Snezhnevsky believes that there are three forms of the illness, the "continuous," the "periodic," and the "shift-like." These three forms

differ from each other in the course that the illness takes during the lifetime of the patient. In the "continuous" form, the patient becomes ill early in life, usually in late adolescence, and grows continuously worse. In the "periodic" form, the patient has attacks of illness but recovers after each attack; and, when he is recovered, he is as well as he had been before the attack. And, finally, in the "shift-like" form, the patient also suffers acute attacks; but, after recovering from such an attack, he is left clinically more impaired than he had been before it came on. In short, the "shift-like" form possesses characteristics that are a combination of the first two forms: a continuous progression in the severity of the illness, but a progression characterized by acute attacks.

What is important about these Snezhnevskyan forms of schizophrenia is that, in two of them, the "continuous" and the "shift-like," there are subtypes--mild, moderate, and severe. The moderate and severe subtypes of each of these course forms would be considered true schizophrenia by psychiatrists almost anywhere in the world: persons suffering from 、 symptoms described in Soviet textbooks as typical of those subtypes would probably be diagnosed as schizophrenic whether the diagnostician were a Soviet psychiatrist or, say, an American one. This is not the case, however, with the mild subtypes. The clinical characteristics described by Snezhnevsky as typical of the mild subtypes do not include the one

characteristic--psychosis, or the inability to properly assess reality--
that is generally required for the diagnosis of schizophrenia by most
psychiatrists in most countries. Instead, the symptoms attributed by
Snezhnevsky to persons belonging in these mild subtypes are what would be
considered in the West to be neurotic, or even normal. For example, a
person may be diagnosed, according to Snezhnevsky's criteria, as having
"sluggish schizophrenia," which is the name of the mild subtype of the
"continuous" form, if he is self-conscious, highly introspective, full
of obsessive doubts, has conflicts with parental and other authorities,
or has a penchant for reforming society. Similarly, a person may be
diagnosed as belonging to the mild subtype of "shift-like" schizophrenia
if he displays a great deal of social contentiousness, is beset by
philosophical concerns, or is self-absorbed.

Clearly, these "symptoms" are characteristic of many people who are not sick at all, or only mildly so. However, when such people become

involved in political activities in the Soviet Union, come to the attention of the KGB, and are sent to psychiatrists, they may be seen by psychiatrists as easily classifiable into one or another of these mild categories, usually the "sluggish" subtype.

That this has actually happened is borne out by the descriptions of

the dissidents that have been provided in some of the case histories that have reached the West. Table 1 contains a list of some of the characteristics that have been used to describe several of the hospitalized dissidents by the psychiatrists who examined them. Many of these characteristics--fear and suspiciousness, religiosity, depression, ambivalence, a poor adaptation

to the social environment, a penchant for reforming society--are characteristics that could be expected to be typical of persons who live

as dissidents in a repressive environment. But those characterists also happen to be ones that are cited in Soviet psychiatric textbooks as being typical of persons with mild schizophrenia. And it has been in the diagnoses of dissidents that these styles of life have come to be classified as forms of illness.

I should note that, in the spring of 1982, I had the opportunity to visit Dr. Snezhnevsky and his colleagues at their institute in Moscow. I am submitting to the Subcommittee the article I wrote for the New York Times Magazine based on that visit. That article, which was published on January 30, 1983, contains a description of Soviet psychiatry itself, of Snezhnevsky and his colleagues, and of the research they have carried out to support the theories I have described. In addition, it provides an account of the criticisms of Soviet psychiatry that I raised during the meeting and of the ways in which the Soviet psychiatrists responded to those criticisms.

Table 1

VULNERABLE STYLES

(Overlap of Common Dissident Styles
and Schizophrenic Symptoms as
Described by Moscow School)

Mr. YATRON. Thank you, Dr. Reich.

Now we would like to call the next witness, Dr. Zoubok.

STATEMENT BY BORIS ZOUBOK, MEMBER OF THE STAFF OF FOUR WINDS HOSPITAL, INSTRUCTOR IN PSYCHIATRY AT COLUMBIA UNIVERSITY, AND A FORMER SOVIET PSYCHIATRIST Dr. ZOUBOK. Mr. Chairman, and members of the subcommittee, ladies and gentlemen of the press.

Thank you for the honor of your invitation to testify in front of this distinguished subcommittee. The role of a psychiatrist in contemporary society is truly a difficult one. It is fraught with contradictions. On the one hand, a psychiatrist owes his allegiance only to his patients. Legal tradition worldwide recognizes the confidentiality and the special nature of this relationship.

On the other hand, psychiatrists are frequently called upon to act as agents of society in its legitimate desire to protect itself from what society sees as a potential danger arising from a "deranged mind." To be sure, these instances are quite rare, but their percep