control, based historically on a great connementof the insane and
physical punishment and chains, later exchanged in the moral treatment era for psychological oppression and internalized
restraint. American sociologist Thomas Sche applied labeling theory to psychiatry in 1966 in Being Mentally Ill
. Sche argued that society views certain actions as deviant and, in order to come to terms with and understand these
actions, often places the label of mental illness on those who exhibit them. Certain expectations are then placed on these
individuals and, over time, they unconsciously change their behavior to fulll them.
Observation of the abuses of psychiatry in the Soviet Union in the so-called Psikhushka hospitals also led to questioning
the validity of the practice of psychiatry in the West.* [32] In particular, the diagnosis of many political dissidents with
schizophrenia led some to question the general diagnosis and punitive usage of the label schizophrenia. This raised questions as to whether the schizophrenia label and resulting involuntary psychiatric treatment could not have been similarly
used in the West to subdue rebellious young people during family conicts.* [33]
4.1.5
Since 1970
New professional approaches were developed as an alternative or reformist complement to psychiatry. The Radical Therapist, a journal begun in 1971 in North Dakota by Michael Glenn, David Bryan, Linda Bryan, Michael Galan and Sara
Glenn, challenged the psychotherapy establishment in a number of ways, raising the sloganTherapy means change, not
adjustment.It contained articles that challenged the professional mediator approach, advocating instead revolutionary
politics and authentic community making. Social work, humanistic or existentialist therapies, family therapy, counseling
and self-help and clinical psychology developed and sometimes opposed psychiatry.
Psychoanalysis was increasingly criticized as unscientic or harmful.* [34] Contrary to the popular view, critics and biographers of Freud, such as Alice Miller, Jerey Masson and Louis Breger, argued that Freud did not grasp the nature
of psychological trauma. Non-medical collaborative services were developed, for example therapeutic communities or
Soteria houses.
The psychoanalytically trained psychiatrist Szasz, although professing fundamental opposition to what he perceives as
medicalization and oppressive or excuse-giving diagnosisand forced treatment, was not opposed to other aspects
104
Scientologists on an anti-psychiatry demonstration.
of psychiatry (for example attempts tocure-heal souls, although he also characterizes this as non-medical). Although
generally considered anti-psychiatry by others, he sought to dissociate himself politically from a movement and term
associated with the radical left-wing. In a 1976 publication Anti-psychiatry: The paradigm of a plundered mind,
which has been described as an overtly political condemnation of a wide sweep of people, Szasz claimed Laing, Cooper
and all of anti-psychiatry consisted of self-declared socialists, communists, or at least anti-capitalists and collectivists".
While saying he shared some of their critique of the psychiatric system, Szasz compared their views on the social causes
of distress/deviance to those of anti-capitalist anti-colonialists who claimed that Chilean poverty was due to plundering by
American companies, a comment Szasz made not long after a CIA-backed coup had deposed the democratically elected
Chilean president and replaced him with Pinochet. Szasz argued instead that distress/deviance is due to the aws or
failures of individuals in their struggles in life.* [35]
The anti-psychiatry movement was also being driven by individuals with adverse experiences of psychiatric services. This
included those who felt they had been harmed by psychiatry or who felt that they could have been helped more by other
approaches, including those compulsorily (including via physical force) admitted to psychiatric institutions and subjected
to compulsory medication or procedures. During the 1970s, the anti-psychiatry movement was involved in promoting
restraint from many practices seen as psychiatric abuses.
The gay rights movement continued to challenge the classication of homosexuality as a mental illness and in 1974, in
a climate of controversy and activism, the American Psychiatric Association membership (following a unanimous vote
by the trustees in 1973) voted by a small majority (58%) to remove it as an illness category from the DSM, replacing
it with a category of sexual orientation disturbanceand then ego-dystonic homosexuality,which was deleted in
1987, although "gender identity disorder" and a wide variety of "paraphilias" remain. It has been noted that gay activists
at the time adopted many of Szasz's arguments against the psychiatric system, but also that Szasz had written in 1965
that: I believe it is very likely that homosexuality is, indeed, a disease in the second sense [expression of psychosexual
immaturity] and perhaps sometimes even in the stricter sense [a condition somewhat similar to ordinary organic maladies
perhaps caused by genetic error or endocrine imbalance. Nevertheless, if we believe that by categorising homosexuality
as a disease we have succeeded in removing it from the realm of moral judgement, we are in error.]"* [36]
Increased legal and professional protections, and a merging with human rights and disability rights movements, added to
anti-psychiatry theory and action.
Anti-psychiatry came to challenge a "biomedical" focus of psychiatry (dened to mean genetics, neurochemicals and
4.2. CHALLENGES TO PSYCHIATRY
105
pharmaceutic drugs). There was also opposition to the increasing links between psychiatry and pharmaceutical companies,
which were becoming more powerful and were increasingly claimed to have excessive, unjustied and underhand inuence
on psychiatric research and practice. There was also opposition to the codication of, and alleged misuse of, psychiatric
diagnoses into manuals, in particular the American Psychiatric Association, which publishes the Diagnostic and Statistical
Manual of Mental Disorders.
Anti-psychiatry increasingly challenged alleged psychiatric pessimism and institutionalized alienation regarding those
categorized as mentally ill. An emerging consumer/survivor movement often argues for full recovery, empowerment,
self-management and even full liberation. Schemes were developed to challenge stigma and discrimination, often based
on a social model of disability; to assist or encourage people with mental health issues to engage more fully in work and
society (for example through social rms), and to involve service users in the delivery and evaluation of mental health
services. However, those actively and openly challenging the fundamental ethics and ecacy of mainstream psychiatric
practice remained marginalized within psychiatry, and to a lesser extent within the wider mental health community.
Three authors came to personify the movement against psychiatry, and two of these were practicising psychiatrists. The
initial and most inuential of these was Thomas Szasz who rose to fame with his book The Myth of Mental Illness, although
Szasz himself did not identify as an anti-psychiatrist. The well-respected R D Laing wrote a series of best-selling books,
including The Divided Self. Intellectual philosopher Michel Foucault challenged the very basis of psychiatric practice and
cast it as repressive and controlling. The termanti-psychiatrywas coined by David Cooper in 1967.* [1]* [2] In parallel
with the theoretical production of the mentioned authors, the Italian physician Giorgio Antonucci questioned the basis
themselves of psychiatry through the dismantling of the psychiatric hospitals Osservanza and Luigi Lolli and the liberation
and restitution to life of the people there secluded.* [37]
William Glasser, MD wroteWarning: Psychiatry Can Be Hazardous to Your Mental Health, 2004 ISBN 0-06-053866X.
4.2 Challenges to psychiatry

4.2.1
Civilization as a cause of distress
In recent years, psychotherapists David Smail and Bruce E. Levine, considered part of the anti-psychiatry movement, have
written widely on how society, culture, politics and psychology intersect. They have written extensively of theembodied
natureof the individual in society, and the unwillingness of even therapists to acknowledge the obvious part played by
power and nancial interest in modern Western society. They argue that feelings and emotions are not, as is commonly
supposed, features of the individual, but rather responses of the individual to his situation in society. Even psychotherapy,
they suggest, can only change feelings in as much as it helps a person to change the proximaland distalinuences
on his / her life, which range from family and friends, to the workplace, socio-economics, politics and culture.* [38]* [39]
R D Laing notoriously emphasized family nexus as a mechanism whereby individuals become victimized by those around
them, and spoke about a dysfunctional society.* [40]* [41]
4.2.2
Evolution research
One evolutionary argument against psychology and psychiatry is from the study of swarm intelligence. There is evidence
that since the same number of individuals with certain characteristics is enough to carry out the same function in the
swarm regardless of the size of the swarm,* [42] the ideal percentage of specialindividuals decreases with increased
group size.* [43] Therefore, global stabilizing selection maintaining the same percentage of psychiatric conditions in all
human populations is not possible, given the dierences in group size that already existed based on food availability across
climates in the Paleolithic and became even greater upon the invention of agriculture. If a condition was only present
in 1% of humans, which is what psychiatry claims to be a culturally universal gure for multiple diagnoses including
schizophrenia and psychopathy, small Stone Age bands would at any given time be at a signicant risk of not having
a single member with any given 1% condition.* [44] If at least one member with each 1% diagnosis was essential for
any group's survival, random chance would in few generations have ensured human extinction in the Paleolithic.* [45]
What behaviors are necessary for a group's survival also varies depending on the group's lifestyle, ensuring a divergence-
106
enhancing weak niche construction as opposed to the divergence-hampering strong niche construction believed in by
psychiatry.* [46]* [47]* [48]* [49] Advocates of this evolutionary antipsychiatry tend not to sympathize with the Church
of Scientology but instead point at similarities between psychiatry and scientology, such as both arbitrarily and often
moralizingly deciding what they consider normal or pathological, scientology's belief in retained body thetans after going
clear resembling psychiatry's belief in sane people also having human aws, both claiming to have the only cure, both
demanding signicant amounts of money for their treatment, both having very accommodative claims that are extremely
dicult to impossible to test scientically, both sometimes resorting to coercive treatment, scientology's use of sts and
buckets of cold water doing similar harm as psychiatry's use of drugs and electroconvulsive therapy, and both explaining
human behavior today with self-inconsistent and archaeologically invalid stories about human pre-history.* [50]
4.2.3
Normality and illness judgments
In 2013, psychiatrist Allen Frances said thatpsychiatric diagnosis still relies exclusively on fallible subjective judgments
rather than objective biological tests.* [3]
Reasons have been put forward to doubt the ontic status of mental disorders.* [51]* :13 Mental disorders engender ontological
skepticism on three levels:
1. Mental disorders are abstract entities that cannot be directly appreciated with the human senses or indirectly, as
one might with macro- or microscopic objects.
2. Mental disorders are not clearly natural processes whose detection is untarnished by the imposition of values, or
human interpretation.
3. It is unclear whether they should be conceived as abstractions that exist in the world apart from the individual
persons who experience them, and thus instantiate them.* [51]* :13
In the scientic and academic literature on the denition or classication of mental disorder, one extreme argues that it is
entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely
objective and scientic (including by reference to statistical norms).* [52] Common hybrid views argue that the concept of
mental disorder is objective but a fuzzy prototype" that can never be precisely dened, or alternatively that it inevitably
involves a mix of scientic facts and subjective value judgments.* [53]
One remarkable example of psychiatric diagnosis being used to reinforce cultural bias and oppress dissidence is the
diagnosis of drapetomania. In the US prior to the American Civil War, physicians such as Samuel A. Cartwright diagnosed
some slaves with drapetomania, a mental illness in which the slave possessed an irrational desire for freedom and a
tendency to try to escape.* [54] By classifying such a dissident mental trait as abnormal and a disease, psychiatry promoted
cultural bias about normality, abnormality, health, and unhealth. This example indicates the probability for not only
cultural bias but also conrmation bias and bias blind spot in psychiatric diagnosis and psychiatric beliefs.
In addition, many feel that they are being pathologized for simply being dierent. Some people diagnosed with Asperger
syndrome or autism hold this position, particularly those involved in the autism rights movement. While many parents of
children diagnosed as autistic support the eorts of autistic activists, there are some who say they value the uniqueness of
their children and do not desire acurefor their autism. The autistic community has coined a number of terms that would
appear to form the basis for a new branch of identity politics; terms such as "neurodiversity" and "neurotypical".* [55]
However, an anti-psychiatric viewpoint is absent in nearly all of those advocating acceptance for autists or otheroutsiders
.
It has been argued by philosophers like Foucault that characterizations ofmental illnessare indeterminate and reect the
hierarchical structures of the societies from which they emerge rather than any precisely dened qualities that distinguish
a healthymind from a sickone. Furthermore, if a tendency toward self-harm is taken as an elementary symptom
of mental illness, then humans, as a species, are arguably insane in that they have tended throughout recorded history to
destroy their own environments, to make war with one another, etc.* [56]
107
A madness of civilization: the American physician Samuel A. Cartwright identied what he called drapetomania, an ailment that caused
slaves to be possessed by a desire for freedom and a want to escape
108
Psychiater Europas! Wahret Eure heiligsten Diagnosen!" (Psychiatrists of Europe! Protect your sanctied diagnoses!"), says the
inscription on the cartoon by Emil Kraepelin, who introduced the schizophrenia concept, Bierzeitung, Heidelberg, 1896
4.2.4
Psychiatric labeling
Mental disorders were rst included in the sixth revision of the International Classication of Diseases (ICD-6) in
1949.* [57] Three years later, the American Psychiatric Association created its own classication system, DSM-I.* [57]
The denitions of most psychiatric diagnoses consist of combinations of phenomenological criteria, such as symptoms
and signs and their course over time.* [57] Expert committees combined them in variable ways into categories of mental
disorders, dened and redened them again and again over the last half century.* [57]
The majority of these diagnostic categories are called disordersand are not validated by biological criteria, as most
medical diseases are; although they purport to represent medical diseases and take the form of medical diagnoses.* [57]
These diagnostic categories are actually embedded in top-down classications, similar to the early botanic classications
of plants in the 17th and 18th centuries, when experts decided a priori about which classication criterion to use, for
instance, whether the shape of leaves or fruiting bodies were the main criterion for classifying plants.* [57] Since the era
of Kraepelin, psychiatrists have been trying to dierentiate mental disorders by using clinical interviews.* [58]
In 1972, psychologist David Rosenhan published the Rosenhan experiment, a study questioning the validity of psychiatric
diagnoses.* [59] The study arranged for eight individuals with no history of psychopathology to attempt admission into
psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians,
including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder.
Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to
52 days. In a later part of the study, psychiatric sta were warned that pseudo-patients might be sent to their institutions,
but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one sta member
to be actors. The study concluded that individuals without mental disorders were indistinguishable from those suering
from mental disorders.* [59]
109
Critics such as Robert Spitzer placed doubt on the validity and credibility of the study, but did concede that the consistency
of psychiatric diagnoses needed improvement.* [60] It is now realized that the psychiatric diagnostic criteria are not perfect.
To further rene psychiatric diagnosis, according to Tadafumi Kato, the only way is to create a new classication of
diseases based on the neurobiological features of each mental disorder.* [58] On the other hand, according to Heinz
Katsching, neurologists are advising psychiatrists just to replace the term mental illnessby brain illness.* [57]
There are recognized problems regarding the diagnostic reliability and validity of mainstream psychiatric diagnoses, both
in ideal and controlled circumstances* [61] and even more so in routine clinical practice (McGorry et al.. 1995).* [62]
Criteria in the principal diagnostic manuals, the DSM and ICD, are inconsistent.* [63] Some psychiatrists who criticize
their own profession say that comorbidity, when an individual meets criteria for two or more disorders, is the rule rather
than the exception. There is much overlap and vaguely dened or changeable boundaries between what psychiatrists claim
are distinct illness states.* [64]
There are also problems with using standard diagnostic criteria in dierent countries, cultures, genders or ethnic groups.
Critics often allege that Westernized, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups. For example, several studies have shown that African Americans are more often
diagnosed with schizophrenia than Caucasians,* [65] and women more than men. Some within the anti-psychiatry movement are critical of the use of diagnosis as it conforms with the biomedical model.
4.2.5
Tool of social control
According to Franco Basaglia, Giorgio Antonucci, Bruce E. Levine and Edmund Schnenberger whose approach pointed
out the role of psychiatric institutions in the control and medicalization of deviant behaviors and social problems, psychiatry is used as the provider of scientic support for social control to the existing establishment, and the ensuing standards
of deviance and normality brought about repressive views of discrete social groups.* [39]* [66]* [67]* :70 According to
Mike Fitzpatrick, resistance to medicalization was a common theme of the gay liberation, anti-psychiatry, and feminist
movements of the 1970s, but now there is actually no resistance to the advance of government intrusion in lifestyle if it
is thought to be justied in terms of public health.* [68]
Moreover, the pressure for medicalization also comes from society itself.* [68] Feminists, who once opposed state intervention as oppressive and patriarchal, now demand more coercive and intrusive measures to deal with child abuse and
domestic violence.* [68] According to Richard Gosden, the use of psychiatry as a tool of social control is becoming obvious in preventive medicine programmes for various mental diseases.* [69]* :14 These programmes are intended to identify
children and young people with divergent behavioral patterns and thinking and send them to treatment before their supposed mental diseases develop.* [69]* :14 Clinical guidelines for best practice in Australia include the risk factors and signs
which can be used to detect young people who are in need of prophylactic drug treatment to prevent the development of
schizophrenia and other psychotic conditions.* [69]* :14
4.2.6
Psychiatry and the pharmaceutical industry
Critics of psychiatry commonly express a concern that the path of diagnosis and treatment in contemporary society is
primarily or overwhelmingly shaped by prot prerogatives, echoing a common criticism of general medical practice in
the United States, where many of the largest psychopharmaceutical producers are based.* [39]* [70]
Psychiatric research has demonstrated varying degrees of ecacy for improving or managing a number of mental health
disorders through either medications, psychotherapy, or a combination of the two. Typical psychiatric medications include
stimulants, antidepressants, hypnotic minor tranquilizers and neuroleptics (antipsychotics).
On the other hand, organizations such as MindFreedom International and World Network of Users and Survivors of
Psychiatry maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of adverse drug
reaction. They and other activists believe individuals are not given balanced information, and that current psychiatric medications do not appear to be specic to particular disorders in the way mainstream psychiatry asserts;* [71] and psychiatric
drugs not only fail to correct measurable chemical imbalances in the brain, but rather induce undesirable side eects. For
example, though children on Ritalin and other psycho-stimulants become more obedient to parents and teachers,* [72] critics have noted that they can also develop abnormal movements such as tics, spasms and other involuntary movements.* [73]
110
Whitchurch Hospital.
111
This has not been shown to be directly related to the therapeutic use of stimulants, but to neuroleptics.* [74]* [75] The
diagnosis of attention decit hyperactivity disorder on the basis of inattention to compulsory schooling also raises critics'
concerns regarding the use of psychoactive drugs as a means of unjust social control of children.* [72]
The inuence of pharmaceutical companies is another major issue for the anti-psychiatry movement. As many critics from
within and outside of psychiatry have argued, there are many nancial and professional links between psychiatry, regulators, and pharmaceutical companies. Drug companies routinely fund much of the research conducted by psychiatrists,
advertise medication in psychiatric journals and conferences, fund psychiatric and healthcare organizations and health
promotion campaigns, and send representatives to lobby general physicians and politicians. Peter Breggin, Sharkey, and
other investigators of the psycho-pharmaceutical industry maintain that many psychiatrists are members, shareholders or
special advisors to pharmaceutical or associated regulatory organizations.* [76]* [77]
There is evidence that research ndings and the prescribing of drugs are inuenced as a result. A United Kingdom crossparty parliamentary inquiry into the inuence of the pharmaceutical industry in 2005 concludes: The inuence of the
pharmaceutical industry is such that it dominates clinical practice* [78] and that there are serious regulatory failings
resulting in the unsafe use of drugs; and the increasing medicalization of society.* [79] The campaign organization
No Free Lunch details the prevalent acceptance by medical professionals of free gifts from pharmaceutical companies
and the eect on psychiatric practice.* [80] The ghostwriting of articles by pharmaceutical company ocials, which are
then presented by esteemed psychiatrists, has also been highlighted.* [81] Systematic reviews have found that trials of
psychiatric drugs that are conducted with pharmaceutical funding are several times more likely to report positive ndings
than studies without such funding.* [82]
The number of psychiatric drug prescriptions have been increasing at an extremely high rate since the 1950s and show no
sign of abating.* [22] In the United States antidepressants and tranquilizers are now the top selling class of prescription
drugs, and neuroleptics and other psychiatric drugs also rank near the top, all with expanding sales.* [82] As a solution to
the apparent conict of interests, critics propose legislation to separate the pharmaceutical industry from the psychiatric
profession.
John Read and Bruce E. Levine have advanced the idea of socioeconomic status as a signicant factor in the development
and prevention of mental disorders such as schizophrenia and have noted the reach of pharmaceutical companies through
industry sponsored websites as promoting a more biological approach to mental disorders, rather than a comprehensive
biological, psychological and social model.* [39]* [83]
4.2.7
Electroconvulsive therapy
Main article: Electroconvulsive therapy

Psychiatrists may advocate psychiatric drugs, psychotherapy or more controversial interventions such as electroshock or
psychosurgery to treat mental illness. Electroconvulsive therapy (ECT) is administered worldwide typically for severe
mental disorders. Across the globe it has been estimated that approximately 1 million patients receive ECT per year.* [84]
Exact numbers of how many persons per year have ECT in the United States are unknown due to the variability of settings
and treatment. Researchers' estimates generally range from 100,000 to 200,000 persons per year.* [85]
Some persons receiving ECT die during the procedure (ECT is performed under a general anaesthetic, which always
carries a risk). Leonard Roy Frank writes that estimates of ECT-related death rates vary widely. The lower estimates
include: 1 in 10,000 (Boodmans rst entry in 1996) 1 in 1,000 (Impastatos rst entry in 1957) 1 in 200, among
the elderly, over 60 (Impastatos in 1957) Higher estimates include: 1 in 102 (Martins entry in 1949) 1 in 95
(Boodmans rst entry in 1996) 1 in 92 (Freeman and Kendells entry in 1976) 1 in 89 (Sagebiels in 1961)
1 in 69 (Gralnicks in 1946) 1 in 63, among a group undergoing intensive ECT (Perrys in 19631979) 1 in 38
(Ehrenbergs in 1955) 1 in 30 (Kurlands in 1959) 1 in 9, among a group undergoing intensive ECT (Weils in
1949) 1 in 4, among the very elderly, over 80 (Kroessler and Fogels in 19741986).* [86]
4.2.8
Main article: Political abuse of psychiatry

See also: Political abuse of psychiatry in the Soviet Union
112
A Bergonic chair for giving general electric treatment for psychological eect, in psycho-neurotic cases, according to original photo
description. World War I era.
Psychiatrists around the world have been involved in the suppression of individual rights by states wherein the denitions
of mental disease had been expanded to include political disobedience.* [87]* :6 Nowadays, in many countries, political
prisoners are sometimes conned to mental institutions and abused therein.* [88]* :3 Psychiatry possesses a built-in capacity
for abuse which is greater than in other areas of medicine.* [89]* :65 The diagnosis of mental disease can serve as proxy
for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that
work in favour of ideological conformity and in the broader interests of society.* [89]* :65 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.* [89]* :65
Under the Nazi regime in the 1940s, the 'duty to care' was violated on an enormous scale.* [25] In Germany alone 300,000
individuals that had been deemed mentally ill, work-shy or feeble-minded were sterilized. An additional 200,000 were
euthanized.* [90] These practices continued in territories occupied by the Nazis further aeld (mainly in eastern Europe),
aecting thousands more.* [91] From the 1960s up to 1986, political abuse of psychiatry was reported to be systematic in the Soviet Union, and to surface on occasion in other Eastern European countries such as Romania, Hungary,
Czechoslovakia, and Yugoslavia.* [89]* :66 A mental health genocidereminiscent of the Nazi aberrations has been
located in the history of South African oppression during the apartheid era.* [92] A continued misappropriation of the
discipline was subsequently attributed to the People's Republic of China.* [93]
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.* [94] In an article published
in 1994 by American psychiatrist Thomas Szasz on the Journal of Medical Ethics he stated thatthe classication by slave
owners and slave traders of certain individuals as Negroes was scientic, in the sense that whites were rarely classied
as blacks. But that did not prevent the 'abuse' of such racial classication, because (what we call) its abuse was, in fact,
its use.* [95] Szasz argued that the spectacle of the Western psychiatrists loudly condemning Soviet colleagues for
113
The psychiatric ward at Guantanamo Bay.
their abuse of professional standards was largely an exercise in hypocrisy.* [69]* :220* [95] Szasz states that K. Fulford,
A. Smirnov, and E. Snow, who correctly emphasize the value-laden nature of psychiatric diagnoses and the subjective
character of psychiatric classications, fail to accept the role of psychiatric power.* [95] 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 into the social role of the psychiatrist in democratic and totalitarian societies
alike.* [69]* :220* [95] Musicologists, drama critics, art historians, and many other scholars also create their own subjective
classications; however, lacking state-legitimated power over persons, their classications do not lead to anyones being
deprived of property, liberty, or life.* [95] For instance, plastic surgeons classication of beauty is subjective, but the
plastic surgeon cannot treat his or her patient without the patients consent, therefore, there cannot be any political abuse
of plastic surgery.* [95]
The bedrock of political medicine is coercion masquerading as medical treatment.* [96]* :497 What transforms coercion
into therapy are physicians diagnosing the persons condition an illness,declaring the intervention they impose on
the victim atreatment,and legislators and judges legitimating these categorizations asillnessesandtreatments.
*
[96]* :497 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.* [96]* :497* [97]
From the commencement of his political career, Hitler put his struggle against enemies of the statein medical
rhetoric.* [96]* :502 In 1934, addressing the Reichstag, Hitler declared, I gave the orderto burn out down to the
raw esh the ulcers of our internal well-poisoning.* [96]* :502* [98]* :494 The entire German nation and its National
Socialist politicians learned to think and speak in such terms.* [96]* :502 Werner Best, Reinhard Heydrichs deputy,
stated that the task of the police was to root out all symptoms of disease and germs of destruction that threatened the
political health of the nation[In addition to Jews,] most [of the germs] were weak, unpopular and marginalized groups,
such as gypsies, homosexuals, beggars, 'antisocials', 'work-shy', and 'habitual criminals'.* [96]* :502* [98]* :541
In spite of all the evidence, people underappreciate or, more often, ignore the political implications of the therapeutic
character of Nazism and of the use of medical metaphors in modern democracies.* [96]* :503 Dismissed as an "abuse of
psychiatry", this practice is a touchy subject not because the story makes psychiatrists in Nazi Germany look bad, but
114
because it highlights the dramatic similarities between pharmacratic controls in Germany under Nazism and those that
have emerged in the US under the free market economy.* [96]* :503* [99]
4.2.9
Therapeutic State
TheTherapeutic Stateis a phrase coined by Szasz in 1963.* [100] The collaboration between psychiatry and government
leads to what Szasz calls the therapeutic state, a system in which disapproved actions, thoughts, and emotions are
repressedcured
(
) through pseudomedical interventions.* [101]* [102]* :17 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.* [102]* :17 When faced with demands for measures
to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that we must guard against charges
of nanny statism.* [68] The nanny statehas turned into the therapeutic statewhere nanny has given way to
counselor.* [68] Nanny just told people what to do; counselors also tell them what to think and what to feel.* [68] The
nanny statewas punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportiveand even more
authoritarian.* [68] 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.* [96]* :515
Faced with the problem of madness,Western individualism proved to be ill-prepared to defend the rights of the
individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if
once people agree that they have identied the one true God, or Good, it brings about that they have to guard members
and nonmembers of the group from the temptation to worship false gods or goods.* [96]* :496 A secularization of God
and the medicalization of good resulted in the post-Enlightenment version of this view: once people agree that they have
identied the one true reason, it brings about that they have to guard against the temptation to worship unreasonthat is,
madness.* [96]* :496
Civil libertarians warn that the marriage of the State with psychiatry could have catastrophic consequences for civilization.* [103]
In the same vein as the separation of church and state, Szasz believes that a solid wall must exist between psychiatry and
the State.* [96]
4.2.10 Total Institution

In his book Asylums, Erving Goman coined the term 'Total Institution' for mental hospitals and similar places which
took over and conned a person's whole life.* [104]* :150* [105]* :9 Goman placed psychiatric hospitals in the same
category as concentration camps, prisons, military organizations, orphanages, and monasteries.* [106] In Asylums Goman
describes how the institutionalisation process socialises people into the role of a good patient, someone dull, harmless
and inconspicuous; it in turn reinforces notions of chronicity in severe mental illness.* [107]
4.3 Law
While the insanity defense is the subject of controversy as a viable excuse for wrongdoing, Szasz and other critics contend that being committed in a psychiatric hospital can be worse than criminal imprisonment, since it involves the risk of
compulsory medication with neuroleptics or the use of electroshock treatment.* [108]* [109] Moreover, while a criminal
imprisonment has a predetermined and known time of duration, patients are typically committed to psychiatric hospitals for indenite durations, an unjust and arguably outrageous imposition of fundamental uncertainty.* [110] It has
been argued that such uncertainty risks aggravating mental instability, and that it substantially encourages a lapse into
hopelessness and acceptance that precludes recovery.
4.4. PSYCHIATRY AS PSEUDOSCIENCE AND FAILED ENTERPRISE
4.3.1
115
Involuntary hospitalization
Main articles: Involuntary commitment and involuntary treatment

Critics see the use of legally sanctioned force in involuntary commitment as a violation of the fundamental principles
of free or open societies. The political philosopher John Stuart Mill and others have argued that society has no right to
use coercion to subdue an individual as long as he or she does not harm others. Mentally ill people are essentially no
more prone to violence than sane individuals, despite Hollywood and other media portrayals to the contrary.* [111]* [112]
The growing practice, in the United Kingdom and elsewhere, of Care in the Community was instituted partly in response
to such concerns. Alternatives to involuntary hospitalization include the development of non-medical crisis care in the
community.
In the case of people suering from severe psychotic crises, the American Soteria project used to provide what was
argued to be a more humane and compassionate alternative to coercive psychiatry. The Soteria houses closed in 1983 in
the United States due to lack of nancial support. However, similar establishments are presently ourishing in Europe,
especially in Sweden and other North European countries.* [113]
The physician Giorgio Antonucci, during his activity as a director of the Ospedale Psichiatrico Osservanza of Imola, refused any form of coercion and any violation of the fundamental principles of freedom, questioning the basis of psychiatry
itself.* [66]
4.4 Psychiatry as pseudoscience and failed enterprise

Many of the above issues lead to the claim that psychiatry is a pseudoscience.* [114] According to some philosophers of
science, for a theory to qualify as science it needs to exhibit the following characteristics:
parsimony, as straightforward as the phenomena to be explained allow (see Occam's razor);
empirically testable and falsiable (see Falsiability);
changeable, i.e. if necessary, changes may be made to the theory as new data are discovered;
progressive, encompasses previous successful descriptions and explains and adds more;
provisional, i.e. tentative; the theory does not attempt to assert that it is a nal description or explanation.
Psychiatrist Colin A. Ross and Alvin Pam maintain that biopsychiatry does not qualify as a science on many counts.* [115]
Stuart A. Kirk has argued that psychiatry is a failed enterprise, as mental illness has grown, not shrunk, with about 20%
of American adults diagnosable as mentally ill in 2013.* [116]
4.5 Diverse paths

Szasz has since (2008) re-emphasized his disdain for the term anti-psychiatry, arguing that its legacy has simply been a
catchall term used to delegitimize and dismiss critics of psychiatric fraud and force by labeling them 'antipsychiatrists'".
He points out that the term originated in a meeting of four psychiatrists (Cooper, Laing, Berke and Redler) who never
dened it yet counter-label[ed] their discipline as anti-psychiatry, and that he considers Laing most responsible for
popularizing it despite also personally distancing himself. Szasz describes the deceased (1989) Laing in vitriolic terms,
accusing him of being irresponsible and equivocal on psychiatric diagnosis and use of force, and detailing his pastpublic
behavioras a t subject for moral judgmentwhich he gives as a bad person and a fraud as a professional.* [117]
Daniel Burston, however, has argued that overall the published works of Szasz and Laing demonstrate far more points of
convergence and intellectual kinship than Szasz admits, despite the divergence on a number of issues related to Szasz being
a libertarian and Laing an existentialist; that Szasz employs a good deal of exaggeration and distortion in his criticism of
116
Laing's personal character, and unfairly uses Laing's personal failings and family woes to discredit his work and ideas;
and that Szasz's clear-cut, crystalline ethical principles are designed to spare us the agonizing and often inconclusive
reections that many clinicians face frequently in the course of their work.* [118] Szasz has indicated that his own views
came from libertarian politics held since his teens, rather than through experience in psychiatry; that in hisrarecontacts
with involuntary mental patients in the past he either sought to discharge them (if they were not charged with a crime)
orassisted the prosecution in securing [their] conviction(if they were charged with a crime and appeared to be prima
facie guilty); that he is not opposed to consensual psychiatry anddoes not interfere with the practice of the conventional
psychiatrist, and that he provided listening-and-talking (psychotherapy)" for voluntary fee-paying clients from
1948 until 1996, a practice he characterizes as non-medical and not associated with his being a psychoanalytically trained
psychiatrist.* [117]
The gay rights or gay liberation movement is often thought to have been part of anti-psychiatry in its eorts to challenge
oppression and stigma and, specically, to get homosexuality removed from the American Psychiatric Association's (APA)
Diagnostic and Statistical Manual of Mental Disorders. However, a psychiatric member of APA's Gay, Lesbian, and
Bisexual Issues Committee has recently sought to distance the two, arguing that they were separate in the early 70s
protests at APA conventions and that APA's decision to remove homosexuality was scientic and happened to coincide
with the political pressure. Reviewers have responded, however, that the founders and movements were closely aligned;
that they shared core texts, proponents and slogans; and that others have stated that, for example, the gay liberation critique
was made possible by (and indeed often explicitly grounded in) traditions of antipsychiatry.* [119]* [120]
In the clinical setting, the two strands of anti-psychiatrycriticism of psychiatric knowledge and reform of its practices
were never entirely distinct. In addition, in a sense, anti-psychiatry was not so much a demand for the end of psychiatry, as it was an often self-directed demand for psychiatrists and allied professionals to question their own judgements,
assumptions and practices. In some cases, the suspicion of non-psychiatric medical professionals towards the validity of
psychiatry was described as anti-psychiatry, as well the criticism ofhard-headedpsychiatrists towardssoft-headed
psychiatrists. Most leading gures of anti-psychiatry were themselves psychiatrists, and equivocated over whether they
were really against psychiatry, or parts thereof. Outside the eld of psychiatry, howevere.g. for activists and nonmedical mental health professionals such as social workers and psychologists'anti-psychiatry' tended to mean something
more radical. The ambiguous termanti-psychiatrycame to be associated with these more radical trends, but there was
debate over whether it was a new phenomenon, whom it best described, and whether it constituted a genuinely singular
movement.* [121] In order to avoid any ambiguity intrinsic to the term anti-psychiatry, a current of thought that can be
dened as Critique of the basis of psychiatry, radical and unambiguous, aims for the complete elimination of psychiatry.
The main representative of the Critique of the basis of psychiatry is an Italian physician, Giorgio Antonucci.
In the 1990s, a tendency was noted among psychiatrists to characterize and to regard the anti-psychiatric movement as
part of the past, and to view its ideological history as irtation with the polemics of radical politics at the expense of
scientic thought and enquiry. It was also argued, however, that the movement contributed towards generating demand
for grassroots involvement in guidelines and advocacy groups, and to the shift from large mental institutions to community
services. Additionally, community centers have tended in practice to distance themselves from the psychiatric/medical
model and have continued to see themselves as representing a culture of resistance or opposition to psychiatry's authority. Overall, while antipsychiatry as a movement may have become an anachronism by this period and was no longer
led by eminent psychiatrists, it has been argued that it became incorporated into the mainstream practice of mental
health disciplines.* [26] On the other hand, mainstream psychiatry became more biomedical, increasing the gap between
professionals.
Henry Nasrallah claims that while he believes anti-psychiatry consists of many historical exaggerations based on events and
primitive conditions from a century ago,antipsychiatry helps keep us honest and rigorous about what we do, motivating
us to relentlessly seek better diagnostic models and treatment paradigms. Psychiatry is far more scientic today than it
was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past. The best antidote
for antipsychiatry allegations is a combination of personal integrity, scientic progress, and sound evidence-based clinical
care.* [2]
A criticism was made in the 1990s that three decades of anti-psychiatry had produced a large literature critical of psychiatry, but little discussion of the deteriorating situation of the mentally troubled in American society. Anti-psychiatry
crusades have thus been charged with failing to put suering individuals rst, and therefore being similarly guilty of what
they blame psychiatrists for. The rise of anti-psychiatry in Italy was described by one observer as simply a transfer of
psychiatric control from those with medical knowledge to those who possessed socio-political power.* [28]
4.6. SEE ALSO
117
Some components of antipsychiatric theory have in recent decades been reformulated into a critique ofcorporate psychiatry, heavily inuenced by the pharmaceutical industry. A recent editorial about this was published in the British Journal
of Psychiatry by Moncrie, arguing that modern psychiatry has become a handmaiden to conservative political commitments. David Healy is a psychiatrist and professor in Psychological Medicine at Cardi University School of Medicine,
Wales. He has a special interest in the inuence of the pharmaceutical industry on medicine and academia.* [122]
In the meantime, members of the psychiatric consumer/survivor movement continued to campaign for reform, empowerment and alternatives, with an increasingly diverse representation of views. Groups often have been opposed and
undermined, especially when they proclaim to be, or when they are labelled as being, anti-psychiatry.* [123] However, as of the 1990s, more than 60 percent of ex-patient groups reportedly support anti-psychiatry beliefs and consider
themselves to be psychiatric survivors.* [124] Although anti-psychiatry is often attributed to a few famous gures
in psychiatry or academia, it has been pointed out that consumer/survivor/ex-patient individuals and groups preceded it,
drove it and carried on through it.* [125]
A schism exists among those critical of conventional psychiatry between radical abolitionists and more moderate reformists. Laing, Cooper and others associated with the initial anti-psychiatry movement stopped short of actually advocating for the abolition of coercive psychiatry. Thomas Szasz, from near the beginning of his career, crusaded for
the abolition of forced psychiatry. Today, realizing that coercive psychiatry marginalizes and oppresses people with its
harmful, controlling, and abusive practices, many who identify as anti-psychiatry activists are proponents of the complete
abolition of non-consensual and coercive psychiatry. Furthermore, as there is little evidentiary basis to support the eld's
medical pretensions, many contemporary anti-psychiatry activists envision, and see themselves as working towards, an
eventual end to the profession itself.
4.6 See also

Against Therapy
Antipsychology
Double bind
Flexner Report
History of mental disorders
Icarus Project
Interpretation of Schizophrenia
Liberation by Oppression: A Comparative Study of Slavery and Psychiatry
Mind Freedom
Positive Disintegration
Psychiatric survivors movement
Psychoanalytic theory
Radical Psychology Network
Rosenhan experiment
Self-help groups for mental health
World Network of Users and Survivors of Psychiatry
118
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[75] Marilyn Elias (May 2, 2006). New antipsychotic drugs carry risks for children. USA Today. Contributing: Susan O'Brian.
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[95] Szasz, Thomas (September 1994).Psychiatric diagnosis, psychiatric power and psychiatric abuse(PDF). Journal of Medical
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[97] Black, Edwin (2012). War Against the Weak: Eugenics and America's Campaign to Create a Master Race. Dialog Press. ISBN
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[98] Kershaw, Ian (1999). Hitler: 18891936. Norton: New York. ISBN 0-393-04671-0.
[99] Klein, Naomi. The Shock Doctrine: The Rise of Disaster Capitalism. Knopf Canada. Highlights similarity between Psychiatric
treatments and disaster Capitalism.
[100] Baker, Robert (Winter 2003). Psychiatry's Gentleman Abolitionist (PDF). The Independent Review VII (3): 455460.
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[101] Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum (July 2000). Reason Magazine.
[102] Costigan, Lucy (2004). Social Awareness in Counselling. iUniverse. p. 17. ISBN 0-595-75523-2. Retrieved 2014-01-12.
[103] Sheldon Richman (March 4, 2005). Bush's Brave New World. The Future of Freedom Foundation. Archived from the
original on 2005-03-06. (Web page changed slightly; this is current page)
[104] Davidson, Larry; Rakfeldt, Jaak; Strauss, John, eds. (2010). The Roots of the Recovery Movement in Psychiatry: Lessons
Learned. John Wiley and Sons. p. 150. ISBN 88-464-5358-1.
[105] Wallace, Samuel (1971). Total Institutions. Transaction Publishers. p. 9. ISBN 88-464-5358-1. Retrieved 2014-01-12.
[106] Weinstein R.M. (1982). Goman's Asylums and the Social Situation of Mental Patients (PDF). Orthomolecular psychiatry
11 (4): 267274. Retrieved 2014-01-13.
[107] Lester H., Gask L.; Gask (May 2006). Delivering medical care for patients with serious mental illness or promoting a
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16648523.
[108] Szasz, Thomas (1989). Law, Liberty, and Psychiatry: An Inquiry into the Social Uses of Mental Health Practices. Syracuse
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[109] Mental Illness On Trial: The Rodney Yoder Story. Stopshrinks.org.
[110] Szasz, Thomas (2002). Patient or Prisoner?". Ideas on Liberty 52: 3132.
[111] UNC study: Mental illness by itself does not predict future violent behavior. UNC Health Care. February 2, 2009.
[112] Search Content | Science News. Science News.
[113] Dr. Loren Mosher, 19332004. Alliance for Human Research Protection. 13 July 2004. Retrieved 2014-01-13.
[114] Warme, Gordon (2006). Daggers of the Mind: Psychiatry and the Myth of Mental Disease. Canada: House of Anansi. ISBN
0-88784-197-X.
[115] Ross, Colin (1995). Errors of logic in biological psychiatryin Colin Ross and Alvin Pam Pseudoscience in Biological
Psychiatry. NY: Wiley & Sons. pp. 85128.
[116] Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. p. 326.
[117] Szasz, Thomas (June 2008). Debunking Antipsychiatry: Laing, Law, and Largactil. Current Psychology 27 (2): 79101.
doi:10.1007/s12144-008-9024-z. (subscription required (help)).
[118] Burston, Daniel (2004). Szasz, Laing and Existential Psychotherapy. Existential-Human Institute. Retrieved 2014-01-13.
[119] McCommon B (2006).Antipsychiatry and the Gay Rights Movement
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[120] Rissmiller DJ, Rissmiller J; Rissmiller (2006).Letter in reply
. Psychiatr Serv 57 (12): 18091810. doi:10.1176/appi.ps.57.12.1809a.
[121] Laey, Paul (2003). Antipsychiatry in Australia: Sources for a Social and Intellectual History (PDF). Health & History 5
(2): 1736. doi:10.2307/40111451. JSTOR 40111451.
[122] Seyyed Nassir Ghaemi (2006). Paradigms of Psychiatry: Eclecticism and Its Discontents. Current Opinion in Psychiatry
19 (6). (login required)
[123] McLean, A. (2003).Recovering Consumers and a Broken Mental Health System in the United States: Ongoing Challenges for
Consumers/ Survivors and the New Freedom Commission on Mental Health. Part II: Impact of Managed Care and Continuing
Challenges. International Journal of Psychosocial Rehabilitation 8: 5870.
4.8. WORKS CITED
123
[124] Everett B (1994). Something is happening: the contemporary consumer and psychiatric survivor movement in historical
context. Journal of Mind and Behavior 15: 557.
[125] Rissmiller, D.J.; Rissmiller, J.H. (June 2006). Evolution of the Antipsychiatry Movement into mental health consumerism
(PDF). Psychiatric Services 57 (6): 863866. doi:10.1176/appi.ps.57.6.863. PMID 16754765.
4.8 Works cited

Foucault, Michel (1997). Psychiatric Power. In Rabinow, Paul. Ethics, subjectivity and truth. Translated by
Robert Hurley and others. New York: The New Press. ISBN 978-1-56584-352-3. OCLC 46638170.
4.9 Further reading

Antonucci Giorgio (1986). Coppola, Alessio, ed. I pregiudizi e la conoscenza. Critica alla psichiatria (preface by
Thomas Szasz) [The prejudices and knowledge. Critics of psychiatry] (1st ed.). Apache Cooperative Ltd.
Antonucci Giorgio (1994). Critica al giudizio psichiatrico [Critique of psychiatric judgment]. Sensibili alle Foglie.
ISBN 8889883014.
Laing, R.D. (1976). The Divided Self. Penguin Books. ISBN 978-0-14-020734-7.
Laing, R.D. (1983). The Politics of Experience. Pantheon. ISBN 978-0-394-71475-2.
Szasz, Thomas (1997). The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health
Movement. Syracuse University Press. ISBN 978-0-8156-0461-7.
Glasser, William, Warning: Psychiatry Can Be Hazardous to Your Mental Health, 2004 ISBN 0-06-053866-X
4.10 External links

The Antipsychiatry Coalition
International Center for Humane Psychiatry and Dan L. Edmunds, Ed.D.
National Mental Health Consumers' Self-Help Clearinghouse
Commercial inuence and the content of medical journals British Medical Journal.
ICSPP.orgInternational Center for the Study of Psychiatry and Psychology
PsychRights.orgLaw Project for Psychiatric Rights
IAAPA International Association Against Psychiatric Assault
PSAT Psychiatric Survivor Archives of Toronto
Antipsychiatry Antipsiquiatra: Deconstruccin del concepto de enfermedad mental y crtica de la 'razn psiquitrica
- Antipsychiatry: Deconstruction of the concept of mental illness and critique of psychiatric reason
Critical Psychiatry Website (UK) Network of Psychiatrists Critical to Psychiatry Working in the UK.
Anti Psychiatry Community on Reddit
Anti-Psychiatry and its Legacies (video)". Nottingham Contemporary. Retrieved 12 November 2013. 1213
February 2013
124
Drug Company Dominance Makes Some Shrinks Rich, and Many Patients Over Drugged. Some of the biggest
names in the psychiatric establishment are distancing themselves from psychiatrys diagnostic system and its
treatments.Bruce E. Levine, AlterNet, 2014.04.15
Chapter 5
Antipsychology
Anti-psychology describes the suspicion and resistance that some people feel towards psychological treatment. It is
not a wholly accurate term, as critics tend to focus on psychological intervention in cases of mental illness rather than on
psychology as a science, which covers a broad and diverse spectrum of topics. Thus at some points the term anti-psychiatry
is more accurate. Some critics of psychology / psychiatry deny that mental illness exists at all, arguing that psychology
/ psychiatry aims to pathologise perfectly normal variations in human behaviour; whereas others accept the existence
of mental illness but state that current mainstream psychological interventions are ineective at best and unethical at
worst.* [1]
Critiques against the application of psychology in its entirety often stem from moral objections to the degradation of the
psyche through reductive systematic categorization. In this context the term anti-psychologymay describe discontent
with the incorporation of psychological tenets and techniques into religious practice. It may also describe the view that
psychological manipulation aects the sovereignty of cognitive processes, corrupting free will.* [2] Psychology applied in
this manner is readily discerned in advertising.
5.1 References
[1] Savage, Mike (2009). Psychology and Contemporary Society. Modern Intellectual History (Cambridge University Press)
6: 627636. doi:10.1017/S1479244309990217.
[2] Beltran, Susana (September 2005). The international protection of human rights versus groups employing psychological
manipulation. The International Journal of Human Rights 9 (3): 285305. doi:10.1080/13642980500170709.
125
Chapter 6
The biopsychiatry controversy is a dispute over which viewpoint should predominate and form the scientic basis of
psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its
critics include disparate groups such as the antipsychiatry movement and some academics.
6.1 Overview of opposition to biopsychiatry

Over centuries of progress medical science has developed a variety of therapeutic practices that have made many illnesses
more treatable or even fully eradicable. Biological psychiatry or biopsychiatry aims to investigate determinants of mental
disorders devising remedial measures of a primarily somatic nature.
This has been criticized by Alvin Pam for being a stilted, unidimensional, and mechanistic world-view, so that
subsequent research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological
factors underlie and cause social deviance.* [1] According to Pam theblame the bodyapproach, which typically oers
medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances.
6.2 Research issues

6.2.1
Current status in biopsychiatric research
Biopsychiatric research has produced reproducible abnormalities of brain structure and function, and a strong genetic
component for a number of psychiatric disorders (although the latter has never been shown to be causative, merely correlative). It has also elucidated some of the mechanisms of action of medications that are eective in treating some of
these disorders. Still, by their own admission, this research has not progressed to the stage that they can identify clear
biomarkers of these disorders.
Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists
that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily
discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical
lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some
of the mechanisms of action of medications that are eective for depression, schizophrenia, anxiety, attention decit, and cognitive disorders such as Alzheimer's disease. These medications clearly exert inuence
126
6.2. RESEARCH ISSUES
127
on specic neurotransmitters, naturally occurring brain chemicals that eect, or regulate, communication
between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In
1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health,
for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as
norepinephrine in the synapses, or gaps, between nerve cells.
American Psychiatric Association, Statement on Diagnosis and Treatment of Mental Disorders* [2]
6.2.2
Focus on genetic factors
Researchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of
dimensions of genetic risk* [3] and reports show signicant associations between specic genomic regions and psychiatric
disorders.* [4]* [5] Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible
for psychiatric conditions.* [6]* [7] For example, one reported nding suggests that in persons diagnosed as schizophrenic
as well as in their relatives with chronic psychiatric illnesses, the gene that encodes phosphodiesterase 4B (PDE4B) is
disrupted by a balanced translocation.* [8]
The reasons for the relative lack of genetic understanding is because the links between genes and mental states dened as
abnormal appear highly complex, involve extensive environmental inuences and can be mediated in numerous dierent
ways, for example by personality, temperament or life events.* [9] Therefore while twin studies and other research suggests
that personality is heritable to some extent, nding the genetic basis for particular personality or temperament traits, and
their links to mental health problems, isat least as hard as the search for genes involved in other complex disorders.* [10]
Theodore Lidz* [11] and The Gene Illusion.* [12]* [13] argue that biopsychiatrists use genetic terminology in an unscientic
way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the
genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the
environments of some extremely abusive families or societies.* [14]
6.2.3
Focus on biochemical factors
See also: Chemical imbalance and Monoamine Hypothesis

The chemical imbalance hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric
conditions and that these conditions can be improved with medication which corrects this imbalance. In this hypothesis,
emotions within a normalspectrum reect a proper balance of neurochemicals, but abnormally extreme emotions,
such as clinical depression, reect an imbalance. This conceptual framework has been challenged within the scientic
community, although no other demonstrably superior hypothesis has emerged. While the hypothesis has been shown to be
simplistic and lacking (especially regarding psychotropic drugs with novel mechanisms such as tianeptine),* [15] there is
sucient evidence to consider it as a useful heuristic in the aiding of our understanding of brain chemistry and explaining
pharmacotherapy.* [16]* [17] On the other hand, Elliot Valenstein, a psychologist, neuroscientist and prominent critic of
biopsychiatry, states that the broad biochemical assertions and assumptions of mainstream psychiatry are not supported
by evidence.* [18]
6.2.4
Reductionism
Niall McLaren emphasizes in his books Humanizing Madness and Humanizing Psychiatry that the major problem with
psychiatry is that it lacks a unied model of the mind and has become entrapped in a biological reductionist paradigm.
The reasons for this biological shift are intuitive as reductionism has been very eective in other elds of science and
medicine. However, despite reductionism's ecacy in explaining the smallest parts of the brain this does not explain the
mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect
of a computer can be understood scientically down to the very last atom, however this does not reveal the program
that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of
openness to self-criticism and therefore halts the very engine of scientic progress.* [19] He has proposed his own natural
128
CHAPTER 6. BIOPSYCHIATRY CONTROVERSY
dualist model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers and Alan Turing
and does not fall into the dualist's trap of spiritualism.* [20]
6.3 Economic inuences on psychiatric practice

American Psychiatric Association president Steven S. Sharfstein has stated that when the prot motive of pharmaceutical
companies and human good are aligned, that the results are mutually benecial and that Pharmaceutical companies
have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The
proven eectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public
to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma
associated with psychiatric treatment and with psychiatrists.However, too often "[t]he practice of psychiatry and the
pharmaceutical industry have dierent goals and abide by dierent ethics.He states a number of concerns exacerbating
this situation which he suggests require remedying, including:* [21]
that the psychiatric profession has allowed the biopsychosocial model to become entirely dominated by biological
factors;
a broken health care systemthat allows many patients [to be] prescribed the wrong drugs or drugs they don't
need";
medical education opportunities sponsored by pharmaceutical companies [that] are often biased toward one product or another";
"[d]irect marketing to consumers [that] also leads to increased demand for medications and inates expectations
about the benets of medications";
drug company gifts to doctors, that have become suciently problematical as to warrant legislative constraints; and
drug companies [paying] physicians to allow company reps to sit in on patient sessions allegedly to learn more
about care for patients and then advise the doctor on appropriate prescribing.
Nevertheless, Sharfstein concluded that "[a]s psychiatrists, we should all be grateful for the modern pharmacopia and the
promise of even more improvements in the future.* [21]
6.3.1
Pharmaceutical industry inuence on the psychiatric profession
Studies have shown that medical students and residents are susceptible to undue inuence from pharmaceutical companies
due to the companies involvement in medical school programs.* [22]
Certain antidepressants have been shown to have only a minimal eect, over that of a placebo, on patients. In an analysis
of the ecacy data submitted to the U.S. Food and Drug Administration for approval of the six most widely prescribed
antidepressants approved between 1987 and 1999, it was found that
Approximately 80% of the response to medication was duplicated in placebo control groups, and the
mean dierence between drug and placebo was approximately 2 points on the 17-item (50-point) and 21item (62-point) Hamilton Depression Scale. Improvement at the highest doses of medication was not different from improvement at the lowest doses. The proportion of the drug response duplicated by placebo
was signicantly greater with observed cases (OC) data than with last observation carried forward (LOCF)
data. If drug and placebo eects are additive, the pharmacological eects of antidepressants are clinically
negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants.* [23]
6.4. SEE ALSO
129
In an essay on advertisements for anti-depressants published in PLoS Medicine, social work academic Jerey Lacasse and
neuroanatomist Jonathan Leo state that, despite this, the chemical imbalance theory is promoted by the medical industry
as an explanation to depression and that their medicines correct the chemical imbalance. They also state that there is
some evidence that both patients and professionals are inuenced by the advertisements and patients may get prescribed
medicines when other interventions are more suitable.* [24]
In a further article they state that chemical imbalance has also been cited in media as an important cause of depression
despite a lack of scientic literature that shows this causality.* [25]
6.4 See also

6.4.1
General
Anti-psychiatry - A movement critiquing psychiatry from the human rights perspective.

Bipolar disorders research - biopsychiatric analysis into the cause of bipolar disorders.
Elliott Valenstein - a psychologist and neuroscientist, author of Blaming the Brain.
The Gene Illusion - a book by clinical psychologist Jay Joseph.
Causes of schizophrenia
Controversy about ADHD
A Brief History of Anxiety (Yours & Mine), a book by journalist Patricia Pearson
Trauma model of mental disorders
6.4.2
Groups critical of the biomedical paradigm
Mindfreedom - A group which advocates for choiceregarding psychopharmaceuticals.

ICSPP (International Center for the Study of Psychiatry and Psychology)
isps (International Society for the Psychological Treatment of the Schizophrenias and other Psychoses)
6.5 External links

6.5.1
Criticisms from psychologists & the medical profession
1. APA Fights Attempt to Limit Access to Psychoactive Drugs, American Psychiatric Association president Michelle
Riba, M.D., M.S.
2. Against Biologic Psychiatry - an article by David Kaiser, M.D., in Psychiatric Times (1996, Vol. XIII, Issue 12).
3. Challenging the Therapeutic State - special issue of The Journal of Mind and Behavior (1990, Vol.11:3).
4. Letter of Resignation from the American Psychiatric Association - from Loren R. Mosher, M.D., former Chief of
Schizophrenia Studies at the National Institute of Mental Health.
5. Memorandum from the Critical Psychiatry Network to the United Kingdom Parliament - Written evidence to the
House of Commons Select Committee on Health, April 2005.
130
6.5.2
CHAPTER 6. BIOPSYCHIATRY CONTROVERSY
Methodological issues
1. On the Limits of Localization of Cognitive Processes in the Brain - an essay by William R. Uttal, Professor Emeritus
of Psychology at the University of Michigan, based on his book The New Phrenology (MIT Press, 2001).
6.6 References
[1] Pam, Alvin (1995). Biological psychiatry: science or pseudoscience?". In Colin Ross and Alvin Pam. Pseudoscience in
Biological Psychiatry: Blaming the Body. NY: Wiley & Sons. pp. 784. ISBN 0-471-00776-5.
[2] APA statement on Diagnosis and Treatment of Mental Disorders, American Psychiatric Association, September 26, 2003
[3] Most psychiatric disorders share a small number of genetic risk factors, VCU study shows, Virginia Commonwealth University
[4] Pickard BS, Malloy MP, Clark L et al. (March 2005). Candidate psychiatric illness genes identied in patients with pericentric inversions of chromosome 18. Psychiatric Genetics 15 (1): 3744. doi:10.1097/00041444-200503000-00007. PMID
15722956.
[5] Macgregor S, Visscher PM, Knott SA et al. (December 2004).A genome scan and follow-up study identify a bipolar disorder
susceptibility locus on chromosome 1q42. Molecular Psychiatry 9 (12): 10831090. doi:10.1038/sj.mp.4001544. PMID
15249933.
[6] van Belzen MJ, Heutink P; Heutink (2006).Genetic analysis of psychiatric disorders in humans. Genes, Brain and Behavior
5 (Suppl 2): 2533. doi:10.1111/j.1601-183X.2006.00223.x. PMID 16681798.
[7] Meyer-Lindenberg A, Weinberger DR; Weinberger (October 2006). Intermediate phenotypes and genetic mechanisms of
psychiatric disorders. Nature Reviews Neuroscience 7 (10): 818827. doi:10.1038/nrn1993. PMID 16988657.
[8] Millar JK, Pickard BS, Mackie S et al. (November 2005). DISC1 and PDE4B are interacting genetic factors in schizophrenia
that regulate cAMP signaling
. Science 310 (5751): 11871191. Bibcode:2005Sci...310.1187M. doi:10.1126/science.1112915.
PMID 16293762.
[9] Kates WR (April 2007).Inroads to mechanisms of disease in child psychiatric disorders. The American Journal of Psychiatry
164 (4): 547551. doi:10.1176/appi.ajp.164.4.547. PMID 17403964.
[10] Van Gestel S, Van Broeckhoven C; Van Broeckhoven (October 2003). Genetics of personality: are we making progress?".
Molecular Psychiatry 8 (10): 840852. doi:10.1038/sj.mp.4001367. PMID 14515135.
[11] Lidz T, Blatt S; Blatt (April 1983).Critique of the Danish-American studies of the biological and adoptive relatives of adoptees
who became schizophrenic. The American Journal of Psychiatry 140 (4): 42634. PMID 6837778.
[12] Joseph, Jay (2003). The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope. New York, NY:
Algora. ISBN 0-87586-344-2.
[13] Joseph, Jay (2006). The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes. NY: Algora Publishing. ISBN
0-87586-410-4.
[14] Jay Joseph The Missing Gene
[15] McEwen BS, Chattarji S, Diamond DM et al. (August 2009). The neurobiological properties of tianeptine (Stablon): from
monoamine hypothesis to glutamatergic modulation. Molecular Psychiatry 15 (3): 237249. doi:10.1038/mp.2009.80. PMC
2902200. PMID 19704408.
[16] Schildkraut JJ (November 1965). The catecholamine hypothesis of aective disorders: a review of supporting evidence.
The American Journal of Psychiatry 122 (5): 50922. doi:10.1176/appi.ajp.122.5.509 (inactive 2015-01-01). PMID 5319766.
[17] Looking Beyond the Monoamine Hypothesis
[18] Valenstein, Elliot (1998). Blaming the Brain: The Truth about Drugs and Mental Health. The Free Press. ISBN 0-684-84964-X.
[19] McLaren, Niall (2007). Humanizing Madness. Ann Arbor, MI: Loving Healing Press. pp. 321. ISBN 1-932690-39-5.
[20] McLaren, Niall (2009). Humanizing Psychiatry. Ann Arbor, MI: Loving Healing Press. pp. 1718. ISBN 1-61599-011-9.
6.6. REFERENCES
131
[21] Sharfstein, Steven S. (August 19, 2005).Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly. Psychiatric
News (American Psychiatric Association) 40 (16): 3. Retrieved January 2008.
[22] Zipkin DA, Steinman MA; Steinman (August 2005). Interactions between pharmaceutical representatives and doctors in
training. A thematic review. Journal of General Internal Medicine 20 (8): 777786. doi:10.1111/j.1525-1497.2005.0134.x.
PMC 1490177. PMID 16050893.
[23] Waring DR (December 2008). The antidepressant debate and the balanced placebo trial design: an ethical analysis. International Journal of Law and Psychiatry 31 (6): 453462. doi:10.1016/j.ijlp.2008.09.001. PMID 18954907.
[24] Lacasse JR, Leo J; Leo (December 2005). Serotonin and depression: a disconnect between the advertisements and the
scientic literature. PLoS Medicine 2 (12): e392. doi:10.1371/journal.pmed.0020392. PMC 1277931. PMID 16268734.
[25] Leo, Jonathan; Lacasse, Jerey R. (2007). The Media and the Chemical Imbalance Theory of Depression. Society 45:
3545. doi:10.1007/s12115-007-9047-3.
Chapter 7
Against Therapy
Against Therapy: Emotional Tyranny and the Myth of Psychological Healing is a 1988 book by Jerey Moussaie
Masson.
7.1 Summary
Masson claims that psychotherapy is a form of socially sanctioned abuse. Psychiatric Times called itabattle cryfor
the abolition of psychotherapy.* [1]
According to Masson, therapists ask patients to do more than is reasonably possible, theydistort another person's reality
to try to change people in ways that conform to the therapist's concepts and prejudices. Therapists are, in Masson's opinion,
inevitably corrupted by power and abuse of one form or another is built into the very fabric of psychotherapy.
7.2 Reception
Time magazine wrote, Although the author's slash-and-burn style of argument can be entertaining, readers should keep
their hands on their wallets. Assertions tend to be sold as established facts.* [2] The New York Times argued thatMasson
has failed to put a stake through the heart of therapy - in fact, he's greatly missed the mark.* [3]
7.3 References
[1] Lothane, Zvi (1 December 1996). Psychoanalytic Method and the Mischief of Freud-Bashers. Psychiatric Times 13 (12).
[2] Gray, Paul (22 August 1988). The Shrink Has No Clothes. TIME. Retrieved 2009-07-15.
[3] Collins, Glenn (13 November 1988). Back alleys of psychodynamics. New York Times. Retrieved 2009-07-15.
7.4 External links

Against Therapy Author's site
Against Therapy World Library Catalog
132
Chapter 8
Outline of the psychiatric survivors

movement
The following outline is provided as an overview of and topical guide to the psychiatric survivors movement:
Psychiatric survivors movement diverse association of individuals who are either currently clients of mental health
services, or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients
of mental health services. The movement typically campaigns for more choice and improved services, for empowerment
and user-led alternatives, and against the prejudices they face in society.
8.1 What is the psychiatric survivors movement?

The psychiatric survivors movement can be described as all of the following:
a political movement
a human rights movement
part of the disability rights movement
Psychiatric survivors as a group is:
an advocacy group
a community
a special interest group
8.2 Participants
Mental health consumer
Mental patient : currently redirects to Mental disorder
Former mental patient
Lunatic
8.2.1
Supporters
Richard Bentall
133
134
CHAPTER 8. OUTLINE OF THE PSYCHIATRIC SURVIVORS MOVEMENT
Patch Adams
Robert Whittaker
The Radical Therapist
8.3 History of the psychiatric survivors movement

History of mental disorders
8.3.1
People
18th century
Samuel Bruckshaw
19th century
Elizabeth Packard
Early 20th century
Cliord Whittingham Beers
Late 20th century to the present
Linda Andre
Ted Chabasinski
Judi Chamberlin
Lyn Du
Leonard Roy Frank
Kate Millett
8.4 Issues
Coercion
Involuntary treatment
Involuntary commitment
Outpatient commitment
Mentalism (discrimination)
8.4.1
Pharmaceutical industry
Pharmaceutical industry
Allen Jones (whistleblower)
Anatomy of an Epidemic
8.5. PSYCHIATRY
8.5 Psychiatry
Main article: Outline of psychiatry
Psychiatry
Mental disorder
History of mental disorder
Mental Health
Therapeutic relationship
8.5.1
Psychiatric services
Services for mental disorders

Care programme approach (UK)
8.5.2
Public agencies
United Kingdom
England and Wales
Commissioners in Lunacy
United States of America
Federal Bodies
National Council on Disability
New Freedom Commission on Mental Health
8.5.3
Legal framework for psychiatric treatment

See Outline of psychiatry#Legal framework for psychiatric treatment
8.6 Organisations
8.6.1
Advocacy groups, by region
United Kingdom
England
19th century
Alleged Lunatics' Friend Society
Germany
Socialist Patients' Collective
International
GROW
135
136

MindFreedom International
United States of America

Committee for Truth in Psychiatry
Hearing Voices Movement
Hearing Voices Network
Icarus Project
Insane Liberation Front
Mad Pride
Mental Patients Liberation Front
National Empowerment Center
Network Against Psychiatric Assault
8.6.2
Self-help groups
Self-help groups
Self-help groups for mental health
8.7 Related movements

8.7.1
Anti-psychiatry movement
Anti-psychiatry
People of the anti-psychiatry movement
Franco Basaglia
David Cooper (psychiatrist)
Michel Foucault
R.D. Laing
Loren Mosher
Thomas Szasz
Anti-psychiatry publications
Against Therapy
Anti-Oedipus
Madness and Civilization
8.8. SEE ALSO

Anti-psychiatry organisations
American Association for the Abolition of Involuntary Mental Hospitalization
8.8 See also

Against Therapy
Antipsychology
Democratic Psychiatry
Feeble-minded
Icarus Project
Independent living
Insanity
Interpretation of Schizophrenia
Involuntary treatment
Mad Pride
Mad Studies
Medicalization
Mental patient
National Empowerment Center
Peer support
Peer support specialist
Philadelphia Association
Positive Disintegration
Psychiatric rehabilitation
Psychoanalytic theory
Radical Psychology Network
Recovery model
Rosenhan experiment
Self-advocacy
Social rms
Soteria
137
138
Therapeutic community
People
Judi Chamberlin
Kate Millett
Kingsley Hall
Leonard Roy Frank
Linda Andre
Loren Mosher
Lyn Du
Ted Chabasinski
Health and mortality
Physical health in schizophrenia
Schizophrenia and smoking
8.9 External links

CAN (Mental Health) Inc - Australia
The Mental Health Rights Coalition - Hamilton, ON, Canada
Recovering Consumers and a Broken Mental Health System in the United States: Ongoing Challenges for Consumers/
Survivors and the New Freedom Commission on Mental Health. Part I: Legitimization of the Consumer Movement
and Obstacles to It., by McLean, A. (2003), International Journal of Psychosocial Rehabilitation. 8, 47-57
Recovering Consumers and a Broken Mental Health System in the United States: Ongoing Challenges for Consumers/
Survivors and the New Freedom Commission on Mental Health. Part II: Impact of Managed Care and Continuing
Challenges, by McLean, A. (2003), International Journal of Psychosocial Rehabilitation. 8, 58-70.
History
Guide on the History of the Consumer Movement from the National Mental Health Consumers' Self-Help Clearinghouse
Organizations
National Mental Health Consumers' Self-Help Clearinghouse
Chapter 9
The Protest Psychosis

The Protest Psychosis: How Schizophrenia Became a Black Disease is a 2010 book written by psychiatrist Jonathan
Metzl (who also has a Ph.D. in American studies), and published by Beacon Press,* [1] covering the history of the 1960s
Ionia State Hospitallocated in Ionia, Michigan and converted into the Ionia Correctional Facility in 1986. The facility is claimed to have been one of America's largest and most notorious state psychiatric hospitals in the era before
deinstitutionalization.
The book focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of
their civil rights ideas. The book suggests that in part the sudden inux of such diagnoses could be traced to a change in
wording in the DSM-II, which compared to the previous edition added hostilityand aggressionas signs of the
disorder. Metzl writes that this change resulted in structural racism.
139
140
CHAPTER 9. THE PROTEST PSYCHOSIS
The book was well reviewed in JAMA, where it was described as a fascinating, penetrating book by one of medicine's
most exceptional young scholars.* [2] The book was also reviewed in the American Journal of Psychiatry,* [3] Psychiatric
Services,* [4] Transcultural Psychiatry,* [5] Psychiatric Times,* [6] The American Journal of Bioethics,* [7] Social History
of Medicine,* [8] Medical Anthropology Quarterly,* [9] Journal of African American History,* [10] Journal of Black Psychology,* [11] Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine,* [12] The Sixties:
A Journal of History, Politics and Culture.* [13]
9.1 See also

Political abuse of psychiatry in the United States
Drapetomania
List of medical ethics cases
9.2 References
[1] Metzl, Jonathan (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press. ISBN 0-8070-85928.
[2] Wear, D. (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. JAMA: the Journal of the American
Medical Association 303 (19): 19841984. doi:10.1001/jama.2010.629.
[3] Luhrmann, T. M. (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. American Journal of
Psychiatry 167 (4): 479480. doi:10.1176/appi.ajp.2009.09101398.
[4] Bell, Carl (1 August 2011). The Protest Psychosis: How Schizophrenia Became a Black Disease. Psychiatric Services 62
(8): 979980. doi:10.1176/appi.ps.62.8.979-a.
[5] McKenzie, Kwame (JulySeptember 2012). Jonathan M. Metzl, The Protest Psychosis: How Schizophrenia Became a Black
Disease. Transcultural Psychiatry 49 (34): 640642. doi:10.1177/1363461512448783.
[6] Fernando, Suman (21 October 2010). Review The Protest Psychosis: How Schizophrenia Became a Black Disease.
Psychiatric Times.
[7] Aultman, Julie (2010). Review of Jonathan Metzl, The Protest Psychosis: How Schizophrenia Became a Black Disease.
The American Journal of Bioethics 10 (11): 3738. doi:10.1080/15265161.2010.520600.
[8] Wald, P. (2011). Jonathan M. Metzl, the Protest Psychosis: How Schizophrenia Became a Black Disease. Social History
of Medicine 24: 194195. doi:10.1093/shm/hkr027.
[9] Freidenberg, Judith (June 2012). The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan Metzl.
Medical Anthropology Quarterly 26 (2): 309310. doi:10.1111/j.1548-1387.2012.01214.x.
[10] Johnson, Frank (Fall 2012). The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan M. Metzl.
Journal of African American History 97 (4): 499501. doi:10.5323/jafriamerhist.97.4.0499.
[11] Sherry, Alissa (August 2011). Book Review: Metzl, J. M. (2010). The Protest Psychosis: How Schizophrenia Became a
Black Disease. Journal of Black Psychology 37 (3): 381383. doi:10.1177/0095798411407066.
[12] Schneider, B. (2011). Book review: J.M. Metzl, the Protest Psychosis: How Schizophrenia Became a Black Disease, Beacon
Press: Boston, MA, 2010; 246 pp. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
15 (2): 213214. doi:10.1177/13634593110150020605.
[13] Staub, Michael (2010).The protest psychosis: how schizophrenia became a black disease. The Sixties: A Journal of History,
Politics and Culture 3 (2): 253255. doi:10.1080/17541328.2010.525948.
9.3. EXTERNAL LINKS
141
9.3 External links

The Protest Psychosis video recording of talk by Metzl aired on January 13, 2010 by CSPAN-2's Book TV (90
minutes)
Interview with Metzl about the book by Christopher J. Lane on Psychology Today
Interview with Metzl on WNYC radio, February 12, 2010
How the Black man became schizophrenic blog post on the book by Karen Franklin on Psychology Today
Schizophrenia as Political Weapon. The disease turned from a benign illness to a violent disease in the 1960s, just
as black men joined protests against racism. article and interview with Metzl in The Root by Felicia Pride
The protest psychosis Essay by Metzl from June 9, 2010 in Michigan Today, summarizing the book's ideas.
Audio interview with Metzl on New Books in African American Studies(44 minutes)
Metzl discusses his book on ABC Radio National's All In The Mind program (30 minutes)
Chapter 10
Sluggish schizophrenia or slow progressive schizophrenia (Russian: , vyalotekushchaya
shizofreniya)* [1] is a diagnostic category that describes a form of schizophrenia characterized by a slowly progressive
course; it can be diagnosed even in a patient who shows no symptoms of schizophrenia or other psychosis, on the assumption that these symptoms will appear later.* [2] It was developed in the 1960s by Soviet psychiatrist Andrei Snezhnevsky
and his colleagues,* [3]* [4] and was used exclusively in the USSR and several Eastern Bloc countries.* [5] It has never been
used or recognized in Western countries,* [6] or by international organizations such as the World Health Organization.* [7]
Sluggish schizophrenia was the most infamous of diagnoses used by Soviet psychiatrists, due to its usage against political
dissidents.* [8] After being discharged from a hospital, persons diagnosed with sluggish schizophrenia were deprived of
their civic rights, employability, and credibility.* [9] The usage of this diagnosis has been internationally condemned.* [10]
The fall of communism brought an end to Snezhnevsky's theories in Ukraine as well.* [11]
In the Russian version of the 10th revision of the International Statistical Classication of Diseases and Related Health
Problems (ICD-10), which has long been used throughout present-day Russia, sluggish schizophrenia is no longer listed
as a form of schizophrenia,* [12] but it is still included as a schizotypal disorder in section F21 of chapter V.* [13]
According to Sergei Jargin, the same Russian term vyalotekushchayafor sluggish schizophrenia continues to be used
and is now translated in English summaries of articles not as sluggishbut as slow progressive.* [1]
10.1 Development of theory

In the 1960s, professor Andrei 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 classication of mental disorders postulating
an original set of diagnostic criteria.* [14] Snezhnevsky and his colleagues who developed the concept were supported by
Soviet psychiatrists Fedor Kondratev, Sergei Semyonov, and Yakov Frumkin.* [15] All were members of the Moscow
schoolof psychiatry.
A majority of experts believe that the concept was developed under instructions from the Soviet secret service KGB and
the Communist Party.* [16]
10.2 Use against political dissidents

See also: Political abuse of psychiatry in the Soviet Union
Psychiatric diagnoses such as sluggish schizophrenia were used in the USSR for political purposes;* [17] the diagnosis of
sluggish schizophrenia was most frequently used for Soviet dissidents.* [18] Sluggish schizophrenia as a diagnostic category
was created to facilitate the stiing of dissidents and was a root of self-deception among psychiatrists to placate their
142
10.3. PREMISES FOR USING THE DIAGNOSIS
143
consciences when the doctors acted as a tool of oppression in the name of a political system.* [19] American psychiatrist
Peter Breggin points out that the term sluggish schizophreniawas created to justify involuntary treatment of political
dissidents with drugs normally used for psychiatric patients.* [20]
Critics implied that Snezhnevsky designed the Soviet model of schizophrenia (and this diagnosis) to make political dissent
a mental illness.* [21]
St. Petersburg academic psychiatrist professor Yuri Nuller notes that the concept of Snezhnevskys school allowed
psychiatrists to consider, for example, schizoid psychopathy and even schizoid character traits as early, delayed in their
development, stages of the inevitable progredient process, rather than as personality traits inherent to the individual,
the dynamics of which might depend on various external factors.* [22] The same also applied to a number of other
personality disorders.* [22] It entailed the extremely broadened diagnostics of sluggish (neurosis-like, psychopathy-like)
schizophrenia.* [22] Despite a number of its controversial premises, but in line with the traditions of then Soviet science,
Snezhnevskys hypothesis immediately acquired the status of dogma, which was later overcome in other disciplines but
rmly stuck in psychiatry.* [23] Snezhnevskys concept, with its dogmatism, proved to be psychologically comfortable
for many psychiatrists, relieving them from doubt when making a diagnosis.* [23]
On the covert orders of the KGB, thousands of social and political reformersSoviet dissidentswere incarcerated
in mental hospitals after being labelled with diagnoses of sluggish schizophrenia.* [24] Snezhnevsky himself diagnosed,
or was otherwise involved in, a series of famous dissident cases,* [18] and in dozens of cases he personally signed a
commission decision on the legal insanity of dissidents who were in fact mentally healthy, including Vladimir Bukovsky,
Natalya Gorbanevskaya, Leonid Plyushch, Mikola Plakhotnyuk,* [25] and Pyotr Grigorenko.* [26] Revaz Korinteli, a
professor of the Grigol Robakidze University, says that Snezhnevsky broadened the borders of schizophrenia, and in this
connection there was legal and theoretical justication for employing compulsory, involuntary treatment of dissenters in
mental hospitals.* [27]
10.3 Premises for using the diagnosis

According to Robert van Voren, the political abuse of psychiatry in the USSR arose from the concept that people who
opposed the Soviet regime were mentally ill (since there was no logical reason to oppose the sociopolitical system considered the best in the world).* [28] The diagnosis of sluggish schizophrenia furnished a framework for explaining this
behavior.* [28]This seemed to many Soviet psychiatrists a logical explanation for why someone would be willing to abandon his happiness, family, and career for a conviction so dierent from what most individuals seemed to believe.* [16]
10.4 Popularity of diagnosis

Because of diagnoses of sluggish schizophrenia, Russia in 1974 had 57 cases of schizophrenia per 1,000 population,
compared to 34 per 1,000 in the United Kingdom.* [29] In the 1980s, Russia had three times as many schizophrenic
patients per capita as the USA, twice as many schizophrenic patients as West Germany, Austria and Japan,* [30] and more
schizophrenic patients than any Western country.* [30] The city with the highest diagnosed prevalence of schizophrenia
in the world was Moscow.* [31]
Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of
dissenters.* [14] Darrel Regier of the National Institute of Mental Health, one of the U.S. experts who visited Soviet
psychiatric hospitals in 1989, testied that asubstantial numberof political dissenters had been recognized as mentally
sick on the basis of such symptoms as anti-Soviet thoughtsor delusions of reformism.* [32]
According to Moscow psychiatrist Alexander Danilin, the nosological approach in the Moscow psychiatric school established by Andrei Snezhnevsky (whom Danilin considered a state criminal) boiled down to the ability to diagnose
schizophrenia.* [33]
144
CHAPTER 10. SLUGGISH SCHIZOPHRENIA
10.5 Systematics by Snezhnevsky

The Soviet model of schizophrenia is based on the hypothesis that a fundamental characteristic (by which schizophrenia
spectrum disorders are distinguished clinically) is its longitudinal course.* [34] The hypothesis implies three main types
of schizophrenia:
Continuous: unremitting, proceeding rapidly (malignant) or slowly (sluggish), with a poor prognosis
Periodic (or recurrent): characterized by an acute attack, followed by full remission with little or no progression
Mixed (German: schubweise; in German, schub meansphaseorattack): mixture of continuous and periodic
types which occurs periodically and is characterized by only partial remission.* [34]
The classication of schizophrenia types attributed to Snezhnevsky* [35] is still used in Russia,* [36] and considers sluggish
schizophrenia an example of the continuous type.* [37] The prevalence of Snezhnevskys theories has particularly led
to a broadening of the boundaries of disease such that even the mildest behavioral change is interpreted as indication of
mental disorder.* [38]
10.5.1
Conditions posed as symptoms
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.* [14] Symptoms
considered part of the negative axisincluded pessimism, poor social adaptation and conict with authorities, and
were themselves sucient for a formal diagnosis of sluggish schizophrenia with few symptoms.* [14] According to
Snezhnevsky, patients with sluggish schizophrenia could present as seemingly sane but manifest minimal (and clinically
relevant) personality changes which could remain unnoticed by the untrained eye.* [14] Patients with non-psychotic mental
disorders (or who were not mentally ill) could be diagnosed with sluggish schizophrenia.* [14]
Harold Merskey and Bronislava Shafran write that many conditions which would probably be diagnosed elsewhere as
hypochondriacal or personality disorders, anxiety disorders or depressive disorders appear liable to come under the banner
of slowly progressive schizophrenia in Snezhnevskys system.* [39]
The incidence of sluggish schizophrenia increased because, according to Snezhnevsky and his colleagues, patients with
this diagnosis were capable of socially functioning almost normally.* [28] Their symptoms could resemble those of a
neurosis or paranoia.* [28] Patients with paranoid symptoms retained insight into their condition, but overestimated their
signicance and had grandiose ideas of reforming society.* [28] Sluggish schizophrenia could have such symptoms as
reform delusions, perseveranceand struggle for the truth.* [28] As Viktor Styazhkin reported, Snezhnevsky
diagnosed a reform delusion in every case where a patientdevelops a new principle of human knowledge, drafts an ideal
of human happiness or other projects for the benet of mankind.* [40]
During the 1960s and 1970s, theories which contained ideas about reforming society, struggling for the truth, and religious convictions were not considered delusional paranoid disorders in nearly any foreign classications; however, Soviet
psychiatry (for ideological reasons) considered critiques of the political system and proposals to reform it as delusional
behavior.* [41] The diagnoses of sluggish schizophrenia and paranoid states with delusions of reform were used only in
the Soviet Union and several Eastern European countries.* [42]
An audience member at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute asked, Tell us,
Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?* [43] Since the question was asked ironically
Morozov replied ironically:You know, dear colleagues, this is a very peculiar disease. There are not delusional disorders,
there are not hallucinations, but there is schizophrenia!* [43]
The two Soviet psychiatrists Marat Vartanyan and Andrei Mukhin in their interview to the Soviet newspaper Komsomolskaya
Pravda issued on 15 July 1987 explained how it was possible that a person might be mentally ill, while people surrounding him did not notice it, for example, in the case of sluggish schizophrenia.* [44] What was meant by saying that
a person is mentally ill?* [44] Marat Vartanyan said, "When a person is obsessively occupied with something. If you
discuss another subject with him, he is a normal person who is healthy, and who may be your superior in intelligence,
10.6. RECOGNIZING METHOD, TREATMENT AND STUDY
145
knowledge and eloquence. But as soon as you mention his favourite subject, his pathological obsessions are up wildly.
*
[44] Vartanyan conrmed that hundreds of people with this diagnosis were hospitalized in the Soviet Union.* [44] According to Mukhin, it took place becausethey disseminate their pathological reformist ideas among the masses.* [44]
A few months later the same newspaper listedan exceptional interest in philosophical systems, religion and artamong
symptoms of sluggish schizophrenia from a Manual on Psychiatry of Snezhnevskys Moscow school.* [45]
10.6 Recognizing method, treatment and study

Only specially instructed psychiatrists could recognize sluggish schizophrenia to indenitely treat dissenters in aSpecial
Psychiatric Hospitalwith heavy doses of antipsychotic medication.* [9] Convinced of the immortality of the totalitarian
USSR, Soviet psychiatrists, especially in Moscow, did not hesitate to form scienticarticles and defend dissertations
by using the cases of dissidents.* [46] For example, Snezhnevsky diagnosed dissident Vladimir Bukovsky as schizophrenic
on 5 July 1962* [47] and on 12 November 1971 wrote to writer Viktor Nekrasov that the characteristics of Bukovsky's
mental disease were included in the dissertation by Snezhnevsky's colleague.* [48] All the paper products were available in
medical libraries.* [46] As Semyon Gluzman recollects, when he returned to Kiev in 1982 after his absence of ten years,
he was amazed to see all thisscienticliterature in open storage at the Kiev medical library and was even more amazed
to read all theridiculous stuhardly put into scientic psychiatric terminology.* [46] In their papers and dissertations on
treatment for litigiousness and reformism, Kosachyov and other Soviet psychiatrists recommended compulsory treatment
for persons with litigiousness and reformism, in the same psychiatric hospitals used for murderers:* [49]
Compulsory treatment in psychiatric hospitals of special type is to be recommended in cases of brutal
murders committed on delusional grounds as well as in cases of persistent litigiousness and reformism with
an inclination to induce surrounding persons and with a tendency to repetition of the illegal acts.
10.7 Western criticism

Westerners rst became aware of sluggish schizophrenia and its political uses in the mid-1970s, as a result of the high
reported incidence of schizophrenia in the Russian population.* [29] Snezhnevsky was personally attacked in the West
as an example of psychiatric abuse in the USSR.* [18] He was charged with cynically developing a system of diagnosis
that could be bent for political purposes. American psychiatrist Alan A. Stone stated that Western criticism of Soviet
psychiatry focused on Snezhnevsky personally because he was responsible for the diagnosis of sluggish schizophrenia for
reformismand other such symptoms.* [50]
10.8 Recurrence in post-Soviet Russia

In 2010, Yuri Savenko, the president of the Independent Psychiatric Association of Russia, warned that Professor Anatoly Smulevich, author of the monographs Problema Paranoyi (The Problem of Paranoia) (1972) and Maloprogredientnaya Shizofreniya (Continuous Sluggish Schizophrenia) (1987), which had contributed to the hyperdiagnosis of sluggish schizophrenia, had again begun to play the same role. Under his inuence, therapists have begun to widely use
antidepressants and antipsychotics but often in inadequate cases and in inappropriate doses, without consulting psychiatrists. This situation has opened up a huge new market for pharmaceutical rms, and the ow of the mentally ill to
internists.* [51]
In their joint book Sociodinamicheskaya Psikhiatriya (Sociodynamic Psychiatry), Doctor of Medical Sciences professor of
psychiatry Caesar Korolenko and Doctor of Psychological Sciences Nina Dmitrieva note that Smulevich's clinical description of sluggish schizophrenia is extremely elusive and includes almost all possible changes in mental status and conditions
that occur in a person without psychopathology: euphoria, hyperactivity, unfounded optimism, irritability, explosiveness,
sensitivity, inadequacy and emotional decit, hysterical reactions with conversive and dissociative symptoms, infantilism,
obsessive-phobic states and stubbornness.* [52] At present, the hyperdiagnosis of schizophrenia becomes especially negative due to a large number of schizophreniform psychoses caused by the increasing popularity of various esoteric sects.
146
They practice meditation, sensory deprivation, special exercises with rhythmic movements which directly stimulate the
deep subconscious and, by doing so, lead to the development of psychoses with mainly reversible course.* [53] Smulevich
bases the diagnosis of continuous sluggish schizophrenia, in particular, on appearance and lifestyle and stresses that the
forefront in the picture of negative changes is given to the contrast between retaining mental activity (and sometimes quite
high capacity for work) and mannerism, unusualness of one's appearance and entire lifestyle.* [54] In his 2014 interview,
Anatoly Smulevich says, Now everything has slightly turned in a dierent way, sluggish schizophrenia has been transformed into schizotypal disorder, etc. I think it is not the end of his [Snezhnevsky's] teaching, because after a while,
everything will get back into a rut, but it will not be a simple repetition but will get some new direction.* [55]
In 2009, Tatyana Dmitrieva, the then director of the Serbsky Center, said to the BBC Russian Service, A diagnosis is
now made only according to the international classication, so called ICD-10. In this classication, there is no sluggish
schizophrenia, and therefore, even this diagnosis has not just been made for a long time.* [56] However, according to the
2012 interview by the president of the Ukrainian Psychiatric Association Semyon Gluzman to Radio Liberty, though the
diagnosis of sluggish schizophrenia no longer exists in Ukraine, in Russia, as far as he knows, this diagnosis still exists, and
was given to Mikhail Kosenko, one of the accused in the Bolotnaya Square case.* [57] The prosecution
s case for his forced
hospitalization rested on conrmation of the diagnosis of sluggish schizophrenia* [7] that he has been treated for over the
last 12 years, until 2013 when the diagnosis was changed to that of paranoid schizophrenia by the Serbsky Center experts
who examined Kosenko and convinced the court to send him for compulsory treatment to a psychiatric hospital.* [58]
Zurab Kekelidze (ru), who heads the Serbsky Center and is the chief psychiatrist of the Ministry of Health and Social
Development of the Russian Federation,* [59] conrmed that Kosenko was diagnosed with sluggish schizophrenia.* [60]
According to the commentary by the Independent Psychiatric Association of Russia on the 2007 text by Vladimir Rotstein,
a doctrinist of Snezhnevsky's school, there are sucient patients with delusion of reformism in psychiatric inpatient
facilities for involuntary treatment.* [61] In 2012, delusion of reformism was mentioned as a symptom of mental disorder
in Psychiatry: National Manual.* [62] In the same year, Vladimir Pashkovsky in his paper reported that he diagnosed 4.7
percent of 300 patients with delusion of reform.* [63] As Russian sociologist Alexander Tarasov wrote, you will be
treated in a hospital so that you and all your acquaintances get to learn forever that only such people as Anatoly Chubais
or German Gref can be occupied with reforming in our country.* [64] According to Raimond Krumgold, a member of
the political party The Other Russia, he was examined because of his delusion of reformism, which gave rise to an
assumption of slow progressive schizophrenia.* [65] In 2012, Tyuvina and Balabanova in their joint paper reported that
they used Sulpiride to treat slow progressive schizophrenia.* [66]
10.9 See also

Drapetomania
Excited delirium
Female hysteria. Hysteria was a common medical diagnosis in the 19th century.
10.10 References
[1] Jargin 2011.
[2] Sfera 2013.
[3] Smulevich 1989.
[4] Korolenko & Kensin 2002.
[5] Wilkinson 1986; Merskey & Shafran 1986; Gluzman 2013a; Korotenko & Alikina 2002, p. 18; Gershman 1984
[6] Moran 2010.
10.10. REFERENCES
[7] RIANovosti 2013.

[8] Robertson & Walter 2013, p. 84.
[9] Plante 2013, p. 110.
[10] Gershman 1984.
[11] Targum, Chaban & Mykhnyak 2013.
[12] Savenko 2008.
[13] Russian adapted version of the ICD-10.
[16] Voren 2010b.
[17] Katona & Robertson 2005, p. 77.
[18] Reich 1983.
[19] Tobin 2013.
[20] Breggin 1993.
[21] Stone 2002.
[22] Nuller 2008, p. 17.
[23] Nuller 2008, p. 18.
[24] Healey 2011.
[25] Gluzman 2013b.
[26] Stone 1985, p. 11.
[27] Korinteli 2013.
[28] Voren (2010b, 2013)
[29] Gosden 2001, p. 22.
[30] Vasilenko 2004, p. 33.
[31] Park et al. 2014.
[32] Moseley 1989.
[33] Danilin 2008.
[34] Lavretsky 1998, p. 543.
[35] Bleikher 1984, p. 278.
[36] Zharikov & Tyulpin 2000, p. 371.
[37] Tiganov 1999, p. 414.
[39] Merskey & Shafran 1986.
[40] Styazhkin 1992, p. 66.
147
148

[43] Gluzman 2009.
[44] Voren (2010a, p. 492, 2013)
[45] Voren 2010a, p. 492.
[46] Gluzman 2013a.
[47] Popov 1992, p. 70.
[48] Snezhnevsky (2012, p. 287, 2014)
[49] UPA Herald 2013.
[50] Stone 1985, p. 8.
[51] Savenko 2010.
[54] Smulevich 2009.
[55] Smulevich & Morozov 2014.
[56] Fedenko 2009.
[57] Pavlova & Polyakovskaya 2012.
[58] Davido 2013.
[59] Sana 2011.
[60] Kekelidze 2013.
[61] NPZ 2007.
[62] Dmitrieva, Krasnov & Neznanov 2012, p. 322.
[63] Pashkovsky 2012.
[64] Tarasov 2006, p. 159.
[65] Krumgold 2012.
[66] Tyuvina & Balabanova 2012.
10.11 Sources
The ICD-10 Classication of Mental and Behavioural Disorders. F21 Schizotypal Disorder.
10: . F21
[The ICD-10 Classication of Mental and Behavioural Disorders. F21 Schizotypal Disorder]. Russian.
[The problem of the social danger of the mentally
ill]. Nezavisimiy Psikhiatricheskiy Zhurnal [The Independent Psychiatric Journal]. 2007 [Retrieved 18 February
2014];( 4):1217. Russian.
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Bleikher, Vadim [ ]. ,
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[Headquarters publishers of Publishing
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Bloch, Sidney; Reddaway, Peter. Soviet psychiatric abuse: The shadow over world psychiatry. Westview Press;
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Breggin, Peter. Psychiatry's role in the holocaust. International Journal of Risk & Safety in Medicine. 1993;4(2):133
148. doi:10.3233/JRS-1993-4204. PMID 23511221.
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Davido, Victor. Soviet Psychiatry Returns. 13 October 2013 [Retrieved 9 January 2014].
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, , , ] (eds.). :
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ISBN 5970420301. p. 322.
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Gershman, Carl. Psychiatric abuse in the Soviet Union. Society. JulyAugust 1984;21(5):5459. doi:10.1007/BF02695434.
PMID 11615169.
2013a;(2). Russian.
Gluzman, Semyon [ ]. [Snezhnevsky].
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Gluzman, Semyon [ ]. , [Pictures drawn from
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? (- . ..
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2002. Russian. ISBN 966-7841-36-7.
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Pashkovsky, Vladimir [ ]. -
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[The case of Kosenko: treatment and compensation]; 28 November 2012 [Retrieved 12
December 2012]. Russian.
Plante, Thomas. Abnormal Psychology across the Ages. ABC-CLIO; 2013. ISBN 0313398372. p. 110.
Popov, Yuri. Diagnosis of aSevere Personality Disorderas a Cause of Criminal Inresponsibility: V.K. Bukovsky.
In: Popov, Yuri (ed.). The Bekhterev Review of Psychiatry and Medical Psychology. Washington, DC: American
Psychiatric Press; 1992. ISBN 978-0-88048-667-5. p. 6973.
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Robertson, Michael; Walter, Garry. Ethics and Mental Health: The Patient, Profession and Community. CRC Press;
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health]. 23 December 2011 [Retrieved 21 March 2012]. Russian.
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Smulevich, Anatoly [ ].
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2009. Russian. ISBN 5983224891. 1.
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DC: American Psychiatric Press; 1992. ISBN 978-0-88048-667-5. p. 6568.
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Bukovsky, Vladimir. To build a castle: my life as a dissenter. Deutsch; 1978b. English. p. 194223, 259272,
355391. Russian text: Bukovsky, Vladimir [ ]. [And the wind
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153
Marat Vartanyan (19321993), a key apologist of Soviet psychiatric abuse, the founder and former director of the Mental Health Research
Center of the USSR Academy of Medical Sciences
154
The Leningrad Special Psychiatric Hospital of Prison Type of the USSR Ministry of Internal Aairs where Vladimir Bukovsky, Pyotr
Grigorenko, Alexander Yesenin-Volpin and Viktor Fainberg were imprisoned was one of the psychiatric hospitals of a special type used
to treatlitigiousness and reformism
Vladimir Bukovsky (b. 1942), a British neurophysiologist and former Soviet human rights activist, and political prisoner
155
Chapter 11
Drapetomania
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused
black slaves to ee captivity.* [1]* :41 Today, drapetomania is considered an example of pseudoscience* [2]* :2 and part of
the edice of scientic racism.* [3]
11.1 Etymology
The term derives from the Greek (drapetes, a runaway [slave]") + (mania, madness, frenzy).* [4]
11.2 Description
In Diseases and Peculiarities of the Negro Race, Cartwright points out that the Bible calls for a slave to be submissive to
his master, and by doing so, the slave will have no desire to run away.* [4]
Cartwright described the disorder which, he said, was unknown to our medical authorities, although its diagnostic
symptom, the absconding from service, is well known to our planters and overseers* [4] in a paper delivered before
the Medical Association of Louisiana* [2]* :291 that was widely reprinted.
He stated that the malady was a consequence of masters who made themselves too familiar with [slaves], treating them
as equals.* [5]
11.2.1
Prevention and remedy
In addition to identifying drapetomania, Cartwright prescribed a remedy. His feeling was that with proper medical
advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented.* [4]
In the case of slaves sulky and dissatised without cause a warning sign of imminent ight Cartwright prescribed
"whipping the devil out of themas apreventative measure.* [2]* :35* [7]* [8] As a remedy for thisdisease,doctors
also made running a physical impossibility by prescribing the removal of both big toes.* [1]* :42
11.2.2
Contemporary criticism
While Cartwright's article was reprinted in the South, in the Northern United States it was widely mocked. A satirical
analysis of the article appeared in a Bualo Medical Journal editorial in 1855.* [9] Frederick Law Olmsted, in A Journey
in the Seaboard Slave States (1856), observed that white indentured servants had often been known to ee as well, so
156
11.2. DESCRIPTION
157
American physician Samuel A. Cartwright (17931863)
he satirically hypothesized that the supposed disease was actually of white European origin, and had been introduced to
Africa by traders.* [10]
158
CHAPTER 11. DRAPETOMANIA
11.3 See also

Dysaesthesia aethiopica, the name given to what was seen at one point in time to be a mental illness that was the
cause of laziness among slaves.
Dromomania
Oppositional deant disorder
General:
Fugitive slave
Classication of mental disorders
11.4 References
[1] White, Kevin (2002). An introduction to the sociology of health and illness. SAGE. pp. 41, 42. ISBN 0-7619-6400-2.
[2] Caplan, Arthur; McCartney, James; Sisti, Dominic (2004). Health, disease, and illness: concepts in medicine. Georgetown
University Press. ISBN 1-58901-014-0.
[3] Pilgrim, David (November 2005). Question of the Month: Drapetomania. Jim Crow Museum of Racist Memorabilia.
[4] Cartwright, Samuel A. (1851). Diseases and Peculiarities of the Negro Race. DeBow's Review XI. Retrieved 16 November
2011.
[5] Baynton, Douglas C.Disability and the Justication of Inequality in American History. The New Disability History: American
Perspectives, 2001.
[6] S. L. Chorover. From Genesis to Genocide (Cambridge, Mass: MIT Press 1974). p. 150.
[7] Paul Finkelman (1997). Slavery & the Law. Rowman & Littleeld. p. 305. ISBN 0-7425-2119-2.
[8] Rick Halpern, Enrico Dal Lago (2002). Slavery and Emancipation. Blackwell Publishing. p. 273. ISBN 0-631-21735-5.
[9] S. B. Hunt (1855). Dr. Cartwright on Drapetomania"". Bualo Medical Journal 10: 438442.
[10] Frederick Law Olmsted (1856). A Journey in the Seaboard Slave States, with Remarks on Their Economy. Mason Brothers. p.
226.
11.5 Sources
Samuel A. Cartwright, Report on the Diseases and Physical Peculiarities of the Negro Race, The New Orleans
Medical and Surgical Journal 1851:691715 (May).
Reprinted in DeBow's Review XI (1851). Available at Google Books and excerpted at PBS.org.
Reprinted in Arthur Caplan, H. Tristram Engelhardt, Jr., and James McCartney, eds, Concepts of Health and
Disease in Medicine: Interdisciplinary Perspectives (Boston: Addison-Wesley, 1980).
Reprinted in Arthur L. Caplan, James J. McCartney, Dominic A. Sisti, eds, Health, Disease, and Illness:
Concepts in Medicine (Washington, D.C.: Georgetown University Press, 2004) ISBN 1-58901-014-0
11.6. EXTERNAL LINKS
11.6 External links

An Early History African American Mental Health
Drapetomania: A Disease Called Freedom exhibit
159
Chapter 12
Bullying in medicine
This article primarily concerns bullying involving physicians. For bullying involving nurses, see Bullying in
nursing.
Bullying in the medical profession is common, particularly of student or trainee physicians. It is thought that this is at least
in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession which
may result in a bullying cycle. The rampant problem of medical student mistreatment and bullying was systematically
studied and reported in a 1990 JAMA study by pediatrician Henry K. Silver which found that 46.4 percent of students
at one medical school had been abused at some point during medical school; by the time they were seniors, that number
was 80.6 percent.* [1]
According to Field, bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power
over vulnerable clients, and over vulnerable employees and students.* [2]
12.1 Underlying psychology

While the stereotype of a victimas a weak inadequate person who somehow deserves to be bullied is salient, there is
growing evidence that bullies, who are often driven by jealousy and envy, pick on the highest performing and most skilled
sta or students, whose mere presence is sucient to make the bully feel insecure. Threats (of exposure of inadequacy)
must be ruthlessly controlled and subjugated.* [2] Psychological models such as transference and projection have been
proposed to explain such behaviors, wherein the bully's sense of personal inadequacy is projected or transferred to a
victim; through making others feel inadequate and subordinate, the bully thus vindicates their own sense of inferiority.
Displacement is another defense mechanism that can explain the propensity of many medical educators to bully students, and may operate subconsciously.* [3] Displacement entails the redirection of an impulse (usually aggression) onto
a powerless substitute target.* [4] The target can be a person or an object that can serve as a symbolic substitute.* [5]
Displacement can operate in chain-reactions, wherein people unwittingly become at once victims and perpetrators of
displacement.* [6] For example, a resident physician may be undergoing stress with her patients or at home, but cannot
express these feelings toward patients or toward her family members, so she channels these negative emotions toward
vulnerable students in the form of intimidation, control or subjugation.* [7] The student then acts brashly toward a patient,
channeling reactive emotions which cannot be directed back to the resident physician onto more vulnerable subjects.* [7]
Beyond its ramications for victims, disrespect and bullying in medicine is a threat to patient safety because it inhibits
collegiality and cooperation essential to teamwork, cuts o communication, undermines morale, and inhibits compliance
with and implementation of new practices.* [8]* [9]
160
12.2. IMPACT
161
12.2 Impact
Bullying can signicantly decrease job satisfaction and increase job-induced stress; it also leads to low self condence,
depression, anxiety and a desire to leave employment.* [2]* [10] Bullying contributes to high rates of sta turnover, high
rates of sickness absence, impaired performance, lower productivity, poor team spirit and loss of trained sta.* [2] This
has implications for the recruitment and retention of medical sta.
Chronic and current bullying are associated with substantially worse health,* [11] according to research by Laura M.
Bogart, associate professor of pediatrics at Harvard Medical School.
Studies have consistently shown that physicians have had the highest suicide rate compared to people in any other line of
work40% higher for male physicians and a 130% higher for female physicians.* [12] Research has traced the beginning
of this dierence to the years spent in medical school.* [13] Students enter medical school with mental health proles
similar to those of their peers but end up experiencing depression, burnout, suicidal ideation and other mental illnesses
at much higher rates.* [14] Despite better access to health care, they are more likely to cope by resorting to dysfunctional
and self-injurious behaviors, and are less likely to receive the right care or even recognize that they need some kind of
intervention.
Exposure to bullying and intimidation during formative years of medical training has been found to contribute to these
consequences. Fear of stigmatisation among medical students was the subject of a study in JAMA by Thomas Schwenk
and colleagues at the University of Michigan's Department of Family Medicine, MI, USA. 53% of medical students who
reported high levels of depressive symptoms were worried that revealing their illness would be risky for their careers and
62% said asking for help would mean their coping skills were inadequate, according to the study published in September
2010. Medical students are under extraordinary demands. They feel they are making life and death decisions and that
they can never be wrong. There is such tremendous pressure to be perfect that any sense of falling short makes them very
anxious, says Schwenk.* [15]
12.3 Bullying of medical students

Main article: Bullying in academia
Medical students, perhaps being vulnerable because of their relatively low status in health care settings, may experience verbal abuse, humiliation and harassment (nonsexual or sexual). Discrimination based on gender and race are less
common.* [16]
In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students
questioned said they had been bullied by a medical doctor, while one in six had been bullied by a nurse. Furthermore,
bullying has been known to occur among medical students. Manifestations of bullying include:* [17]
being humiliated by teachers in front of patients or peers
been victimised for not having come from amedical family(often people who enter medicine have an older sibling
pursuing the same degree or share ties with other individuals in the profession with whom familial relationship
confers some degree of protectsia or special inuence - especially within academic settings.) Such practices extend
to admissions procedures, which are regularly inuenced by factors far aeld of candidates' intrinsic merits, such
as being related to faculty members or well-known medical luminaries.* [18]* [19]
being put under pressure to carry out a procedure without supervision.
being ostracized by other medical students for asking questions (due to the medical content being confusing for
some students) through social media networks (Facebook bullying), phone, or in person.
One study showed that the medical faculty was the faculty in which students were most commonly mistreated.* [20]
Bullying extends to postgraduate students.* [21]* [22]
162
CHAPTER 12. BULLYING IN MEDICINE
12.4 Bullying of junior (trainee) physicians

In a UK study, 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one
bullying behaviour. Black and Asian physicians were more likely to be bullied than other physicians . Women were more
likely to be bullied than men.* [23]
Trainee physicians who feel threatened in the clinical workplace develop less eectively and are less likely to ask for advice
or help when they need it.* [24] Persistent destructive criticism, sarcastic comments and humiliation in front of colleagues
will cause all but the most resilient of trainees to lose condence in themselves.* [25]
Consultants who feel burnt out and alienated may take their disaection out on junior colleagues.* [25]
Bullying of medics and consultants is rampant in the UK NHS - for example, eight documented cases of victimized
NHS sta ve physicians and three consultants.* [26]* [27] The farewell interview from Sir Ian Kennedy (Chair of the
HealthcareCommission) caused signicant media interest following his statement that bullying is acorrosiveproblem
that the NHS must address.
12.5 Bullying cycle

Medical training usually takes place in institutions that have a highly structured hierarchical system, and has traditionally
involved teaching by intimidation and humiliation. Such practices may foster a culture of bullying and the setting up of
a cycle of bullying, analogous to other cycles of abuse in which those who experience it go on to abuse others when they
become more senior. Medical doctors are increasingly reporting to the British Medical Association that they are being
bullied, often by older and more senior colleagues, many of whom were badly treated themselves when more junior.* [28]
Physician Jonathan Belsey relates in an emblematic narrative published in AMA Virtual Mentor entitled Teaching By
Humiliation thathowever well you presented the case, somewhere along the line you would trip up and give the predatory
professor his opportunity to expose your inadequacies. Sometimes it would be your lack of medical knowledge; sometimes
the question that you failed to ask the patient that would have revealed the root of the problem, or sometimes your
ineptitude at eliciting the required clinical signs. On one memorable occasion, when I had appeared to cover all the bases
clinically, the professor turned to me and berated me for attending his ward round wearing a plaid shirt that was clearly
inappropriate for an aspiring doctor.* [29]
12.6 Bullying in psychiatry

Psychiatric trainees experience rates of bullying at least as high as other medical students. In a survey of psychiatric
trainees in the West Midlands, 47% had experienced bullying within the last year with even higher percentages amongst
ethnic minorities and females. Qualied psychiatrists are not themselves required to be psychiatrically assessed.* [30]* [31]
12.7 Doctors bullying/abusing patients and nurses

Main articles: Patient abuse and Bullying in nursing
There have been quite a few proven cases of doctors bullying and/or sexually harassing patients and nurses.* [32]* [33]
Speaking of many doctors' predilection for bullying nurses, Theresa Brown writes:
...the most damaging bullying is not agrant and does not t the stereotype of a surgeon having a tantrum
in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle:
condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward
insults.* [34]
12.8. BULLYING IN NURSING
163
12.8 Bullying in nursing

Main article: Bullying in nursing
Nurses experience bullying quite frequently.* [35]* [36] It is thought that relational aggression (psychological aspects of
bullying such as gossipping and intimidation) are commonplace. Relational aggression has been studied among girls but
not so much among adult women.* [37]* [38]
12.9 In popular culture

Sir Lancelot Spratt, a character played by actor James Robertson Justice in the lm series Doctor in the House, is often
referenced as the archetypal arrogant bullying doctor ruling by fear. The lm series also demonstrates bullying of student
doctors by other doctors and the nursing matron.
In the American sitcom Scrubs, Dr. Cox uses intimidation and sarcasm as methods of tormenting the interns and expressing his dislike towards them and their company.
12.10 See also

Aggression in healthcare
Doctor-patient relationship
Burnout and depression of medical students
Medical education
Medical narcissism
Medical school
Sham peer review
Staord Hospital scandal
Whistleblowing
12.11 References
[1] VM -- To Bully and Be Bullied: Harassment and Mistreatment in Medical Education, Mar 14 ... Virtual Mentor.
virtualmentor.ama-assn.org. 2014-03-01. Retrieved 2015-02-09.
[2] Field, T. (2002). Bullying in medicine. BMJ 324 (7340): 786. doi:10.1136/bmj.324.7340.786/a.
[3] Ways of Explaining Workplace Bullying: A Review of Enabling, Motivating and Precipitating Structures and Processes in
the Work Environment. hum.sagepub.com. Retrieved 2015-02-09.
[4] The British Psychological Society (17 August 2006). Youth oending and youth justice (PDF). Educational and Child
Psychology vol 23 No 2. Retrieved 2015-02-09.
[5] "http://www.arimhe.com/uploaded/abstractbook.4th-worldwide-conference.pdf#page=25" (PDF). arimhe.com. Retrieved 201502-09.
[6] http://books.google.com/books?hl=en&lr=&id=h8qYxAhmhUAC&oi=fnd&pg=PA201&dq=displacement+bullying&ots=P1HACC0kvy&
sig=_55D17revFCUaJZZuc7hNzenkHw#v=onepage&q=displacement%20bullying&f=false
164
[7] Harassment and bullying at work: A review of the scandinavian approach. Aggression and Violent Behavior 5: 379401.
doi:10.1016/S1359-1789(98)00043-3. Retrieved 2015-02-09.
[8] Perspective: A Culture of Respect, Part 1: The Nature and... : Academic Medicine. journals.lww.com. Retrieved 201502-09.
[9] Canpimpingkill? The potential eect of disrespectful be... : Journal of the American Academy of Physician Assistants
. journals.lww.com. Retrieved 2015-02-09.
[10] Bjrkqvist, K (2001). Social defeat as a stressor in humans. Physiology & Behavior 73 (3): 43542. doi:10.1016/S00319384(01)00490-5. PMID 11438372.
[11] Peer Victimization in Fifth Grade and Health in Tenth Grade. pediatrics.aappublications.org. Retrieved 2015-02-09.
[12] The New York Times. nytimes.com. Retrieved 2015-02-09.
[13] Doctors who kill themselves: a study of the methods used for suicide | QJM: An International Journal of Medicine.
qjmed.oxfordjournals.org. Retrieved 2015-02-09.
[14] The occupation with the highest suicide rate | Psychology Today. psychologytoday.com. Retrieved 2015-02-09.
[15] An Error Occurred Setting Your User Cookie. thelancet.com. Retrieved 2015-02-09.
[16] Coverdale, J. H.; Balon, R.; Roberts, L. W. (2009). Mistreatment of Trainees: Verbal Abuse and Other Bullying Behaviors
. Academic Psychiatry 33 (4): 26973. doi:10.1176/appi.ap.33.4.269. PMID 19690101.
[17] Curtis P Medical students complain of bullying The Guardian 4 May 2005
[18] VM -- Legacy Admissions in Medical School, Dec 12 ... Virtual Mentor. virtualmentor.ama-assn.org. 2012-12-01.
[19] Connections to University can aect admissions decision | Stanford Daily. stanforddaily.com. Retrieved 2015-02-09.
[20] Rautio, Arja; Sunnari, Vappu; Nuutinen, Matti; Laitala, Marja (2005). Mistreatment of university students most common
during medical studies. BMC Medical Education 5: 36. doi:10.1186/1472-6920-5-36. PMC 1285362. PMID 16232310.
[21] Stebbing, J; Mandalia, S; Portsmouth, S; Leonard, P; Crane, J; Bower, M; Earl, H; Quine, L (2004).A questionnaire survey of
stress and bullying in doctors undertaking research
. Postgraduate Medical Journal 80 (940): 936. doi:10.1136/pmj.2003.009001.
PMC 1742926. PMID 14970297.
[22] Bairy, KL; Thirumalaikolundusubramanian, P; Sivagnanam, G; Saraswathi, S; Sachidananda, A; Shalini, A (2007). Bullying among trainee doctors in Southern India: A questionnaire study. Journal of Postgraduate Medicine 53 (2): 8790.
doi:10.4103/0022-3859.32206. PMID 17495372.
[23] Quine, L. (2002).Workplace bullying in junior doctors: Questionnaire survey
. BMJ 324 (7342): 8789. doi:10.1136/bmj.324.7342.878.
PMC 101400. PMID 11950736.
[24] Isral, E; Louwette, R; Lambotte, C (1975).Two familial cases of congenital erythroderma ichthyosiforme. Revue mdicale
de Lige 30 (13): 43944. PMID 1096266.
[25] Paice E, Smith D (2009). Bullying of trainee doctors is a patient safety issue (PDF). The Clinical Teacher 6: 137.
doi:10.1111/j.1743-498x.2008.00251.x.
[26] A Just NHS. ajustnhs.com. Retrieved 2015-02-09.
[27] Bullying Report in Central London Community Healthcare NHS Trust. scribd.com. Retrieved 2015-02-09.
[28] Williams K (1998) Stress linked to bullying. BMA News Review, April 18
[29] VM -- Teaching by Humiliation--Why It Should Change, Mar 14 ... Virtual Mentor. virtualmentor.ama-assn.org. 201403-01. Retrieved 2015-02-09.
[30] Hoosen, I. A. (2004). A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatric Bulletin 28
(6): 2257. doi:10.1192/pb.28.6.225.
[31] Gadit AA Bullying in psychiatry must stop - Clinical Psychiatry News, May, 2007
165
[32] Doctor faces court-martial in patient abuse case Stars and Stripes January 16, 2010
[33] 'Groping' surgeon found guilty BBC News 28 July 2002
[34] title="Physician Heel Thyself"|url='http://www.nytimes.com/2011/05/08/opinion/08Brown.html'
[35] Hutchinson, M; Wilkes, L; Vickers, M; Jackson, D (2008). The development and validation of a bullying inventory for the
nursing workplace. Nurse researcher 15 (2): 1929. doi:10.7748/nr2008.01.15.2.19.c6326. PMID 18283759.
[36] Porter-O'grady, T (2008). Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz. The
American nurse 40 (2): 7. PMID 18494401.
[37] Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008)
[38] Dellasega, Cheryl A. (2009).Bullying among nurses

. The American journal of nursing 109 (1): 528. doi:10.1097/01.NAJ.0000344039.11651.08
PMID 19112267.

Ahmer, Syed; Yousafzai, Abdul Wahab; Bhutto, Naila; Alam, Sumira; Sarangzai, Amanullah Khan; Iqbal, Arshad
(2008). Syed, Ehsan, ed. Bullying of Medical Students in Pakistan: A Cross-Sectional Questionnaire Survey.
PLoS ONE 3 (12): e3889. doi:10.1371/journal.pone.0003889. PMC 2586648. PMID 19060948.
Faruqui, R. A.; Ikkos, G. (2007). Poorly performing supervisors and trainers of trainee doctors. Psychiatric
Bulletin 31 (4): 14852. doi:10.1192/pb.bp.105.008730.
Frank, E. (2006). Experiences of belittlement and harassment and their correlates among medical students in
the United States: Longitudinal survey. BMJ 333 (7570): 6820. doi:10.1136/bmj.38924.722037.7C.
Gadit, A A M; Mugford, G (2008). A pilot study of bullying and harassment among medical professionals in
Pakistan, focussing on psychiatry: Need for a medical ombudsman. Journal of Medical Ethics 34 (6): 4636.
doi:10.1136/jme.2007.021832. PMID 18511621.
Imran, N; Jawaid, M; Haider, II; Masood, Z (2010). Bullying of junior doctors in Pakistan: A cross-sectional
survey (PDF). Singapore medical journal 51 (7): 5925. PMID 20730401.
Maida, Ana Margarita; Vsquez, Alicia; Herskovic, Viviana; Caldern, Jos Luis; Jacard, Marcela; Pereira, Ana;
Widdel, Lars (2003). A report on student abuse during medical training. Medical Teacher 25 (5): 497501.
doi:10.1080/01421590310001606317. PMID 14522671.
Mukhtar, F; Daud, S; Manzoor, I; Amjad, I; Saeed, K; Naeem, M; Javed, M (2010).Bullying of medical students
. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 20 (12): 8148. PMID 21205548.
Paice, E.; Aitken, M; Houghton, A; Firth-Cozens, J (2004). Bullying among doctors in training: Cross sectional
questionnaire survey. BMJ 329 (7467): 6589. doi:10.1136/bmj.38133.502569.AE. PMC 517643. PMID
15256417.
Mistry M and Latoo J Bullying: a growing workplace menace BJMP Mar 2009 Volume 2 Number 1
Paice, E; Firth-Cozens, J (2003). Who's a bully then?". BMJ (Clinical research ed.) 326 (7393): S127.
doi:10.1136/bmj.326.7393.S127. PMID 12689995.
Quine, Lyn (1999). Workplace bullying in NHS community trust: Sta questionnaire survey. BMJ (Clinical
research ed.) 318 (7178): 22832. doi:10.1136/bmj.318.7178.228. PMC 27703. PMID 9915730.
Vanderstar ES Workplace Bullying in the Healthcare Professions 2004 8 Employee Rights and Employment Policy
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Wood, D. F (2006).Bullying and harassment in medical schools
. BMJ 333 (7570): 6645. doi:10.1136/bmj.38954.568148.BE.
PMC 1584336. PMID 17008645.
Wood DF Bullying in medical schools Student BMJ October 2006
166
12.13 External links

Bullying and harassment British Medical Association 8 May 2007
Guidance for medical students on harassment, intimidation, victimisation and bullying British Medical Association
21 December 2007
Bullying and harassment of doctors in the workplace Report British Medical Association Health Policy & Economic
Research Unit May 2006
The cost of bullying to the NHS
The Bullying Culture of Medical School
News stories
Bullying on the NHS BBC News January 22, 1999
Bullying 'ruining NHS workers' lives' BBC News 6 December 2000
Many junior doctors bullied BBC News 11 April 2002
One in four junior doctors bullied BBC News 26 September 2002
Dunne R 'My fellow doctors bullied me' BBC News 9 June 2003
NHS anti-bullying culture ordered BBC News 12 January 2006
Targets' triggering NHS bullying BBC News 18 May 2006
Surgery team 'unsafe' - and at times 'dangerous' Staordshire Newsletter 10 March 2011
Chapter 13
Bullying in nursing
The nursing organisation workplace has been identied as one in which workplace bullying occurs quite frequently.* [1]* [2]
It is thought that relational aggression (psychological aspects of bullying such as gossipping and intimidation) are relevant.
Relational aggression has been studied amongst girls but not so much amongst adult women.* [3]* [4]
Various bullying permutations are possible, such as:
doctor or management bullying a nurse
nurse bullying another nurse
nurse bullying a patient
patient bullying a nurse
nurse bullying other healthcare providers
13.1 Bullying acts

Lewis identies the following bullying acts in UK nursing:* [5]
undermining of work
disadvantaging the target
physical abuse (rare)
verbal abuse
isolating individuals
interfering in work practices
continual criticism
sarcasm
demeaning
destroying condence
fabricating complaints (false accusations)
167
168
CHAPTER 13. BULLYING IN NURSING
setting up to fail
Such acts are frequently insidious, continuing over periods of time that may be years. Bullies are often serial bullies.
The bullies are invariably aware of the damage they are doing. They undertake such actions basically to gain control and
power.
13.2 Incivility
Laschinger, Leiter, Day, and Gilin found that among 612 sta nurses, 67.5% had experienced incivility from their supervisors and 77.6% had experienced incivility from their coworkers.* [6]
13.3 Bullying of nurses by managers

In 2003 the Community Practitioners' and Health Visitors' Association in the UK carried out a survey showing that
half of health visitors, school nurses and community nurses working in the National Health Service (NHS) have been
bullied by their managers. One in three of the 563 people questioned said the bullying was so bad they had to take time
o work. Constant criticism and humiliation were the most common complaints. Others said they were shouted at or
marginalised.* [7]
13.4 Nurse bullying inventory

In order to further investigate and understand the impact of workplace bullying on the nursing work environment, an
inventory was developed to address specic workplace bullying constructs within the nursing context.* [1]
13.5 Associated terms

Horizontal Violence * [8] is often the same term used when referring to bullying in Nursing. This term describes the
appalling behavior shown by colleagues in the nursing eld. Such demeaning behavior makes the work place stressful and
unpleasant. Another term associated with bullying in nursing is lateral violence. This term is used to describe the eect
that bullying takes on someone lower down on the ladder of workforce, making it hard to climb that ladder.
13.6 Remedial action

Some health organisations are seeking to educate sta and health care team members on how to improve social interactions, proper business etiquette, and foster positive people skills in the work environment. Nurses are entitled to monetary
compensation for bullying.* [9]* [10]* [11]* [12]
13.7 See also

Emotional labor
Patient abuse
13.8. REFERENCES
169
Workplace bullying
Workplace incivility
13.8 References
[1] Hutchinson, M; Wilkes, L; Vickers, M; Jackson, D (2008). The development and validation of a bullying inventory for the
nursing workplace. Nurse researcher 15 (2): 1929. doi:10.7748/nr2008.01.15.2.19.c6326. PMID 18283759.
[2] Porter-O'grady, T (2008). Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz. The
American nurse 40 (2): 7. PMID 18494401.
[3] Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008)
[4] Dellasega, Cheryl A. (2009).Bullying among nurses

. The American journal of nursing 109 (1): 528. doi:10.1097/01.NAJ.0000344039.11651.08
PMID 19112267.
[5] Lewis, Malcolm A. (2006). Nurse bullying: Organizational considerations in the maintenance and perpetration of health
care bullying cultures(PDF). Journal of Nursing Management 14 (1): 528. doi:10.1111/j.1365-2934.2005.00535.x. PMID
16359446.
[6] Spence Laschinger, Heather K.; Leiter, Michael; Day, Arla; Gilin, Debra (2009). Workplace empowerment, incivility,
and burnout: impact on sta nurse recruitment and retention outcomes. Journal of Nursing Management 17 (3): 30211.
doi:10.1111/j.1365-2834.2009.00999.x. PMID 19426367.
[7] NHS nurses 'bullied by managers' BBC News 11 October 2003
[8] Roy, Josie. Horizontal Violence. ADVANCE for Nurses. Retrieved 5 October 2011.
[9] Trossman, S (2008). Behaving badly? Joint Commission issues alert aimed at improving workplace culture, patient care.
The American nurse 40 (5): 1, 6, 12. PMID 19024048.
[10] Martin, William (2008). Is Your Hospital Safe? Disruptive Behavior and Workplace Bullying (PDF). Hospital Topics 86
(3): 218. doi:10.3200/HTPS.86.3.21-28. PMID 18694856.
[11] Nurse Work Injury Compensation Eoin Campbell Injury Compensation Zone
[12] Kerfoot, KM (2008). Leadership, civility, and the 'no jerks' rule. Medsurg nursing 17 (6): 4412. PMID 19248414.

13.9.1
Books
Button SM Bullying of a nursing student: a mixed interpretive study (2007)

Dellasega C When Nurses Hurt Nurses: Recognizing and Overcoming The Cycles of Bullying (2011)
Nurses and the experience of bullying at work: a report for the Claire Thomson, Working Women's Centre (Adelaide, S. Aust.), Australian Nursing Federation. S.A. Branch - 1998
Thompson R Do No HarmApplies To Nurses Too! (2012)
Webb C, Randle J Workplace Bullying in the NHS (2006)
170
13.9.2
CHAPTER 13. BULLYING IN NURSING
Academic papers
Cleary, Michelle; Hunt, Glenn E.; Horsfall, Jan (2010). Identifying and Addressing Bullying in Nursing. Issues
in Mental Health Nursing 31 (5): 3315. doi:10.3109/01612840903308531. PMID 20394479.
Cooper, Janet R. M.; Walker, Jean T.; Winters, Karen; Williams, P. Rene; Askew, Rebecca; Robinson, Jennifer
C. (2009). Nursing students' perceptions of bullying behaviours by classmates. Issues in Educational Research
19 (3): 21226.
Foster, Barry; Mackie, Beth; Barnett, Natasha (2004). Bullying in the Health Sector: A Study of Bullying of
Nursing Students. New Zealand Journal of Employment Relations 29 (2): 6783.
Hogh, Annie; Carneiro, Isabella Gomes; Giver, Hanne; Rugulies, Reiner (2011). Are immigrants in the nursing
industry at increased risk of bullying at work? A one-year follow-up study. Scandinavian Journal of Psychology
52 (1): 4956. doi:10.1111/j.1467-9450.2010.00840.x. PMID 21054415.
Hutchinson, Marie; Vickers, Margaret; Jackson, Debra; Wilkes, Lesley (2006). Workplace bullying in nursing: towards a more critical organisational perspective. Nursing Inquiry 13 (2): 11826. doi:10.1111/j.14401800.2006.00314.x. PMID 16700755.
Hutchinson, Marie; Jackson, Debra; Wilkes, Lesley; Vickers, Margaret H. (2008). A new model of bullying in
the nursing workplace: organizational characteristics as critical antecedents. Advances in Nursing Science 31 (2):
E6071. doi:10.1097/01.ANS.0000319572.37373.0c. PMID 18497582.
Hutchinson, Marie; Wilkes, Lesley; Jackson, Debra; Vickers, Margaret H. (2010). Integrating individual, work
group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. Journal
of Nursing Management 18 (2): 17381. doi:10.1111/j.1365-2834.2009.01035.x. PMID 20465745.
Hutchinson, Marie; Vickers, Margaret H.; Wilkes, Lesley; Jackson, Debra (2009). "'The Worse You Behave, The
More You Seem, to be Rewarded': Bullying in Nursing as Organizational Corruption. Employee Responsibilities
and Rights Journal 21 (3): 21329. doi:10.1007/s10672-009-9100-z.
Johnston, Michelle; Phanhtharath, Phylavanh; Jackson, Brenda S. (2010).The Bullying Aspect of Workplace Violence in Nursing
. JONA's Healthcare Law, Ethics, and Regulation 12 (2): 3642. doi:10.1097/NHL.0b013e3181e6bd19.
Lewis, MA (2001).Bullying in nursing
. Nursing standard 15 (45): 3942. doi:10.7748/ns2001.07.15.45.39.c3064.
PMID 12212387.
Murray, JS (2009). Workplace bullying in nursing: a problem that can't be ignored. Medsurg nursing 18 (5):
2736. PMID 19927962.
Murray, Colonel John S. (2008). On Bullying in the Nursing Workplace. Journal of Obstetric, Gynecologic,
& Neonatal Nursing 37 (4): 393393. doi:10.1111/j.1552-6909.2008.00263.x.
Randle, Jacqueline (2003). Bullying in the nursing profession. Journal of Advanced Nursing 43 (4): 395401.
doi:10.1046/j.1365-2648.2003.02728.x. PMID 12887358.
Smith, Pam; Cowie, Helen (2010). Perspectives on emotional labour and bullying: Reviewing the role of
emotions in nursing and healthcare. International Journal of Work Organisation and Emotion 3 (3): 22736.
doi:10.1504/IJWOE.2010.032923.
Stevens, S. (2002). Nursing Workforce Retention: Challenging A Bullying Culture. Health Aairs 21 (5):
18993. doi:10.1377/hltha.21.5.189. PMID 12224882.
Cleary, Michelle; Hunt, Glenn E.; Horsfall, Jan (2010). Identifying and Addressing Bullying in Nursing. Issues
in Mental Health Nursing 31 (5): 331335. doi:10.3109/01612840903308531. PMID 20394479.
13.9.3
171
Others
Book, Rita (2009). Nursing Interventions for Bullying in a Kindergarten to Grade Eight School (PDF).
Fuller, Willa (2007). Eradication of Horizontal Violence and Bullying in Nursing. FNA Proposal for Action.
Florida Nurses Association Board of Directors.
Chipps, Esther (2009). Workplace Bullying and Normalization of Bullying Acts in the Nursing Workplace. Midwest
Nursing Research Society.
Hutchinson, Marie; Vickers, Margaret H.; Jackson, Debra; Wilkes, Lesley (2004). Bullying in nursing: introducing
an Australian study. Proceedings of Leadership in the 21st Century: Association on Employment Practices and
Principles (AEPP), Twelfth Annual International Conference. Fort Lauderdale Beach, FL., 79 August: Association on Employement Practices and Principles.
Olender-Russo, Lynda (August 1, 2009).Reversing the bullying culture in nursing. ModernMedicine. Advanstar
Communications.
Pugh, Abigail (Winter 20052006). Bullying in nursing: building a culture of respect combats lateral violence
. CrossCurrents. Centre for Addiction and Mental Health.
Dealing with bullying and harassment at work: A guide for RCN members (PDF). Royal College of Nursing. 2005.
Dealing with bullying and harassment: a guide for students (PDF). Royal College of Nursing. 2005.
Stelmaschuk, Stephanie (2010). Workplace Bullying and Emotional Exhaustion among Registered Nurses and Nonnursing, Unit-based Sta (PDF) (Bachelor's thesis). Ohio State University College of Nursing.
Stokowski, Laura A. (September 30, 2010).A Matter of Respect and Dignity: Bullying in the Nursing Profession
. Medscape Nurses. WebMD.
Chapter 14
List of medical ethics cases

Some cases have been remarkable for starting broad discussion and for setting precedent in medical ethics.
14.1 Research
14.2 Controversies relating to termination of mechanical ventilation and life
support
14.3 Person wishes for assisted suicide
14.4 Person wishes for euthanasia for another
14.5 References
[1] Wessely, Simon (October 2009). Surgery for the treatment of psychiatric illness: the need to test untested theories. Journal
of the Royal Society of Medicine 102 (10): 445451. doi:10.1258/jrsm.2009.09k038. PMC 2755332. PMID 19797603.
[2] Huge payout in US stuttering case - BBC News
[3] Washington, Harriet (2008). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from
Colonial Times to the Present. Knopf Doubleday Publishing Group. ISBN 076792939X.
[4] Nelson, Alondra (7 January 2007). Unequal Treatment. Medical Apartheid. The Washington Post.
[5] Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
. Social History of Medicine 20 (3): 620621. 2007. doi:10.1093/shm/hkm086.
[6] R.C. Longworth. Injected! Book review:The Plutonium Files: America's Secret Medical Experiments in the Cold War, The
Bulletin of the Atomic Scientists, Nov/Dec 1999, 55(6): 58-61.
[7] Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 130131. ISBN 978-0-312-30356-3.
[8] Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 132134. ISBN 978-0-312-30356-3.
[9] Richardson, Theresa (2001). Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation
in the name of medical science. Canadian Journal of History 36 (1): 184186.
[10] Report on Ely Hospital. Report of the Committee of Inquiry into Allegations of Ill Treatment of Patients and other
irregularities at the Ely Hospital, Cardi. Socialist Health Association. 11 March 1969.
172
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[11] Milgram, Stanley (1963). Behavioral Study of Obedience. Journal of Abnormal and Social Psychology 67 (4): 37178.
doi:10.1037/h0040525. PMID 14049516. as PDF.
[12] Milgram, Stanley (1974). Obedience to Authority; An Experimental View. Harpercollins. ISBN 0-06-131983-X.
[13] Baumrind, Diana (1964).Some Thoughts on Ethics of Research: After Reading Milgram'sBehavioral Study of Obedience
. American Psychologist 19: 421423. doi:10.1037/h0040128.
[14] Kaplan, Robert (2009). Medical Murder: Disturbing Cases of Doctors Who Kill. Allen & Unwin. ISBN 1741765773.
6. ISBN 0-19-852783-7.
3335. doi:10.1093/schbul/sbp119. PMC 2800147. PMID 19892821.
[18] Katona, Cornelius; Robertson, Mary (2005). Psychiatry at a glance. Wiley-Blackwell. p. 77. ISBN 1-4051-2404-0.
[19] The Stanford Prison Experiment - A Simulation Study of the Psychology of Imprisonment Conducted at Stanford University
[20] Anne Thompson (July 9, 2001). Paxil Maker Held Liable in Murder/Suicide. Lawyers Weekly USA.
[21] Tobin v. SmithKline Verdict, June 6, 2001
[22] Tobin v. SmithKline Judgment, June 6, 2001
[23] Philip J. Hilts (June 8, 2001). Jury Awards $6.4 Million in Killings Tied to Drug. The New York Times.
[24] Draper, Robert (June 8, 2003). The Toxic Pharmacist. New York Times. Retrieved 2010-08-31.
[25] UK rm tried HIV drug on orphans The Observer, Sunday 4 April 2004
[26] Andrews, J.R. 2006. Research in the Ranks: Vulnerable Subjects, Coercible Collaboration, and the Hepatitis E Vaccine Trial
in Nepal. Perspectives in Biology and Medicine 49(1):3551
[27] GSK ned over vaccine trials; 14 babies reported dead Buenos Aires Herald 1 Aug 2012.
[28] Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers.
pp. 218219.
[29] Elliott, Carl (September/October 2010). The deadly corruption of clinical trials.Mother Jones: http://www.motherjones.
com/environment/2010/09/dan-markingson-drug-trial-astrazeneca?page=1
[30] http://markingson.blogspot.com/
[31] http://www.scribd.com/doc/49659724/U-of-M-Board-of-Regents-Markingson-Letter
Chapter 15
Workplace safety in healthcare settings

Workplace safety in healthcare settings usually involves patients being aggressive or violent towards healthcare professionals, or sta members being aggressive against each other. Patient-on-professional aggression commonly involves
direct verbal abuse, although deliberate and severe physical violence has been documented. Sta-on-sta aggression may
be passive, such as a failure to return a telephone call from a disliked colleague, or indirect, such as engaging in backbiting
and gossip. However, most documented cases of healthcare aggressionhave been by caregiversagainst patients.
Aggression was, in 1968, described by Moyer as a behaviour that causes or leads to harm, damage or destruction of
another organism(Weinshenker and Siegel 2002). Human aggression has more recently been dened asany behaviour
directed toward another individual that is carried out with the proximate intent to cause harm(Anderson and Bushman
2002).
The denition can be extended to include the fact that aggression can be physical, verbal, active or passive and be directly
or indirectly focussed at the victimwith or without the use of a weapon, and possibly incorporating psychological or
emotional tactics (Rippon 2000). It requires the perpetrator to have intent, and the victim to attempt evasion of the
actions. Hence harm that is accidental cannot be considered aggressive as it does not incorporate intent, nor can harm
implicated with intent to help (for example the pain experienced by a patient during dental treatment) be classed as
aggression as there is no motivation to evade the action (Anderson and Bushman 2002). A description of workplace
violence by Wynne, Clarkin, Cox, & Griths (1997), explains it to involve incidents resulting in abuse, assault or threats
directed towards sta with regard to workincluding an explicit or implicit challenge to their safety, well-being or health
(Oostrom and Mierlo 2008).
15.1 Aggression in the healthcare industry

Professions within the healthcare industry are becoming increasingly violent places in which to workwith healthcare
professionals being common targets for violent and aggressive behaviour (Rippon 2000).
Aggression and violence negatively impact both the workplace and its employees. For the organisation, greater nancial
costs can be incurred due increased absences, early retirement and reduced quality of care (Arnetz and Arnetz 2000;
Hoel, Sparks, Cooper, 2001). For the healthcare worker however, psychological damage such as post-traumatic stress can
result (Rippon 2000), in addition to a decrease in job motivation (Arnetz and Arnetz 2000).
15.2 Classication models

Classication (LeBlanc and Barling 2004) Patient-on-Professional aggression can be classied as Type II; where the
perpetrator commits a violent act whilst being served by the organisation, with which they have a legitimate relationship (LeBlanc and Barling 2004). It is uncommon for such attacks to result in death (Peek-Asa, Runyan, Zwerling
2001), however they are evidently responsible for approximately 60% of non-fatal assaults at work (Peek-Asa and
174
15.2. CLASSIFICATION MODELS
175
Howard 1999). Within this classication that is based on the relationship between the perpetrator and victim,
Type I aggression involves the perpetrator entering the workplace to commit a crimehaving no relationship to the
organisation or its employees. Type III deals with a current/former employee targeting a co-worker or supervisor
for what they perceive to be wrong-doing. Type IV aggression involves the perpetrator having an ongoing/previous
relationship with an employee within the organisation. (LeBlanc and Barling 2004).
Internal Model (Nijman et al. 1999)
The internal model associates aggression with factors within the person, including mental illness or personality (Duxbury
et al. 2008). This model is supported by the numerous studies correlating a link between aggression and illness
(Duxbury and Whittington 2005). A persons traits can relate to their expression of aggressionnarcissists for
example, tend to become angry and aggressive if their image is threatened (Anderson and Bushman 2002). Sex
tends to aect aggressionwith certain provocations aecting each sex dierently (Bettencourt and Miller 1996).
It was found that males tend to prefer direct aggression, and females indirect (sterman et al. 1998) (Anderson
and Bushman 2002). A study by Hobbs and Keane, 1996 explains that patient factors commonly related to or
causative of patient violence include; male sex, relative youth or the eects of alcohol or drug consumption (Hobbs
and Keane 1996). A study conducted amongst General Medical Practitioners in the West Midlands found that men
were involved in 66% of aggression cases; rising to 76% with regard to assault/injury (Hobbs and Keane 1996)the
main male perpetrator being aged under 40 years of age. Patient anxiety, a particular problem associated with
dentistry, tended to be the most likely instigator for verbal abuse and the second most likely reason for threatening
verbal abuse (Hobbs and Keane 1996).
External Model (Nijman et al. 1999)
This model is based on the idea that social & physical environmental inuences aect aggression (Duxbury et al. 2008).
This includes the provisions for privacy, space and location (Duxbury and Whittington 2005). Motivation for
aversion, possibly due to pain during dental treatment, can increase aggression (Berkowitz, Cochran, Embree
1981)as can general discomfort, such as that resulting from sitting in a hot waiting room (Anderson, Anderson,
Dorr 2000) or in an uncomfortable position (for example in a reclined dental chair) (Duxbury et al. 2008). Alcohol
intoxication or excessive caeine intake tends to indirectly exacerbate aggression (Bushman 1993). The Hobbs &
Keane (1996) study states the involvement of drugs and alcohol; in 65% of cases at one Accident & Emergency Department and in 27% of all general practice cases. The study denotes intoxication to be the main reason for assaults
and injury (along with mental illness) (Hobbs and Keane 1996). Frustration, dened by Anderson and Bushman
(2002) as the blockage of goal attainment, can also contribute to aggressionwhether the frustrations are fully
justied or not (Dill and Anderson 1995). Such frustration-related aggression tended to be against the perpetrator
and persons not involved in failure to reach the goal. Prolonged waiting times in A&E departments and general
practice led to aggression due to frustration; it generally being directed towards receptionistswith approximately
73% of doctors becoming involved (Hobbs and Keane 1996).
Situational/Interactional Model (Nijman et al. 1999)
This deals with factors involved in the immediate situation, for example interactions between patients and sta (Duxbury
et al. 2008). There are numerous studies that support the correlation between sta with a negative attitude and
patient aggression (Duxbury and Whittington 2005). Provocation has been said to be the most important cause
of human aggression (Anderson and Bushman 2002)examples include verbal and physical aggression against the
individual (Anderson and Bushman 2002). It was found that perceived injustice, in the context of equality amongst
sta for example, positively correlated to workplace aggression (Baron 1999).
Expressions of Hostility (Baron 1999)
This is related tobehaviours that are primarily verbal or symbolic in nature(Baron 1999). In terms of Sta-on-Sta
hostility, this can involve he perpetrator talking behind the targets back. With Patient-on-Professional hostility
however, this can deal with the patient assuming false knowledge over the professionalwith the patient belittling
their opinions (Baron 1999).
Obstructionism (Baron 1999)
176
CHAPTER 15. WORKPLACE SAFETY IN HEALTHCARE SETTINGS
This involves the perpetrator conducting actions that aim to obstruct or impede the targets performance(Baron
1999). Failures to pass on information or respond to phone calls for example, are ways in which Sta-on-Sta
obstructionism can be demonstrated. Patient-on-Professional obstructionism can be demonstrated by a failure on
behalf of the patient to comply with the professional conducting a certain task. An unwillingness to allow the
professional to diagnose the patient and a failure to turn up to appointments are examples of such obstructionism.
Overt Aggression (Baron 1999)
This normally relates to workplace violence, and involves behaviours including; threatening abuse, physical assault and
vandalism (Baron 1999). This again can occur with regard to both, Sta-on-Sta and Patient-on-Professional
aggression.
BussThree-Dimensional Model of Aggression (1961)
Buss (1961) dierentiated aggression into a three-dimensional model; physical-verbal, active-passive and direct-indirect
active-passive being removed in 1995 when Buss rened the categories. Physical assault would come under the
category physical-direct-active, whereas obstructionism relates to physical-passivebe it direct or indirect. Verbal
abuse or insults relate to verbal-active-direct aggression, whereas the failure to answer a question when asked, for
example with regard to lifestyle choices or habits, can come under the verbal-passive-direct categoryproviding
the reasons for not answering are directed at the healthcare worker (e.g. hostility), as opposed to fear for example
(Rippon 2000).
15.3 Prevalence
A survey from the British National Audit Oce (2003) stated that violence and aggression accounted for 40% of reported
health and safety incidents amongst healthcare workers (Oostrom and Mierlo 2008). Another survey looking into the
violence and abuse experienced in 3078 general dental practices over a period of three years found that 80% of practice
personnel had experienced violence or abuse within the workplace, which included verbal abuse and physical assault
(Pemberton, Atherton, Thornhill, 2000). It was reported that, over 12 months in Australian hospitals, 95% of sta had
experienced verbal aggression (O'Connell et al. 2000). Moreover, in the UK over 50% of nurses had experienced violence
or aggression over a 12-month period (Badger and Mullan 2004). In the United States, the annual rate of nonfatal, jobrelated violent crime against mental healthcare workers was 68.2 per 1,000 workers compared to 12.6 per 1,000 workers
in all other occupations (Anderson and West, 2011).* [1]
15.4 Coping
When dealing with aggression and violence in the workplace, training and education are the primary strategy for resolution
(Beech and Leather 2006). There are a number or personal factors that can help reduce aggression within the healthcare
setting, which include improved interpersonal skills, with an awareness of patient aggression and knowledge regarding
dealing with emotional patients (Oostrom and Mierlo 2008). Although assertiveness is crucial when it comes to the
interpersonal skills possessed by healthcare workers, it has been shown by numerous studies that nurses tend not to be very
assertive (Oostrom and Mierlo 2008). Training is therefore usually oered by organizations with regard to assertiveness,
and deals mainly with improving self-esteem, self-condence and interpersonal communication (Lin et al. 2004).
The Health Services Advisory Committee (HSAC) recommends a three-dimensional foundation by which to deal with
violence in the workplace. It involvesresearching the problem and assessing the risk, reducing the risk and checking what
has been done (Beech and Leather 2006).
In 1997, HSAC provided the following guidelines as to what good training involves (Beech and Leather 2006):
Theory: To understand the aggression within the workplace
Prevention: To assess the danger and take precautions
15.5. SEE ALSO
177
Interaction: With aggressive individuals

Post-Incident Action: To report, investigate, counsel, and follow up the incident
15.4.1
Assertiveness training
Although many studies looking at the eectiveness of training have provided inconclusive results (Oostrom and Mierlo
2008), a study by Lin et al. (2004) positively correlated the improvement of assertiveness and self-esteem with an assertiveness training programme (Lin et al. 2004). The programme targets dicult interactions that we may face in
day-to-day life and includes both, behavioural and cognitive techniques (Lin et al. 2004). The eectiveness of training
is measured using the Assertive Scale, Esteem Scale, and Interpersonal Communication Satisfaction Inventory (Lin et al.
2004).
15.4.2
Evaluating the eectiveness of training
It remains that training is not universally or consistently oered to healthcare workers (Beech and Leather 2006). Beale
et al. (1998) found that the levels of training oered ranged from nothing to high-level restraint/self-defense training. A
report by the National Audit Oce (NAO) in 2003 found that, within mental health trusts, a reactionary approach tends
to prioritise over prevention. Although criticised by many; restraint, seclusion and medication are used (Wright 1999,
Gudjonsson et al. 2004) (Duxbury and Whittington 2005). Breakaway techniques, restraint, rapid tranquilisation or isolation tend to be recommended when violence is instigated with a failure to prevent aggression (Duxbury and Whittington
2005). This correlates to the level of training oered, which dominates in these areas, however lacks in situation risk
assessment and customer care (Beech and Leather 2006)methods that are vital in a preventative approach to prevent
escalation of the situation, causing for reactionary measures to be brought into play.
The study by Beale et al. (1998) therefore provides the following advice as to good practice (Beech and Leather 2006):
Training should emphasise prevention, calming and negotiation skills as opposed to confrontation
Training should be oered in modules, ranging initially from basic customer care and handling dicult patients to
full control and restraint of patients.
Material relating to the causes of aggression, how to reduce risks, anticipation of violence, resolving conict and
dealing with post-incident circumstances should be provided to sta.
Physical breakaway skills should be taughthowever an understanding as to situations in which such skills should
be practiced must be appreciated.
Sta should be taught to control their own feelings
An understanding of normal/abnormal post-trauma reactions should be reached
Sta should be familiar with local arrangements and policies
15.5 See also

Abuse
Bullying in nursing
Doctor-patient relationship
Medical narcissism
Patient abuse
178
CHAPTER 15. WORKPLACE SAFETY IN HEALTHCARE SETTINGS
15.6 References
[1] Anderson, Ashleigh (March 2011). Violence Against Mental Health Professionals: When the Treater Becomes the Victim
. Innovations in Clinical Neuroscience.
Anderson, A., and West, S. G. (2011) Violence Against Mental Health Professionals: When the Treater Becomes
the Victim. Innovations in Clinical Neuroscience, 8(3), 34-39.
Anderson, C.A. and Bushman, B.J. (2002) Human Aggression. Annual Review of Psychology, 53: 27-51
Anderson, C.A., Anderson, K.B., Dorr, N. (2000) Temperature and Aggression. Advances in Experimental Social
Psychology, 32: 62-133
Arnetz, J.E. and Arnetz, B.B. (2000) Implementation and evaluation of a practical intervention programme for
dealing with violence towards health care workers. Journal of Advanced Nursing, 31 (3): 668-680
Badger, F. and Mullan, B. (2004) Aggressive and violent incidents: perceptions of training and support among sta
caring for older people and people with head injury. Journal of Clinical Nursing, 13 (4): 526-533
Baron, R.A. (1999) Social and Personal Determinants of Workplace Aggression: Evidence for the Impact of Perceived Injustice and the Type A Behavior Pattern. Aggressive Behaviour, 25: 281-296
Beale, D., Leather, P., Cox, T., et al. (1999) Managing violence and aggression towards NHS sta working in the
community. Nursing Times Research, 4 (2): 87-100
Beech, B. and Leather, P. (2006) Workplace violence in the health care sector: A review of sta training and
integration of training evaluation models. Aggression and Violent Behaviour, 11; 27-43
Berkowitz, L., Cochran, S.T., Embree, M.C. (1981) Physical pain and the goal of aversively stimulated aggression.
Journal of Personality and Social Psychology, 40 (4): 687-700
Bettencourt, B.A. and Miller, N. (1996) Gender dierences in aggression as a function of provocation: a metaanalysis. Psychological Bulletin, 119 (3): 422-447
Bushman, B.J. (1993) Human Aggression While Under the Inuence of Alcohol and Other Drugs: An Integrative
Research Review. Current Directions in Psychological Science, 2 (5): 148-151
Cowin, L., Davies, R., Estal, G., et al. (2003) De-escalating aggression and violence in the mental health setting.
International Journal of Mental Health Nursing, 12 (1): 64-73
Dill, J.C. and Anderson, C.A. (1995) Eects of Frustration Justication on Hostile Aggression. Aggressive Behaviour, 21: 359-369
Duxbury, J., Hahn, s., Needham, I. et al. (2008) The Management of Aggression and Violence Attitude Scale
(MAVAS): a cross-national comparative study. Journal of Advanced Nursing, 62 (5): 596-606
Duxbury, J. and Whittington, R. (2005) Causes and management of patient aggression and violence: sta and
patient perspectives. Journal of Advanced Nursing, 50 (5): 469-478
Hobbs, R. and Keane, U.M. (1996) Aggression against doctors: a review. Journal of the Royal Society of Medicine,
89: 69-72
Hoel, H., Sparks, K., Cooper, C.L. (2001) The Cost of Violence/Stress at Work and the Benets of a Violence/StressFree Working Environment. Report Commissioned by the International Labour Organization (ILO) Geneva; (University of Manchester Institute of Science and Technology)
LeBlanc, M.M. and Barling, J. (2004) Workplace Aggression. American Psychological Society, 13 (1): 9-12
Lin, Y., Shiah, I., Chang, Y., et al. (2004) Evaluation of an assertiveness training program on nursing and medical
studentsassertiveness, self-esteem, and interpersonal communication satisfaction. Nurse Education Today, 24:
656-665
15.6. REFERENCES
179
Nijman, H.L., aCampo J.M., Ravelli D.P., et al. (1999) A tentative model of aggression on inpatient psychiatric
wards. Psychiatric Services, 50 (6): 832-834
O'Connell, B., Young, J., Brooks, J., et al. (2000) Nurses' perceptions of the nature and frequency of aggression in
general ward settings and high dependency areas. Journal of Clinical Nursing, 9 (4): 602-610
Oostrom, J.K. and Mierlo H. (2008) An Evaluation of an Aggression Management Training Program to Cope with
Workplace Violence in the Healthcare Sector. Research in Nursing & Health, 31: 320-328
sterman, K., Bjrkqvist, K., Lagerspetz, K.M.J., et al. (1998) Cross-cultural evidence of female indirect aggression. Aggressive Behaviour, 24 (1): 1-8
Peek-Asa, C. and Howard, J. (1999) Workplace-violence investigations by the California Division of Occupational
Safety and Health, 1993-1996. Journal of Occupational and Environmental Medicine, 41 (8): 647-653
Peek-Asa, C., Runyan, C.W., Zwerling, C. (2001) The role of surveillance and evaluation research in the reduction
of violence against workers. Americal Journal of Preventative Medicine, 20 (2): 141-148
Pemberton, M.N., Atherton, G.J., Thornhill, M.H. (2000) Violence and aggression at work. British Dental Journal,
189 (8): 409-410
Rippon, T.J. (2000) Aggression and violence in health care professions. Journal of Advanced Nursing, 31 (2):
452-460
Weinshenker, N.J. and Siegel, A. (2002) Bimodal classication of aggression: aective defense and predatory
attack. Aggression and Violent Behaviour, 7 (3): 237-250
Chapter 16
Psychiatric survivors movement

The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement* [1]) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who
are survivors of interventions by psychiatry, or who are ex-patients of mental health services.* [2]
The psychiatric survivors movement arose out of the civil rights movement of the late 1960s and early 1970s and the
personal histories of psychiatric abuse experienced by some ex-patients.* [3] The key text in the intellectual development of
the survivor movement, at least in the USA, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives
to the Mental Health System.* [2]* [4] Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation
Front.* [5] Coalescing around the ex-patient newsletter Dendron,* [6] in late 1988 leaders from several of the main national
and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the
mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's rst public action
was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside
of) the American Psychiatric Association's annual meeting.* [7] In 2005 the SCI changed its name to Mind Freedom
International with David W. Oaks as its director.* [3]
Common themes aretalking back to the power of psychiatry, rights protection and advocacy, and self-determination.
While activists in the movement may share a collective identity to some extent, views range along a continuum from
conservative to radical in relation to psychiatric treatment and levels of resistance or patienthood.* [8]
16.1 History
See also: Outline of the psychiatric survivors movement
16.1.1
Precursors
The modern self-help and advocacy movement in the eld of mental health services developed in the 1970s, but former
psychiatric patients have been campaigning for centuries to change laws, treatments, services and public policies. The
most persistent critics of psychiatry have always been former mental hospital patients, although few were able to tell
their stories publicly or to openly confront the psychiatric establishment, and those who did so were commonly considered
so extreme in their charges that they could seldom gain credibility.* [9] In 1620 in England, patients of the notoriously
harsh Bethlem Hospital banded together and sent a Petition of the Poor Distracted People in the House of Bedlam
(concerned with conditions for inmates)" to the House of Lords. A number of ex-patients published pamphlets against
the system in the 18th century, such as Samuel Bruckshaw (1774), on theiniquitous abuse of private madhouses, and
William Belcher (1796) with hisAddress to humanity, Containing a letter to Dr Munro, a receipt to make a lunatic, and
a sketch of a true smiling hyena. Such reformist eorts were generally opposed by madhouse keepers and medics.* [10]
180
16.1. HISTORY
181
In the late 18th century, moral treatment reforms developed which were originally based in part on the approach of
French ex-patient turned hospital-superintendent Jean-Baptiste Pussin and his wife Margueritte. From 1848 in England,
the Alleged Lunatics' Friend Society campaigned for sweeping reforms to the asylum system and abuses of the moral
treatment approach. In the United States, The Opal (18511860) was a ten volume Journal produced by patients of Utica
State Lunatic Asylum in New York, which has been viewed in part as an early liberation movement. Beginning in 1868,
Elizabeth Packard, founder of the Anti-Insane Asylum Society, published a series of books and pamphlets describing her
experiences in the Illinois insane asylum to which her husband had had her committed.
16.1.2
Early 20th century
A few decades later, another former psychiatric patient, Cliord W. Beers, founded the National Committee on Mental
Hygiene, which eventually became the National Mental Health Association. Beers sought to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions. His book, A Mind that Found
Itself (1908),* [11] described his experience with mental illness and the treatment he encountered in mental hospitals.
Beers' work stimulated public interest in more responsible care and treatment. However, while Beers initially blamed
psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he
was inuenced by Adolf Meyer and the psychiatric establishment, and toned down his hostility as he needed their support
for reforms. His reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the
organization he helped establish.* [9] In the UK, the National Society for Lunacy Law Reform was established in 1920
by angry ex-patients sick of their experiences and complaints being patronisingly discounted by the authorities who were
using medicalwindow dressingfor essentially custodial and punitive practices.* [12] In 1922, ex-patient Rachel GrantSmith added to calls for reform of the system of neglect and abuse she had suered by publishing The Experiences of
an Asylum Patient.* [13]
We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York (now the
Rockland Psychiatric Center) in the mid to late 1940s, and continued to meet as an ex-patient group. Their goal was
to provide support and advice and help others make the dicult transition from hospital to community. By the early
1950s WANA dissolved after it was taken over by mental health professionals who transformed it into Fountain House, a
psychosocial rehabilitation service for people leaving state mental institutions. The founders of WANA found themselves
pushed aside by professionals with money and inuence, who made them membersof the new organization . During
that period, people who received psychiatric treatment identied themselves as patients, and this term was generally
unchallenged as a self-description until the 1970s. A patronizing attitude by some health care workers led to resentment
among some current and former patients, which eventually found expression in more militant groups beginning in the
early 1970s.* [14]
Originated by crusaders in periods of liberal social change, and appealing not so much to other suerers as to elite
groups with power, when the early reformer's energy or inuence waned, mental patients were again mostly friendless and
forgotten.* [9]
16.1.3
1950s to 1970s
The 1950s saw the reduction in the use of lobotomy and shock therapy. These used to be associated with concerns
and much opposition on grounds of basic morality, harmful eects, or misuse. Towards the 1960s, psychiatric medications came into widespread use and also caused controversy relating to adverse eects and misuse. There were also
associated moves away from large psychiatric institutions to community-based services (later to become a full-scale
deinstitutionalization), which sometimes empowered service users, although community-based services were often decient.
Coming to the fore in the 1960s, an anti-psychiatry movement challenged the fundamental claims and practices of mainstream psychiatry. The ex-patient movement of this time contributed to, and derived much from, antipsychiatry ideology,
but has also been described as having its own agenda, described as humanistic socialism. For a time, the movement shared
aims and practices with radical therapists, who tended to be Marxist. However, the consumer/survivor/ex-patients
gradually felt that the radical therapists did not necessarily share the same goals and were taking over, and they broke
away from them in order to maintain independence.
182
CHAPTER 16. PSYCHIATRIC SURVIVORS MOVEMENT
By the 1970s, the women's movement, gay rights movement, and disability rights movements had emerged. It was in
this context that former mental patients began to organize groups with the common goals of ghting for patients' rights
and against forced treatment, stigma and discrimination, and often to promote peer-run services as an alternative to the
traditional mental health system. Unlike professional mental health services, which were usually based on the medical
model, peer-run services were based on the principle that individuals who have shared similar experiences can help
themselves and each other through self-help and mutual support. Many of the individuals who organized these early
groups identied themselves as psychiatric survivors. Their groups had names such as Insane Liberation Front and the
Network Against Psychiatric Assault.
Dorothy Weiner and about 10 others, including Tom Wittick, established the Insane Liberation Front in the spring of
1970 in Portland, Oregon. Though it only lasted 6 months, it had a notable inuence in the history of North American
ex-patients groups. News that former inmates of mental institutions were organizing was carried to other parts of North
America. Individuals such as Howard Geld, known as Howie the Harp for his harmonica playing, left Portland where he
been involved in ILF to return to his native New York to help found the Mental Patients Liberation Project in 1971. During
the early 1970s, groups spread to California, New York, and Boston, which were primarily antipsychiatry, opposed to
forced treatment including forced drugging, shock treatment and involuntary committal.* [14] In 1972, the rst organized
group in Canada, the Mental Patients Association, started to publish In A Nutshell, while in the US the rst edition of
the rst national publication by ex-mental patients, Madness Network News, was published in Oakland, continuing until
1986.* [14]
Some all-women groups developed around this time such as Women Against Psychiatric Assault, begun in 1975 in San
Francisco.* [15]
In 1978 Judi Chamberlain's book On Our Own: Patient Controlled Alternatives to the Mental Health System was published.
It became the standard text of the psychiatric survivors movement, and in it Chamberlain coined the word "mentalism.
*
[14]* [16] * [17]* [18]
The major spokespeople of the movement have been described in generalities as largely white, middle-class and welleducated. It has been suggested that other activists were often more anarchistic and anti-capitalist, felt more cut o from
society and more like a minority with more in common with the poor, ethnic minorities, feminists, prisoners & gay rights
than with the white middle classes. The leaders were sometimes considered to be merely reformist and, because of their
stratied positionwithin society, to be uncomprehending of the problems of the poor. The radicalssaw no sense
in seeking solutions within a capitalist system that creates mental problems. However, they were united in considering
society and psychiatric domination to be the problem, rather than people designated mentally ill.* [9]
Some activists condemned psychiatry under any conditions, voluntary or involuntary, while others believed in the right of
people to undergo psychiatric treatment on a voluntary basis. Voluntary psychotherapy, at the time mainly psychoanalysis,
did not therefore come under the same severe attack as the somatic therapies. The ex-patients emphasized individual
support from other patients; they espoused assertiveness, liberation, and equality; and they advocated user-controlled
services as part of a totally voluntary continuum. However, although the movement espoused egalitarianism and opposed
the concept of leadership, it is said to have developed a cadre of known, articulate, and literate men and women who did
the writing, talking, organizing, and contacting. Very much the product of the rebellious, populist, anti-elitist mood of the
1960s, they strived above all for self-determination and self-reliance. In generally, the work of some psychiatrists, as well
as the lack of criticism by the psychiatric establishment, was interpreted as an abandonment of a moral commitment to do
no harm. There was anger and resentment toward a profession that had the authority to label them as mentally disabled
and was perceived as infantilizing them and disregarding their wishes.* [9]
16.1.4
1980s and 1990s
By the 1980s, individuals who considered themselves consumersof mental health services rather than passive patientshad begun to organize self-help/advocacy groups and peer-run services. While sharing some of the goals of the
earlier movement, consumer groups did not seek to abolish the traditional mental health system, which they believed was
necessary. Instead, they wanted to reform it and have more choice. Consumer groups encouraged their members to learn
as much as possible about the mental health system so that they could gain access to the best services and treatments
available. In 1985, the National Mental Health Consumers' Association was formed in the United States.* [14]
A 1986 report on developments in the United States noted that there are now three national organizations ... The
16.2. THE MOVEMENT TODAY
183
conservativeshave created the National Mental Health Consumers' Association ... The moderateshave formed the
National Alliance of Mental Patients ... Theradicalgroup is called the Network to Abolish Psychiatry.* [14] Many,
however, felt that they had survived the psychiatric system and itstreatmentsand resented being called consumers. The
National Association of Mental Patients in the United States became the National Association of Psychiatric Survivors.
Phoenix Rising: The Voice of the Psychiatrizedwas published by ex-inmates (of psychiatric hospitals) in Toronto from
1980 to 1990, known across Canada for its antipsychiatry stance.* [14]
In late 1988, leaders from several of the main national and grassroots psychiatric survivor groups decided an independent
coalition was needed, and Support Coalition International (SCI) was formed in 1988, later to become MindFreedom
International. In addition, the World Network of Users and Survivors of Psychiatry (WNUSP), was founded in 1991 as
the World Federation of Psychiatric Users (WFPU), an international organisation of recipients of mental health services.
An emphasis on voluntary involvement in services is said to have presented problems to the movement since, especially
in the wake of deinstitutionalization, community services were fragmented and many individuals in distressed states of
mind were being put in prisons or re-institutionalized in community services, or became homeless, often distrusting and
resisting any help.* [9]
Science journalist Robert Whitaker has concluded that patients rights groups have been speaking out against psychiatric
abuses for decades - the torturous treatments, the loss of freedom and dignity, the misuse of seclusion and restraints,
the neurological damage caused by drugs - but have been condemned and dismissed by the psychiatric establishment and
others. Reading about the experiences they suered through has been described as comparable to reading the stories of
Holocaust survivors.* [19] Recipients of mental health services demanded control over their own treatment and sought to
inuence the mental health system and society's views.
16.2 The movement today

In the United States, the number of mental health mutual support groups (MSG), self-help organizations (SHO) (run
by and for mental health consumers and/or family members) and consumer-operated services (COS) was estimated in
2002 to be 7,467.* [20] In Canada, CSI's (Consumer Survivor Initiatives) are the preferred term. In 1991 Ontario led
the world in its formal recognition of CSI's as part of the core services oered within the mental health sector when it
began to formally fund over CSI's across the province. Consumer Survivor Initiatives in Ontario Building an Equitable
Future' (2009) pg 7. The movement may express a preference for the survivorlabel over the consumerlabel,
with more than 60 percent of ex-patient groups reported to support anti-psychiatry beliefs and considering themselves to
be psychiatric survivors.* [21] There is some variation between the perspective on the consumer/survivor movement
coming from psychiatry, anti-psychiatry or consumers/survivors themselves.* [22]* [23]
The most common terms in Germany are Psychiatrie-Betroene(people aicted by/confronted with psychiatry) and
Psychiatrie-Erfahrene(people who have experienced psychiatry). Sometimes the terms are considered as synonymous
but sometimes the former emphasizes the violence and negative aspects of psychiatry. The German national association
of (ex-)users and survivors of psychiatry is called the Bundesverband Psychiatrie-Erfahrener (BPE).* [24]
There are many grassroots self-help groups of consumers/survivors, local and national, all over the world, which are an
important cornerstone of empowerment. A considerable obstacle to realizing more consumer/survivor alternatives is lack
of funding.* [24] Alternative consumer/survivor groups like the National Empowerment Center in the US which receive
public funds but question orthodox psychiatric treatment, have often come under attack for receiving public funding* [14]
and been subject to funding cuts.
As well as advocacy and reform campaigns, the development of self-help and user/survivor controlled services is a central
issue. The Runaway-House in Berlin, Germany, is an example. Run by the Organisation for the Protection from Psychiatric Violence, it is an antipsychiatric crisis centre for homeless survivors of psychiatry where the residents can live for
a limited amount of time and where half the sta members are survivors of psychiatry themselves.* [24] In Helsingborg,
Sweden, the Hotel Magnus Stenbock is run by a user/survivor organization RSMHthat gives users/survivors a possibility to live in their own apartments. It is nanced by the Swedish government and run entirely by users.* [24] Voice of
Soul is a user/survivor organization in Hungary. Creative Routes is a user/survivor organization in London, England, that
among other support and advocacy activities puts on an annual "Bonkersfest".
WNUSP is a consultant organization for the United Nations. After a long and dicult discussion, ENUSP and
184
WNUSP (European and World Networks of Users and Survivors of Psychiatry) decided to employ the term (ex-)users
and survivors of psychiatry in order to include the identities of the dierent groups and positions represented in these
international NGOs.* [24] WNUSP contributed to the development of the UN's Convention on the Rights of Persons with
Disabilities* [25]* [26] and produced a manual to help people use it entitled Implementation Manual for the United
Nations Convention on the Rights of Persons with Disabilities, edited by Myra Kovary.* [27] ENUSP is consulted by
the European Union and World Health Organization.
In 2007 at a Conference held in Dresden on Coercive Treatment in Psychiatry: A Comprehensive Review, the
president and other leaders of the World Psychiatric Association met, following a formal request from the World Health
Organization, with four representatives from leading consumer/survivor groups.* [28]
The National Coalition for Mental Health Recovery (formerly known as National Coalition for Mental Health Consumer/Survivor Organizations) campaigns in the United States to ensure that consumer/survivors have a major voice in
the development and implementation of health care, mental health, and social policies at the state and national levels,
empowering people to recover and lead a full life in the community.
The United States Massachusetts-based Freedom Center provides and promotes alternative and holistic approaches and
takes a stand for greater choice and options in treatments and care. The center and the New York-based Icarus Project
(which does not self-identify as a consumer/survivor organization but has participants that identify as such) have published
a Harm Reduction Guide To Coming O Psychiatric Drugs and were recently a featured charity in Forbes business
magazine.* [29]
Mad pride events, organized by loosely connected groups in at least seven countries including Australia, South Africa,
the United States, Canada, the United Kingdom and Ghana, draw thousands of participants. For some, the objective is to
continue the destigmatization of mental illness. Another wing rejects the need to treat mental aictions with psychotropic
drugs and seeks alternatives to the careof the medical establishment. Many members of the movement say they are
publicly discussing their own struggles to help those with similar conditions and to inform the general public.* [30]
Survivor David Oaks, Director of MindFreedom, hosts a monthly radio show * [31] and the Freedom Center initiated a
weekly FM radio show now syndicated on the Pacica Network, Madness Radio , hosted by Freedom Center co-founder
Will Hall.* [32]
A new International Coalition of National Consumer/User Organizations was launched in Canada in 2007, called Interrelate.* [33]
16.3 Impact
Research into consumer/survivor initiatives (CSIs) suggests they can help with social support, empowerment, mental
wellbeing, self-management and reduced service use, identity transformation and enhanced quality of life. However,
studies have focused on the support and self-help aspects of CSIs, neglecting that many organizations locate the causes of
membersproblems in political and social institutions and are involved in activities to address issues of social justice.* [34]
A recent series of studies in Canada compared individuals who participated in CSIs with those who did not. The two
groups were comparable at baseline on a wide range of demographic variables, self-reported psychiatric diagnosis, service
use, and outcome measures. After a year and a half, those who had participated in CSIs showed signicant improvement
in social support and quality of life (daily activities), less days of psychiatric hospitalization, and more were likely to have
stayed in employment (paid or volunteer) and/or education. There was no signicant dierence on measures of community
integration and personal empowerment, however. There were some limitations to the ndings; although the active and
nonactive groups did not dier signicantly at baseline on measures of distress or hospitalization, the active group did
have a higher mean score and there may have been a natural pattern of recovery over time for that group (regression to the
mean). The authors noted that the apparent positive impacts of consumer-run organizations were achieved at a fraction
of the cost of professional community programs.* [35]
Further qualitative studies indicated that CSIs can provide safe environments that are a positive, welcoming place to go;
social arenas that provide opportunities to meet and talk with peers; an alternative worldview that provides opportunities
for members to participate and contribute; and eective facilitators of community integration that provide opportunities
to connect members to the community at large.* [36] System-level activism was perceived to result in changes in per-
16.4. SEE ALSO
185
ceptions by the public and mental health professionals (about mental health or mental illness, the lived experience of
consumer/survivors, the legitimacy of their opinions, and the perceived value of CSIs) and in concrete changes in service
delivery practice, service planning, public policy, or funding allocations. The authors noted that the evidence indicated
that the work benets other consumers/survivors (present and future), other service providers, the general public, and
communities. They also noted that there were various barriers to this, most notably lack of funding, and also that the
range of views represented by the CSIs appeared less narrow and more nuanced and complex than previously, and that
perhaps the consumer/survivor social movement is at a dierent place than it was 25 years ago.* [37]
A signicant theme that has emerged from consumer/survivor work, as well as from some psychiatrists and other mental
health professionals, has been a recovery model which seeks to overturn therapeutic pessimism and to support suerers
to forge their own personal journal towards the life they want to live; some argue however that it has been used as a cover
to blame people for not recovering or to cut public services.
There has also been criticism of the movement. Organized psychiatry often views radical consumerist groups as extremist, as having little scientic foundation and no dened leadership, as continually trying to restrict the work of
psychiatrists and care for the seriously mentally ill, and as promoting disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults. However, opponents consistently argue that psychiatry is territorial and prot-driven and stigmatizes and undermines the selfdetermination of patients and ex-patients* [22] The movement has also argued against social stigma or mentalism/saneism
by wider society.
Well-positioned forces in the USA, led by gures such as psychiatrists E. Fuller Torrey and Sally Satel, and some leaders
of the National Alliance for the Mentally Ill, have lobbied against the funding of consumer/survivor groups that promote
antipsychiatry views or promote social and experiential recovery rather than a biomedical model, or who protest against
outpatient commitment.* [38]* [39] Torrey has said the termpsychiatric survivorused by ex-patients to describe themselves is just political correctness and has blamed them, along with civil rights lawyers, for the deaths of half a million
people due to suicides and deaths on the street.* [40] His accusations have been described as inammatory and completely
unsubstantiated, however, and issues of self-determination and self-identity said to be more complex than that.* [14]
16.4 See also

Anti-psychiatry
Outline of the psychiatric survivors movement
Disability rights movement
Neuroplasticity the brain changes in the course of a lifetime.
16.5 References
[1] Talking Back to Psychiatry: The Psychiatric Consumer/Survivor/Ex-Patient Movement (2005)
[2] Corrigan, Patrick W.; David Roe; Hector W. H. Tsang (2011-05-23). Challenging the Stigma of Mental Illness: Lessons for
Therapists and Advocates. John Wiley and Sons. ISBN 978-1-119-99612-5.
[3] Oaks, David (2006-08-01).The evolution of the consumer movement
. Psychiatric Services 57 (8): 1212. doi:10.1176/appi.ps.57.8.1212.
PMID 16870979. Retrieved 2011-08-05.
[4] Chamberlin, Judi (1978). On Our Own: Patient-Controlled Alternatives to the Mental Health System. New York: Hawthorne.
[5] Rissmiller, David J.; Joshua H. Rissmiller (2006-06-01). Evolution of the antipsychiatry movement into mental health consumerism. Psychiatric Services 57 (6): 8636. doi:10.1176/appi.ps.57.6.863. PMID 16754765. Retrieved 2011-08-05.
186
[6] Ludwig, Gregory (2006-08-01). Letter. Psychiatric Services 57 (8): 1213. doi:10.1176/appi.ps.57.8.1213. Retrieved
2011-08-05.
[7] About Us MFI Portal
[8]Talking Back to Psychiatry: Resistant Identities in the Psychiatric Consumer/Survivor/Ex-patient Movement - D-Scholarship@Pitt
. Etd.library.pitt.edu. Retrieved 2013-09-21.
[9] Dain, N. (1989)Critics and dissenters: Reections on anti-psychiatry in the United States Journal of the History of the Behavioral
Sciences Volume 25 Issue 1, Pages 3 - 25
[10] Crossley, N. (2006) Contesting Psychiatry: Social Movements in Mental Health Chapter: contextualizing contention. Routledge
ISBN 0-415-35417-X
[11] Cliord Beers, A Mind That Found Itself, Pittsburgh and London: University of Pittsburgh Press, 1981 ISBN 0-8229-5324-2
[12] Phil Fennell (1996) Treatment Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845
Routledge, 1996 ISBN 0-415-07787-7 pg108
[13] Rachel Grant-Smith (1922) The Experiences of an Asylum Patient John P. McGovern Historical Collections and Research
Center
[14] Reaume G. (2002) Lunatic to patient to person: nomenclature in psychiatric history and the inuence of patients' activism in
North America. Int J Law Psychiatry. Jul-Aug;25(4):405-26. PMID 12613052 doi:10.1016/S0160-2527(02)00130-9
[15] Wendy Chan, Dorothy E. Chunn, Robert J. Menzies (2005) Women, Madness and the Law: A Feminist Reader Routledge
Cavendish, ISBN 1-904385-09-5
[16] Disability History Timeline. Rehabilitation Research & Training Center on Independent Living Management. Temple
University. 2002.
[17] Identifying and Overcoming Mentalism (PDF). Counterpsych.talkspot.com. Retrieved 2013-09-21.
[18] New Law and Ethics in Mental Health Advance Directives: The Convention on ... - Penelope Weller - Google Books. Books.google.com.
[19] Terry Messman Mad In America: An Indictment of Psychiatric Abuse and Brain Damage August 2005 Edition of Street Spirit,
A publication of the American Friends Service Committee
[20] Goldstrom ID, Campbell J, Rogers JA, et al. (2006)
[21] Everett B (1994) Something is happening: the contemporary consumer and psychiatric survivor movement in historical context.
Journal of Mind and Behavior, 15:557
[22] Rissmiller DJ & Rissmiller JH (2006) Evolution of the antipsychiatry movement into mental health consumerism. Psychiatric
Services, Jun;57(6):863-6.
[23] Oaks, D. (2006) The Evolution of the Consumer Movement, Psychiatric Services 57:1212
[24] Hollis, I. (2002) About the impossibility of a single (ex-)user and survivor of psychiatry position Acta Psychiatrica Scandinavica
Volume 104 Issue s410, Pages 102 - 106
[25] UN Enable - Working Group - Contribution by World Network of Users and Survivors of Psychiatry (WNUSP) 30 December
2003. Un.org. Retrieved 2013-09-21.
[26] UN Enable - Promoting the rights of Persons with Disabilities - Contribution by WNUSP. Un.org. Retrieved 2013-09-21.
[27]RESOURCE: Implementing the Disability Rights Treaty, for Users, Survivors of Psychiatry | We Can Do
. Wecando.wordpress.com.
[28] Mezzichi, J.E. (2007) The dialogal basis of our profession: Psychiatry with the Person World Psychiatry. 2007 October; 6(3):
129130.
[29] Will Hall, edited by Richard C Morais (2008) Healing Voices Forbes business magazine:Philanthropic Pitch August 29th
[30] Gabrielle Glaser (2008) Mad PrideFights a Stigma. The New York Times.May 11
16.6. EXTERNAL LINKS
187
[31] MindFreedom The Story of MindFreedom Free Live Internet Radio

[32] Madness Radio Madness Radio
[33] Anne Beales, Susie Crooks, Dan Fisher, Noreen Fitzgerald, Connie McKnight, Shaun MacNeil, and Jenny Speed (2008)
Interrelate: A New International Mental Health Consumer/Survivor Coalition
[34] Georey Nelson, Joanna Ochocka, Rich Janzen, John Trainor (2006) A longitudinal study of mental health consumer/survivor
initiatives: Part 1 - Literature review and overview of the study Journal of Community Psychology, Volume 34 Issue 3, Pages
247 - 260
[35] Georey Nelson, Joanna Ochocka, Rich Janzen, John Trainor (2006) A longitudinal study of mental health consumer/survivor
initiatives: Part 2 - A quantitative study of impacts of participation on new members Journal of Community Psychology, Volume
34 Issue 3, Pages 247 - 260
[36] Georey Nelson, Joanna Ochocka, Rich Janzen, John Trainor (2006) Part 3 - A qualitative study of impacts of participation on
new members Journal of Community Psychology, Volume 34 Issue 3, Pages 247 - 260
[37] Georey Nelson, Joanna Ochocka, Rich Janzen, John Trainor (2006) Part 4 - Benets beyond the self? A quantitative and
qualitative study of system-level activities and impacts Journal of Community Psychology, Volume 34 Issue 3, Pages 247 - 260
[38] Torrey, 2002 Hippie healthcare policy: while one government agency searches for the cure to mental diseases, another clings to
the '60s notion that they don't exist.
[39] McLean, A. (2003) Recovering Consumers and a Broken Mental Health System in the United States: Ongoing Challenges for
Consumers/ Survivors and the New Freedom Commission on Mental Health. Part II: Impact of Managed Care and Continuing
Challenges International Journal of Psychosocial Rehabilitation. 8, 58-70.
[40] E. Fuller Torrey (1997) Taking Issue: Psychiatric Survivorsand Non-Survivors, 48:2 Psychiatric Services 143
16.6 External links

The Antipsychiatry Coalition Coalition of people who have been harmed by psychiatry and their supporters
MindFreedom International Coalition of psychiatric consumers, survivors, and ex-patients ghting for human
rights in mental health
Guide on the History of the Consumer Movement from the National Mental Health Consumers' Self-Help Clearinghouse
Cohen, Oryx (2001) Psychiatric Survivor Oral Histories: Implications for Contemporary Mental Health Policy.
Center for Public Policy and Administration, University of Massachusetts, Amherst
Linda J Morrison. (2006) A Matter of Denition: Acknowledging Consumer/Survivor Experiences through Narrative Radical Psychology Volume Five
Shock Treatment - The Killing of Susan Kelly A poem by insulin/electro shock survivor Dorothy Dundas
McLean, A. (2003). Recovering Consumers and a Broken Mental Health System in the United States: Ongoing
Challenges for Consumers/ Survivors and the New Freedom Commission on Mental Health. Part I: Legitimization
of the Consumer Movement and Obstacles to It. International Journal of Psychosocial Rehabilitation. 8, 47-57
McLean, A. (2003) Recovering Consumers and a Broken Mental Health System in the United States: Ongoing
Challenges for Consumers/ Survivors and the New Freedom Commission on Mental Health. Part II: Impact of
Managed Care and Continuing Challenges International Journal of Psychosocial Rehabilitation. 8, 58-70.
American Iatrogenic Association Promoting accountability for medical professiunals and institutions
Transcript of interview with Peter Breggin, M.D., author of Toxic Psychiatry,Talking Back To Prozacand
Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex.
Psychiatry chapter from Heart Failure - Diary of a Third Year Medical Student by Michael Greger, M.D.
Chapter 17
Liberation by Oppression
Liberation by Oppression: A Comparative Study of Slavery and Psychiatry is a 2002 work on, and a critique of, psychiatry
by Thomas Szasz.
17.1 Outline
Szasz compares the justication of psychiatry with the justication of slavery in the United States, stating that both
necessarily denying the subject's right to personhood.
17.2 Reception
Reviews on this book were published by Psychiatric Services,* [1] The British Journal of Psychiatry,* [2]* [3] The Freeman:
Ideas on Liberty,* [4] Ethical Human Sciences and Services,* [5] and The Independent Review.* [6]
17.3 References
[1] Padykula, Nora LaFond (April 2004).Liberation by Oppression(PDF). Psychiatric Services 55 (4): 461. doi:10.1176/appi.ps.55.4.461.
[2] Persaud, Raj (2003).Liberation by Oppression. The British Journal of Psychiatry 182 (3): 273. doi:10.1192/bjp.182.3.273.
Retrieved 17 February 2012.
[3] Schaler, J. A. (2003).Slavery and psychiatry. The British Journal of Psychiatry 183 (1): 7778. doi:10.1192/bjp.183.1.77-a.
Retrieved 17 February 2012.
[4] Doherty, Brian (April 2004). Liberation by Oppression (PDF). The Freeman: Ideas on Liberty 54 (3): 4446. ISSN
1559-1638.
[5] Cohen, David (2003). Liberation by Oppression: A Comparative Study of Slavery and Psychiatry. Ethical Human Sciences
and Services 5 (1): 7578. ISSN 1523-150X.
[6] Baker, Robert (Winter 2003). Psychiatrys Gentleman Abolitionist (PDF). The Independent Review VII (3): 455460.
188
Chapter 18
Double bind
Not to be confused with double-blind.
A double bind is an emotionally distressing dilemma in communication in which an individual (or group) receives two
or more conicting messages, and one message negates the other. This creates a situation in which a successful response
to one message results in a failed response to the other (and vice versa), so that the person will automatically be wrong
regardless of response. The double bind occurs when the person cannot confront the inherent dilemma, and therefore can
neither resolve it nor opt out of the situation.
Double bind theory was rst described by Gregory Bateson and his colleagues in the 1950s.* [1]
Double binds are often utilized as a form of control without open coercionthe use of confusion makes them both dicult
to respond to as well as to resist.* [2]
A double bind generally includes dierent levels of abstraction in the order of messages and these messages can either
be stated explicitly or implicitly within the context of the situation, or they can be conveyed by tone of voice or body
language. Further complications arise when frequent double binds are part of an ongoing relationship to which the person
or group is committed.* [3]* [4]
Double bind theory is more clearly understood in the context of complex systems and cybernetics because human communication and the mind itself function in an interactive manner similar to ecosystems. Complex systems theory helps us
to understand the interdependence of the dierent parts of a message and provides an ordering in what looks like chaos.
18.1 Explanation
The double bind is often misunderstood to be a simple contradictory situation, where the subject is trapped by two conicting demands. While it's true that the core of the double bind is two conicting demands, the dierence lies in how
they are imposed upon the subject, what the subject's understanding of the situation is, and who (or what) imposes these
demands upon the subject. Unlike the usual no-win situation, the subject has diculty in dening the exact nature of the
paradoxical situation in which he or she is caught. The contradiction may be unexpressed in its immediate context and
therefore invisible to external observers, only becoming evident when a prior communication is considered. Typically, a
demand is imposed upon the subject by someone who they respect (such as a parent, teacher or doctor) but the demand
itself is inherently impossible to fulll because some broader context forbids it. For example, this situation arises when
a person in a position of authority imposes two contradictory conditions but there exists an unspoken rule that one must
never question authority.
Gregory Bateson and his colleagues dened the double bind as follows* [3] (paraphrased):
1. The situation involves two or more people, one of whom (for the purpose of the denition), is designated as the
subject. The others are people who are considered the subject's superiors: gures of authority (such as parents),
189
190
CHAPTER 18. DOUBLE BIND

whom the subject respects.
2. Repeated experience: the double bind is a recurrent theme in the experience of the subject, and as such, cannot be
resolved as a single traumatic experience.
3. A primary injunction" is imposed on the subject by the others in one of two forms:
(a) Do X, or I will punish you";
(b) Do not do X, or I will punish you.
(or both a and b)
The punishment may include the withdrawing of love, the expression of hate and anger, or abandonment resulting
from the authority gure's expression of helplessness.
4. A secondary injunctionis imposed on the subject, conicting with the rst at a higher and more abstract level.
For example: You must do X, but only do it because you want to. It is unnecessary for this injunction to be
expressed verbally.
5. If necessary, a tertiary injunctionis imposed on the subject to prevent them from escaping the dilemma. See
phrase examples below for clarication.
6. Finally, Bateson states that the complete list of the previous requirements may be unnecessary, in the event that the
subject is already viewing their world in double bind patterns. Bateson goes on to give the general characteristics
of such a relationship:
(a) When the subject is involved in an intense relationship; that is, a relationship in which he feels it is vitally
important that he discriminate accurately what sort of message is being communicated so that he may respond
appropriately;
(b) And, the subject is caught in a situation in which the other person in the relationship is expressing two orders of
message and one of these denies the other;
(c) And, the subject is unable to comment on the messages being expressed to correct his discrimination of what
order of message to respond to: i.e., he cannot make a metacommunicative statement.
Thus, the essence of a double bind is two conicting demands, each on a dierent logical level, neither of which can be
ignored or escaped. This leaves the subject torn both ways, so that whichever demand they try to meet, the other demand
cannot be met. I must do it, but I can't do itis a typical description of the double-bind experience.
For a double bind to be eective, the subject must be unable to confront or resolve the conict between the demand placed
by the primary injunction and that of the secondary injunction. In this sense, the double bind dierentiates itself from a
simple contradiction to a more inexpressible internal conict, where the subject really wants to meet the demands of the
primary injunction, but fails each time through an inability to address the situation's incompatibility with the demands of
the secondary injunction. Thus, subjects may express feelings of extreme anxiety in such a situation, as they attempt to
full the demands of the primary injunction albeit with obvious contradictions in their actions.
18.2 History
The term double bind was rst used by the anthropologist Gregory Bateson and his colleagues (including Don D. Jackson,
Jay Haley and John H. Weakland) in the mid-1950s in their discussions on complexity of communication in relation to
schizophrenia. Bateson made clear that such complexities are common in normal circumstances, especially in play,
humor, poetry, ritual and ction(see Logical Types below). Their ndings indicated that the tangles in communication
often diagnosed as schizophrenia are not necessarily the result of an organic brain dysfunction. Instead, they found that
destructive double binds were a frequent pattern of communication among families of patients, and they proposed that
growing up amidst perpetual double binds could lead to learned patterns of confusion in thinking and communication.
18.3. COMPLEXITY IN COMMUNICATION
191
18.3 Complexity in communication

Human communication is complex (see Albert Mehrabian) and context is an essential part of it. Communication consists
of the words said, tone of voice, and body language. It also includes how these relate to what has been said in the past;
what is not said, but is implied; how these are modied by other nonverbal cues, such as the environment in which it is said,
and so forth. For example, if someone saysI love you, one takes into account who is saying it, their tone of voice and
body language, and the context in which it is said. It may be a declaration of passion or a serene rearmation, insincere
and/or manipulative, an implied demand for a response, a joke, its public or private context may aect its meaning, and
so forth.
Conicts in communication are common and often we ask What do you mean?" or seek clarication in other ways.
This is called meta-communication: communication about the communication. Sometimes, asking for clarication is
impossible. Communication diculties in ordinary life often occur when meta-communication and feedback systems are
lacking or inadequate or there isn't enough time for clarication.
Double binds can be extremely stressful and become destructive when one is trapped in a dilemma and punished for
nding a way out. But making the eort to nd the way out of the trap can lead to emotional growth.[body language and
double-bind see (* [5])]
18.4 Examples
The classic example given of a negative double bind is of a mother telling her child that she loves him or her, while
at the same time turning away in disgust.* [6] (The words are socially acceptable; the body language is in conict with
it). The child doesn't know how to respond to the conict between the words and the body language and, because the
child is dependent on the mother for basic needs, he or she is in a quandary. Small children have diculty articulating
contradictions verbally and can neither ignore them nor leave the relationship.
Another example is when one is commanded to be spontaneous. The very command contradicts spontaneity, but it
only becomes a double bind when one can neither ignore the command nor comment on the contradiction. Often, the
contradiction in communication isn't apparent to bystanders unfamiliar with previous communications.
18.5 Phrase examples

Mother telling her child: You must love me.
The primary injunction here is the command itself: you must"; the secondary injunction is the unspoken
reality that love is spontaneous, that for the child to love the mother genuinely, it can only be of his or her
own accord.
Grown-up-in-authority to child: Speak when you're spoken toand Don't talk back!"
These phrases have such time-honoured status that the contradiction between them is rarely perceived: If the
child speaks when spoken to then he cannot avoid answering back. If he does not answer back then he fails
to speak when spoken to. Whatever the child does he is always in the wrong.
Child-abuser to child: You should have escaped from me earlier, now it's too latebecause now, nobody will
believe that you didn't want what I have done, while at the same time blocking all of the child's attempts to escape.
Child-abusers often start the double-bind relationship by "grooming" the child, giving little concessions, or
gifts or privileges to them, thus the primary injunction is: You should like what you are getting from me!"
192

When the child begins to go along (i.e. begins to like what she or he is receiving from the person), then
the interaction goes to the next level and small victimization occurs, with the secondary injunction being:
I am punishing you! (for whatever reason the child-abuser is coming up with (e.g. because you were
bad/naughty/messy, or because you deserve it, or because you made me do it, etc )).
If child shows any resistance (or tries to escape) from the abuser, then the words: You should have escaped
from me earlier (...)" serve as the third level or tertiary injunction.
Then the loop starts to feed on itself, allowing for ever worse victimization to occur.
Mother to son: Leave your sister alone!", while the son knows his sister will approach and antagonize him to get
him into trouble.
The primary injunction is the command, which he will be punished for breaking. The secondary injunction
is the knowledge that his sister will get into conict with him, but his mother will not know the dierence and
will default to punishing him. He may be under the impression that if he argues with his mother, he may be
punished. One possibility for the son to escape this double bind is to realize that his sister only antagonizes
him to make him feel anxious (if indeed it is the reason behind his sister's behavior).
If he were not bothered about punishment, his sister might not bother him. He could also leave the situation
entirely, avoiding both the mother and the sister. The sister can't claim to be bothered by a non-present
brother, and the mother can't punish (nor scapegoat) a non-present son. There are other solutions that are
realised through creative application of logic and reasoning.
18.6 Positive double binds

Bateson also described positive double binds, both in relation to Zen Buddhism with its path of spiritual growth, and the
use of therapeutic double binds by psychiatrists to confront their patients with the contradictions in their life in such a
way that would help them heal. One of Bateson's consultants, Milton H. Erickson (5 volumes, edited by Rossi) eloquently
demonstrated the productive possibilities of double binds through his own life, showing the technique in a brighter light.
18.7 Theory of logical types

Cybernetics contains Russell and Whitehead's Theory of Logical Types: there is a logical discontinuity between set and
element, and in some cases the set cannot be an element of itself. These types must not be muddled and must be kept
separate. For example the name of a class cannot also be a member of the class. A message is made up of words
and the context that modies it. The context is of a higher logical type than the words. For example, the word cat
cannot scratch you. The real animal and the word cat are of two dierent logical types.* [7] Another examplethis one
of purely nonverbal communication among animals is: two puppies are playing and they growl at each other and nip each
other gently. The rst level of the message could be described as, I am threatening you; I will bite youA higher level
of the message is, this is play ghting; I won't hurt you.(See chapters: A Theory of Play and Fantasy and Towards
a Theory of Schizophrenia--subsection The Base in Communications Theory, both in Steps to an Ecology of Mind).
18.8 Science
One of the causes of double binds is the loss of feedback systems. Gregory Bateson and Lawrence S. Bale describe double
binds that have arisen in science that have caused decades-long delays of progress in science because science (who is this
'science' fellow?) had dened something as outside of its scope (or not science)--see Bateson in his Introduction to
Steps to an Ecology of Mind (1972, 2000), pp. xv-xxvi; and Bale in his article, Gregory Bateson, Cybernetics and the
18.9. SCHIZOPHRENIA
193
Social/Behavioral Sciences (esp. pp. 18) on the paradigm of classical science vs. that of systems theory/cybernetics.
(See also Bateson's description in his Forward of how the double bind hypothesis fell into place).
18.9 Schizophrenia
The Double Bind Theory was rst articulated in relationship to schizophrenia, but Bateson and his colleagues hypothesized
that schizophrenic thinking was not necessarily an inborn mental disorder but a learned confusion in thinking. It is helpful
to remember the context in which these ideas were developed. Bateson and his colleagues were working in the Veteran's
Administration Hospital (19491962) with World War II veterans. As soldiers they'd been able to function well in combat,
but the eects of life-threatening stress had aected them. At that time, 18 years before Post-Traumatic Stress Disorder
was ocially recognized, the veterans had been saddled with the catch-all diagnosis of schizophrenia. Bateson didn't
challenge the diagnosis but he did maintain that the seeming nonsense the patients said at times did make sense within
context, and he gives numerous examples in section III of Steps to an Ecology of Mind, Pathology in Relationship.
For example, a patient misses an appointment, and when Bateson nds him later the patient says 'the judge disapproves';
Bateson responds, You need a defense lawyersee following (pp. 1956) Bateson also surmised that people habitually
caught in double binds in childhood would have greater problemsthat in the case of the schizophrenic, the double bind
is presented continually and habitually within the family context from infancy on. By the time the child is old enough
to have identied the double bind situation, it has already been internalized, and the child is unable to confront it. The
solution then is to create an escape from the conicting logical demands of the double bind, in the world of the delusional
system (see in Towards a Theory of Schizophrenia Illustrations from Clinical Data).
One solution to a double bind is to place the problem in a larger context, a state Bateson identied as Learning III, a step
up from Learning II (which requires only learned responses to reward/consequence situations). In Learning III, the double
bind is contextualized and understood as an impossible no-win scenario so that ways around it can be found.
Bateson's double bind theory was never followed up by research into whether family systems imposing systematic double
binds might be a cause of schizophrenia. This complex theory has been only partly tested, and there are gaps in the current
psychological and experimental evidence required to establish causation. The current understanding of schizophrenia takes
into account a complex interaction of genetic, neurological as well as emotional stressors, including family interaction and
it has been argued that if the double bind theory overturns ndings suggesting a genetic basis for schizophrenia then more
comprehensive psychological and experimental studies are needed, with dierent family types and across various family
contexts.* [8]
18.10 In evolution
After many years of research into schizophrenia, Bateson continued to explore problems of communication and learning,
rst with dolphins, and then with the more abstract processes of evolution. Bateson emphasised that any communicative system characterized by dierent logical levels might be subject to double bind problems. Especially including the
communication of characteristics from one generation to another (genetics and evolution).
"...evolution always followed the pathways of viability. As Lewis Carroll has pointed out, the theory [of natural selection]
explains quite satisfactorily why there are no bread-and-butter-ies today.* [9]
Bateson used the ctional Bread and Butter Fly (from Through the Looking Glass, and What Alice Found There) to illustrate
the double bind in terms of natural selection. The gnat points out that the insect would be doomed if he found his food
(which would dissolve his own head), and starve if he did not. Alice suggests that this must happen quite often, to which
the gnat replies it always happens.
The pressures that drive evolution therefore represent a genuine double bind. And there is truly no escape: It always
happens.No species can escape natural selection, including our own.
Bateson suggested that all evolution is driven by the double bind, whenever circumstances change: If any environment
becomes toxic to any species, that species will die out unless it transforms into another species, in which case, the species
becomes extinct anyway.
194
Most signicant here is Bateson's exploration of what he later came to call 'the pattern that connects'* [10]that problems
of communication which span more than one level (e.g., the relationship between the individual and the family) should
also be expected to be found spanning other pairs of levels in the hierarchy (e.g. the relationship between the genotype
and the phenotype):
We are very far, then, from being able to pose specic questions for the geneticist; but I believe that the wider implications
of what I have been saying modify somewhat the philosophy of genetics. Our approach to the problems of schizophrenia
by way of a theory of levels or logical types has disclosed rst that the problems of adaptation and learning and their
pathologies must be considered in terms of a hierarchic system in which stochastic change occurs at the boundary points
between the segments of the hierarchy. We have considered three such regions of stochastic changethe level of genetic
mutation, the level of learning, and the level of change in family organization. We have disclosed the possibility of a
relationship of these levels which orthodox genetics would deny, and we have disclosed that at least in human societies
the evolutionary system consists not merely in the selective survival of those persons who happen to select appropriate
environments but also in the modication of family environment in a direction which might enhance the phenotypic and
genotypic characteristics of the individual members.* [11]
18.11 Usage in Zen Buddhism

According to philosopher and theologian Alan Watts, the double bind has long been used in Zen Buddhism as a therapeutic
tool. The Zen Master purposefully imposes the double bind upon his students (through various skilful means, called
upaya), hoping that they achieve enlightenment (satori). One of the most prominent techniques used by Zen Masters
(especially those of the Rinzai school) is called the koan, in which the master gives his or her students a question, and
instructs them to pour all their mental energies into nding the answer to it. As an example of a koan, a student can be
asked to present to the master their genuine self, Show me who you really are. According to Watts, the student will
eventually realize there is nothing they can do, yet also nothing they cannot do, to present their actual self; thus, they truly
learn the Buddhist concept of anatman (non-self) via reductio ad absurdum.
Zen koan: Be genuineor Who are you?"
Argued by Watts to be the underlying theme of all Zen koans, the idea here is to present your true self to
the roshi (master). The more the students try, the phonier they are, and even the actof not trying is just
another version of trying.
18.12 Girard's mimetic double bind

Ren Girard, in his literary theory of mimetic desire,* [12] proposes what he calls a model-obstacle, a role model
who demonstrates an object of desire and yet, in possessing that object, becomes a rival who obstructs fulllment of the
desire.* [13] According to Girard, the internal mediationof this mimetic dynamic operates along the same lines
as what Gregory Bateson called the double bind.* [14] Girard found in Sigmund Freud's psychoanalytic theory, a
precursor to mimetic desire.* [15]The individual who 'adjusts' has managed to relegate the two contradictory injunctions
of the double bindto imitate and not to imitateto two dierent domains of application. This is, he divides reality in
such a way as to neutralize the double bind.* [16] While critical of Freud's doctrine of the unconscious mind, Girard
sees the ancient Greek tragedy, Oedipus the King, and key elements of Freud's Oedipus complex, patricidal and incestuous
desire, to serve as prototypes for his own analysis of the mimetic double bind.* [16]
Far from being restricted to a limited number of pathological cases, as American theoreticians suggest,
the double binda contradictory double imperative, or rather a whole network of contradictory imperatives
is an extremely common phenomenon. In fact, it is so common that it might be said to form the basis of
all human relationships.
Bateson is undoubtedly correct in believing that the eects of the double bind on the child are particularly
devastating. All the grown-up voices around him, beginning with those of the father and mother (voices
18.13. NEURO-LINGUISTIC PROGRAMMING
195
which, in our society at least, speak for the culture with the force of established authority) exclaim in a variety
of accents, Imitate us!Imitate me!I bear the secret of life, of true being!The more attentive
the child is to these seductive words, and the more earnestly he responds to the suggestions emanating from
all sides, the more devastating will be the eventual conicts. The child possesses no perspective that will
allow him to see things as they are. He has no basis for reasoned judgements, no means of foreseeing the
metamorphosis of his model into a rival. This model's opposition reverberates in his mind like a terrible
condemnation; he can only regard it as an act of excommunication. The future orientation of his desires
that is, the choice of his future modelswill be signicantly aected by the dichotomies of his childhood.
In fact, these models will determine the shape of his personality.
If desire is allowed its own bent, its mimetic nature will almost always lead it into a double bind. The
unchanneled mimetic impulse hurls itself blindly against the obstacle of a conicting desire. It invites its own
rebus and these rebus will in turn strengthen the mimetic inclination. We have, then, a self-perpetuating
process, constantly increasing in simplicity and fervor. Whenever the disciple borrows from his model what
he believes to be thetrueobject, he tries to possess that truth by desiring precisely what this model desires.
Whenever he sees himself closest to the supreme goal, he comes into violent conict with a rival. By a mental
shortcut that is both eminently logical and self-defeating, he convinces himself that the violence itself is the
most distinctive attribute of this supreme goal! Ever afterward, violence will invariably awaken desire...
Ren Girard, Violence and the SacredFrom Mimetic Desire to the Monstrous Double, pp.156157
18.13 Neuro-linguistic programming

The eld of neuro-linguistic programming also makes use of the expressiondouble bind. Grinder and Bandler (both of
whom had personal contact with Bateson) asserted that a message could be constructed with multiple messages, whereby
the recipient of the message is given the impression of choicealthough both options have the same outcome at a higher
level of intention. This is called adouble bindin NLP terminology,* [17] and has applications in both sales and therapy.
In therapy, the practitioner may seek to challenge destructive double binds that limit the client in some way and may also
construct double binds in which both options have therapeutic consequences. In a sales context, the speaker may give the
respondent the illusion of choice between two possibilities. For example, a salesperson might ask: Would you like to
pay cash or by credit card?", with both outcomes presupposing that the person will make the purchase; whereas the third
option (that of not buying) is intentionally excluded from the spoken choices.
Note that in the NLP context, the use of the phrasedouble binddoes not carry the primary denition of two conicting
messages; it is about creating a false sense of choice which ultimately binds to the intended outcome. In the cash or
credit card?" example, this is not a Bateson double bindsince there is no contradiction, although it still is an NLP
double bind. Similarly if a salesman were selling a book about the evils of commerce, it could perhaps be a Bateson
double bindif the buyer happened to believe that commerce was evil, yet felt compelled or obliged to buy the book.
18.14 See also

Ambiguity
Buridan's bridge
Catch-22 (logic)
Cognitive dissonance
Dialectic
Doublethink
Evaporating Cloud
196
Expressed emotion
False dilemma
Four sides model
Loaded question
Master suppression techniques
Mutually exclusive events
No-win situation
Procrastination
Psychological manipulation
Ronald David Laing
Self and Others
Self-reference
Zeno's Paradoxes
Zugzwang
18.15 Notes
[1] Bateson, G., Jackson, D. D., Haley, J. & Weakland, J. (1956), Towards a Theory of Schizophrenia. in Behavioral Science, Vol
1, 251264
[2] Bateson, G. (1972). Double bind, 1969. Steps to an ecology of the mind: A revolutionary approach to man's understanding of
himself, 271-278. Chicago: University of Chicago Press
[3] Bateson, G., Jackson, D. D., Haley, J. & Weakland, J., 1956, Toward a theory of schizophrenia. (in: 'Behavioral Science', vol.1,
251264)
[4] Bateson, Gregory (1972). Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. University Of Chicago Press.
[5] Zysk, Wolfgang (2004), Krpersprache Eine neue Sicht, Doctoral Dissertation 2004, University Duisburg-Essen (Germany).
[6] Koopmans, Mathijs. Schizophrenia and the Family: Double Bind Theory Revisited 1997.
[7] Bateson (1972) Steps to an Ecology of Mind.
[8] Koopmans, Mathijs (1997). Schizophrenia and the Family: Double Bind Theory Revisited.
[9] Bateson, Gregory (April 1967). Cybernetic Explanation. American Behavioral Scientist 10 (8): 2932.
[10] Bateson, Gregory (1979). Mind and Nature. ISBN 1-57273-434-5.
[11] Bateson, Gregory (1960). A.M.A. Archives of General Psychiatry 2: 477491. Missing or empty |title= (help)
[12] IntroductionRen Girard. 5 November 2010. The hypothesis. Version franaise L'hypothse.
[13] Girard, Ren (1965). Deceit, Desire, and the Novel: Self and Other in Literary Structure. Deceit, Desire, and the Novel. p. 101.
LCCN 65028582.
[14] Fleming, C. (2004). Ren Girard: Violence and Mimesis. Key Contemporary Thinkers. p. 20. ISBN 978-0-7456-2947-6.
LCCN ocm56438393.
18.16. REFERENCES
197
[15] Meloni, Maurizio (2002). A Triangle of Thoughts: Girard, Freud, Lacan. Journal Of European Psychoanalysis. WinterSpring (14).
[16] Girard, Ren; Gregory, Patrick (2005). Violence and the Sacred. Continuum Impacts. pp. 187188, 156157. ISBN 978-08264-7718-7. LCCN 77004539.
[17] Bandler, R., Grinder, J. (1981) Reframing: Neuro-Linguistic Programming and the Transformation of Meaning Real People
Press. ISBN 0-911226-25-7
18.16 References
Watts, Alan (1999). The Way of Zen. Vintage. ISBN 0-375-70510-4.
Bateson, Gregory. (1972, 1999) Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology.Part III: Form and Pathology in Relationship. University of Chicago Press, 1999, originally
published, San Francisco: Chandler Pub. Co., 1972.
Gibney, Paul (May 2006) The Double Bind Theory: Still Crazy-Making After All These Years. in Psychotherapy
in Australia. Vol. 12. No. 3. http://www.psychotherapy.com.au/TheDoubleBindTheory.pdf
Koopmans, Matthijs (1998) Schizophrenia and the Family II: Paradox and Absurdity in Human Communication
Reconsidered. http://www.goertzel.org/dynapsyc/1998/KoopmansPaper.htm
Zysk, Wolfgang (2004), Krpersprache Eine neue Sicht, Doctoral Dissertation 2004, University DuisburgEssen (Germany).
18.17 External links

http://www.mri.org/dondjackson/brp.htm
http://www.behavenet.com/capsules/treatments/famsys/dblebnd.htm
http://www.laingsociety.org/cetera/pguillaume.htm
Reference in Encyclopedia of NLP
Double-bind loop feeding on itself, an illustration by chart (and a poem)
198
18.18 Text and image sources, contributors, and licenses

18.18.1
Text
Political abuse of psychiatry Source: https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry?oldid=673754572 Contributors: WhisperToMe, Phil Boswell, Richard Arthur Norton (1958- ), GregorB, Sj, Rjwilmsi, Vegaswikian, SmackBot, Kjetil1001, Penbat, Cydebot, Albany
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Thierry Caro, Bluebot, Tommyjb, PiMaster3, TenPoundHammer, Will Beback, RandomCritic, MTSbot~enwiki, Smackbot, Sam Clark,
Billy Hathorn, Alexei Kouprianov, Gonzo fan2007, Mattisse, Malleus Fatuorum, Steve Dufour, Chris Dubey, Albany NY, PhilKnight, EverSince, Cyborg Ninja, Tdadamemd, Bonadea, Malik Shabazz, , Metatron's Cube, Sapphic, BotMultichill, Thomjakobsen, Sfan00
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Koavf, Chris Capoccia, SmackBot, Penbat, Hebrides, Albany NY, Hellosparta, Bakerstmd, Boromir123, Eustress, Aleksd, Editor2020, Addbot,
Wireless friend, Yobot, Kilom691, AnomieBOT, Citation bot, FrescoBot, EmausBot, WikitanvirBot, Jack Greenmaven, BG19bot, Toccata
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Carriearchdale, Cmacauley, MrOllie, Jarble, Legobot, Yobot, AnomieBOT, RayvnEQ, Citation bot, LilHelpa, Psychiatrick, Earlypsychosis,
Jonesey95, LilyKitty, John of Reading, Pile-Up, Wikignome0530, , Azurelens24, DASHBotAV, Serasuna, Erasistratus1, DS Belgium, FiachraByrne, Helpful Pixie Bot, AJPlotnik, BG19bot, Yisenberg, Glacialfox, Monkbot, Jaywboll and Anonymous: 29
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TAnthony, Cgingold, Steel1943, Johnfos, Addbot, AndersBot, Xqbot, Psychiatrick, FreeKnowledgeCreator, And we drown, Cobaltcigs, Polisher of Cobwebs, Interested in science, Star767, Monkbot and Anonymous: 1
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Schulz, Action potential, Degreezero, ThirteenthGreg, CLW, SmackBot, Cosmetor, Supercriminal, Psiphiorg, Bluebot, Colonies Chris, Emurphy42, Jjoensuu, DRahier, Poppi12, Kittybrewster, CamXV, Tsop, Takima~enwiki, Bn, Meco, RichardF, Loggerisms, B7T, Iridescent,
Igni, Jsmaye, Penbat, Gregbard, Jasperdoomen, Jonathan Tweet, A876, Dynaow, NHBaritone, Letranova, CopperKettle, RichardVeryard,
AgentPeppermint, Nick Number, Itistoday, Albany NY, Magioladitis, Lenschulwitz, Cailil, JaGa, Smartings, Hbent, Aguynamededdy, Vi2,
AstroHurricane001, Maurice Carbonaro, Mahewa, Mufka, Alexanderabbit, Jmrowland, Mark v1.0, AllGloryToTheHypnotoad, Aron.Foster,
Michael Frind, SieBot, Jruderman, DancingPhilosopher, RobinHood70, Admiral Norton, Kai-Hendrik, Jamespkeim, Alexbot, DumZiBoT,
Brennanyoung, Addbot, Reidlophile, Margaret9mary, Zorrobot, Mro, Uruandimi, Yobot, Gongshow, AnomieBOT, Citation bot, ArthurBot,
LilHelpa, Ed8r, Omnipaedista, Mark Schierbecker, FrescoBot, Machine Elf 1735, Louperibot, Metalola, Tstinson, Seren-dipper, Evanh2008,
, Jacobisq, Tablethree, ClueBot NG, PoqVaUSA, Frietjes, Helpful Pixie Bot, Curb Chain, Mrt3366, Hair, Schrauwers, Someone
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Psychaitry and Control

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Contents

Political abuse of psychiatry

1.1.10 South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1.11 Soviet Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1.12 United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Political abuse of psychiatry in the Soviet Union

Political trend toward mass abuse onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examination and hospitalization

Struggle against abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Classication of the victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Incomplete gures estimated due to some archival documents . . . . . . . . . . . . . . . . . . . . . .

2.10 Residual problems

2.12 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.15 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Struggle against political abuse of psychiatry in the Soviet Union

Soviet psychiatric abuse exposed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Congress in Mexico City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UN Principles for the Protection of Persons with Mental Illness . . . . . . . . . . . . . . . . . . . . .

Working Commission to Investigate the Use of Psychiatry For Political Purposes . . . . . . . . . . . .

Resolutions for expulsion or suspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.10 Vienna Congress

3.12 Visit of the US delegation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.13 Establishing the IPA

3.14 Athens Congress

3.15 Visit of the WPA delegation

3.16 Russian Mental Health Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.17 See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.20 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Early 1900s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

1940s and 1950s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Since 1970 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Civilization as a cause of distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Evolution research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Normality and illness judgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Psychiatric labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Tool of social control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Psychiatry and the pharmaceutical industry

Political abuse of psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Therapeutic State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

4.2.10 Total Institution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Involuntary hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Psychiatry as pseudoscience and failed enterprise

Diverse paths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Works cited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

4.10 External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Overview of opposition to biopsychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Research issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Current status in biopsychiatric research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Focus on genetic factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Focus on biochemical factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Economic inuences on psychiatric practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Pharmaceutical industry inuence on the psychiatric profession . . . . . . . . . . . . . . . . . 128

See also . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Groups critical of the biomedical paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Criticisms from psychologists & the medical profession . . . . . . . . . . . . . . . . . . . . . 129

Methodological issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

External links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132