When they finally are diagnosed as mentally ill and end up in hospitals, they are still disturbers of the local peace in that they say things that are terribly annoying to those around them, who at this point are the doctors and the attendants in the hospitals.

They, unlike the genuinely ill patients, have their wits about them, unless they have been on many medications, and they know how to enrage those around them by focusing on precisely those things that disturb them, asking questions such as, "How can you call yourself a doctor if you say such-and-such, or if you know that I am not sick, or if you know that I have been charged with a crime that has to do with free speech? Don't you consider yourself a Soviet man who believes in the freedoms that are guaranteed in the Soviet Constitution?"

These are very disturbing kinds of challenges, and the responses also represent expressions of disturbance responses such as the use of medications, which in fact is a means by which psychiatric patients anywhere, especially in prison hospitals in any country, are responded to if they become problems; but this response appears to occur even more frequently in the Soviet Union in the cases of dissidents. This is a partial explanation, in my view, for that.

I must add that in many of the cases of the dissident misdiagnoses--that is, diagnoses of schizophrenia in dissidents who, anywhere else, would have been considered sane-there may have been, on the part of the Soviet diagnostician, a certain level of true belief. These dissidents do indeed seem very strange in Soviet society. In that country, dissent is not usual; and, therefore, it is sometimes considered abnormal to speak in the ways in which they speak. They do strike some members of that society as very odd characters, odd enough perhaps to justify being sent to psychiatrists for evaluation, as well as for reasons of convenience.

Soviet psychiatrists are, after all, also Soviet people, also have that kind of world view, and it becomes possible for them to misdiagnose those people in partially true belief. I believe that in some cases but certainly not in all cases, such true belief has existed, made possible, in part, by the availability of a diagnostic system, the Snezhnevskyan one, that is very broad that can accommodate, as I tried to indicate earlier, behavior that in any other country would not be considered to be a basis for the diagnosis of mental illness.

Mr. YATRON. Does that justify giving them drugs for pain and fever that will bring on hallucinations?

Dr. REICH. Nothing, I believe, justifies that.

Mr. YATRON. Dr. Reich, one further question. Dr. Anatoly Koryagin, a Soviet psychiatrist, was imprisoned for fighting against the perversion of psychiatry in the Soviet Union. Do you think that he and other psychiatrists who espouse his beliefs would also be considered mentally ill by their peers?

Dr. REICH. Perhaps some get to be so considered, but I think that Soviet psychiatrists and Soviet authorities understand that Dr. Koryagin is not mentally ill, but he certainly is by Soviet standards a dissident. As has been mentioned here, he has been honored by the American Psychiatric Association for his courageous behavior. Mr. YATRON. Thank you, Dr. Reich.

I have one final question for Dr. Visotsky. How many of the patients treated in the Soviet Union for mental illness ever recover, and are they allowed to reenter society after having been diagnosed as being mentally ill?

Dr. VISOTSKY. Again, the numbers are not verifiable, but we do know of individuals, who we had interest in, who had been returned to society. They are returned to society with two hooks in them. One is that they frequently are told to report to the local psychiatric clinic to monitor them. Two, they are always under the gun, if you will, to be returned to the psychiatric hospital if they engage in any activity that might be questionable.

The issue for us from a professional point of view is not so much whether there is a distortion in diagnosis, there may well be. In 1968, I was with the first U.S. Mission to review the psychiatric facilities of the U.S.S.R., and I found many of them to be fine facilities. The issue is when they select a certain group of individuals and put them in special hospitals whose jurisdiction is not under the Ministry of Health, but under the Ministry of Interior, when those hospitals have a staff in used a particular way, for a diagnosis which apparently is supposed to be universal for all Russian citizens, and they are treated in a punitive fashion. Then this truly becomes a crime.

Mr. YATRON. Thank you, Dr. Visotsky.

I want to thank each of you, gentlemen, for appearing here today and giving us the benefit of your views. Thank you very much. Dr. VISOTSKY. Thank you, Mr. Chairman.

Mr. YATRON. Our final witnesses this afternoon are Dr. John Karlavage, a physician who has worked on behalf of victims of Soviet psychiatric abuse, and Mr. Harvey Fireside, coordinator of the Working Group Against Psychiatric Abuse of the Medical Capacity Committee of Amnesty International, USA.

Gentlemen, we will follow the same procedures with you as with our previous panel. Dr. Karlavage, you may proceed.

I would like to say for the record that Dr. Karlavage is a physician, a friend, and a constituent from my congressional district. I welcome both of you gentlemen here today.

STATEMENT OF JOHN KARLAVAGE, M.D.,

Dr. KARLAVAGE. Thank you, sir.

I would like to respond from your Sixth Congressional District that all of us in your district are extremely proud and happy that you now have this extremely prestigious position in the Congress. Mr. YATRON. Thank you very much, Dr. Karlavage.

Dr. KARLAVAGE. Dear Sirs.

I come before you today on behalf of a Soviet worker, Alexei Nikitin. Several years ago, Kevin Klose of the Washington Post and David Satter brought to my attention the problem of Soviet coal miners in the Ukraine Soviet Socialist Republic. They documented the problem that a certain coal miner was having due to his efforts in improving the situation of his fellow coal workers. That coal miner's name is Alexei Nikitin.

Nikitin lived in the city of Donetsk in the Ukraine and worked in one of the regional coal mine. He was a hard worker and popu

lar with his fellow coworkers. The men were attracted to him because he appeared to be a natural born union leader whose interests were in promoting the health and welfare of his fellow coal miners. When problems arose in reference to wages, Nikitin took the complaints of the men to the trade union leadership and to the director of the mine. The problems were rejected by both.

It should be noted that trade unions in the Soviet Union are of a peculiar nature. They are adjuncts to the Communist Party and represent the interests in general of the enterprise, rather than the workers of the enterprise. So the trade unions are similar, in our American experience, to the "company union" whose interests are generally associated with the company rather than the worker.

Through Nikitin's leadership, the mine workers also complained about safety conditions in the mine. These complaints were also rejected. Nikitin's efforts were so bothersome to the managers that eventually he was incarcerated in a local mental hospital even though he had no history or signs of psychiatric illness.

Later, a mine explosion occurred and several miners were killed and injured at the same location in the mine about which Nikitin had complained. Nikitin was released from the hospital and returned to his work. The same problems persisted with no changes by the director and no help from the trade union.

In desperation, Nikitin invited Kevin Klose and David Satter to his home to talk about the problems of Soviet coal miners. This was the straw that broke the camel's back. A few days after the journalists left, Nikitin was incarcerated in the local special psychiatric hospital and eventually transferred thousands of miles away to a special psychiatric hospital in Alma Ata near the Afghanistan/Chinese border. He is still there to this day, and has little likelihood of being release for the rest of his life.

This experience, unfortunately, is not an exceptional event in the Soviet Union. Such groups as independent trade unionists, independent peace activists, active religious believers, and nationalists suffer the same fate among many others in the Soviet Union.

What makes Nikitin's situation so different is the heroic role of Dr. Anatoly Koryagin of Karkow. Several years ago, there was an independent committee formed to fight the abuses of psychiatry. Dr. Koryagin was asked to be a consultant to the committee and he accepted. He had the opportunity to examine Nikitin and found him not to be suffering from any psychiatric illness. He was able to publish his findings in a British medical journal. This act, in addition to other documented abuses, produced a great negative impact on the Soviet psychiatry as it is viewed in the West.

Dr. Koryagin was subsequently arrested on the grounds of possession of a firearm. Specifically, he had an old hunting shotgun that did not work, and did not have any ammunition, which was given to him by his uncle. When the police raided the doctor's apartment, they confiscated Dr. Koryagin's writings and typewriter. Certainly, as far as the Soviet authorities were concerned, the typewriter was a more threatening weapon than the rusted and broken shotgun.

Dr. Koryagin was sentenced to a work camp. At the camp, due to inadequate medical care of his fellow inmates, Dr. Koryagin started to assist in the case of their medical problems as best he could.

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This led the authorities to punish him by transferring him to Christopol Prison, where he is still incarcerated today.

This past summer, I had the opportunity of studying occupational health in the Soviet Union. Much of my time was spent in the coal mining town of Donetsk. While I was there, I visited Nikitin's home on Denisenko Street and spoke with his sister Ludmyla.

While there, in a humanitarian effort, I gave hundreds of vitamin pills, cartons of cigarettes and clothing to Ludmyla, and she promised to forward half of the amount to her brother Alma Ata and half to Mrs. Koryagin in Karkov so that she could forward the material to Dr. Koryagin in Christopol Prison.

I also supplied emigration papers for Nikitin that were given to me by David Satter. Ludmyla wrote a message to David Satter stating that Nikitin's physical health is not good.

I was able to communicate with Mrs. Koryagin in Karkow. We eventually received a message stating that Dr. Koryagin had told his wife to leave the Soviet Union with their children since there is little hope for his release and no future for his family in the Soviet Union. We are in the process of forwarding the papers necessary for her emigration.

Finally, it must be noted that these individuals are not counterrevolutionaries, spies or provocateurs. These individuals are patriotic Soviet citizens who in their own way tried to improve and change in a positive way the system wherein they are trapped. These are individuals that truly are heroes of the working class that have been crushed by the Communist Party of the Soviet Union.

Thank you, sir.

Mr. YATRON. Thank you, Dr. Karlavage, for your testimony.
Mr. Fireside.

STATEMENT OF HARVEY FIRESIDE, COORDINATOR, WORKING GROUP AGAINST PSYCHIATRIC ABUSE OF THE MEDICAL CAPACITY COMMITTEE, AMNESTY INTERNATIONAL USA

Mr. FIRESIDE. Thank you, Mr. Chairman.

I would like to have permission to have inserted in the record, in addition to the statement for Amnesty International, the two appendices. One of them is the March 1983 briefing paper entitled "The Political Abuse of Psychiatry in the U.S.S.R.," and the second is the most recent, September 1983, update of what Amnesty International has found, including five specific cases of newly interned human rights prisoners.

Mr. YATRON. Without objection, they will be included in the record, Mr. Fireside.

Mr. FIRESIDE. Thank you very much.

I would like to mention briefly that the body of the written statement tells you about the work of Amnesty International, about its concern for individuals who are imprisoned for their basically political and religious dissent, in this case, in the Soviet psychiatric hospitals that have been identified, starting with the 1975 report.

Amnesty International has well trained, extensive staff in London that carefully investigate these allegations of abuse, and in the 8-year period since 1975, has corroborated that there are at last

300 individual cases of Soviet citizens who are shut up in mental hospitals against their will, most of them in ordinary psychiatric hospitals, but the most troublesome or irritating, as Dr. Reich put it, are put into these special psychiatric hospitals that are really institutions for the criminally insane, among the murderers, rapists, and other violent criminals.

In the commitments to these special psychiatric hospitals, generally the person has been picked up by the police for what amounts to a thought crime such as simply speaking out of turn or writing statements that are interpreted as "anti-Soviet agitation or propaganda," although there are clauses in the Soviet law, the Soviet Constitution of 1977, and in the U.N. Declaration on Human Rights, and other conventions adopted by the Soviet Union, that guarantee such freedoms to speak, assemble, publish, or even to exercise one's religion.

One major concern of Amnesty International is that under Soviet law, people can be committed to an ordinary hospital if they are a danger to society, and to a special psychiatric hospital only when they are a special danger. Those terms have never been pragmatically defined, but certainly a commonsense understanding of those terms, and a psychiatric usage, would imply that they are physically threatening to other people, that they have hurt or harmed someone or threatened suicide or some harm to themselves.

In not a single case of these 300 that Amnesty International has investigated is something there any sign that what is threatening about these people is other than simply their ideas and their beliefs. That is really the heart of what Amnesty International considers the psychiatric abuse in the Soviet Union.

Amnesty International considers the involuntary treatment of essentially sane dissidents in mental hospitals cruel, inhuman, and degrading punishment. Since 1977, Western protests have come to a head. At the Honolulu Congress, the Sixth Congress of the World Psychiatry Association, I think the major anticlimax has been how little response there has been by the Soviet authorities, which certainly seems to be cause for them to have looked into the allegations of abuse of a medical specialty. Instead, what we have had are blanket denials by the leading psychiatrists, including Dr. Snezhnevsky, that Soviet psychiatry has made a single mistake.

I think with the kind of testimony that has been heard here today, I agree with my colleague, Professor Reddaway, that the reformers in the Soviet profession will have good cause to question what this policy has led to, this international isolation, and to have serious investigations into what has been done unethically, how medicine itself has been perverted.

There have also been choruses of official charges from the Soviet side that survivors of the special hospital, who have managed to reach the West as refugees, are incurably ill and periodically are rehospitalized. As far as Amnesty International has been able to learn, these are slanderous charges.

I, myself, had occasion at press conferences to meet very eminently sane persons like Gen. Pyotr Grigorenko, and Vladimir Bukovsky, and Leonid Plyushch. Instead of responses, Soviet action has been to kill the messenger who is bearing the bad news.