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| Our answer in all cases was W

to the pol u ilting in the direction of Nading illness, and even at the risk of harming Grigorenko. We would have to alter our usual hlorarchy of values, placing our duty to our protection and to the project above our duty to the patient; and we know that we would have to take stope that would demonstrate -to Grigoronto, to others and to ourselves that we had done so. Before anything how ever, we would have to obtain troca Grigorenko, in advanca, his Informed consent.

We aplained to him what we had in mind, and what the potencial dangers were for bum, sina me were insisting cant be grantes permisadon not only to carry out the comptation, but also to publik ctn it in any way we vished Be actonowledged our wartIng nd copted our couch to the complan approval. Aller all, he said, bebed noch ing wore to lone. He had at rendy beca labeled tisane.

And so we propered a doci moat for Grigortalo's stone care that embodied these condido -a document that

under ordinary strom Stano, nown of us would have

da pacient to sten In thats can, however, we felt we had to forecall any future objec con that we had been bound to Grigortako by the usual di cal auths and abilgation and that in ettuct, we had pro coded under condition of ad vanda cantorahip. Grigortako mund the documeat in Rundan and stoned # wth, he said, 10 regret

military and caring acasway, trona c h he was udtad otth daduction in 184. Drated into the Red Army, he saw his first military action ta 1930 against the Japenosa, and his back wus injured in a greande plagioa. He was injured twice more in battle against the German

After the war, Grigortako joined the start of the Frunze Military Academy in Moscow; in 1948, he was appointed deputy chairman of the de partient of scleancro surda and then in 1958, chair

of the department of cybermedia. Menawile he w woning the degree of Mer of Military Science

La 1800, Grigoronto achieved his highest military rank major general. By the end of his military arter five year later, he run the author of more than articles in all tary tean, or of the canthod, and porned

a ou docondon, includ. ing the Order of Lanin, two Ordan d the Rod Broner, the Order of the Red Star, the Order of the Second World War, w ell as seves nilitary

ferred to a los port in the Fur Eur :

Then, Grigorento founded a 13-cember "Union for the Ro vival of Leninism" in 1983 and prepared and distributed lent. lets calling for a return to Leninist tenets and principle He was arrested and sent for his free psychiatric namin don at the Serbuky Institute of Forensic Puychiatry in Mar cow, where he was judged to be mentally ill. Hospitalized, bo was not related uncil the spring of 1905, after Khrust chor's tall.

Unable to obtain any part deo in his own feld, having los bols of car's pension be v torood to find wort, at age S8, as a porter and longsboro

an. He seat protest lotters to Prime Minister Kosyon Pravda and the K.G.B.; be openly complained about the lots of his position and his title, and he publicly demonstrated against the trials of promineat die dents.

In 1902, in response to an ap peal, he now to Tashket to be a deten words in a anal of desideat leaders. He was ar rested and seat to a Tasheet paychalatric conantatoa for

mtadion. That commi ston found him to be wtthout mental Indes. However, la an

al move. Grigoreale was transterred across the country to the Serbuky last auta la Moscow for a second

umtadion, where he wu, again, found to be mentally ill. Once more he was forcibly hospital and, this time more than touran. In 1974 he was released, and

ed his dissident activt de. In 1977, he roomved the shooch visa to visit his sca la New York, where he said he could obtain medical treat

at that was unavailable to raat home. Three months later, the Supreme Soviet muda decree, signed by Leo adid Brechnev, revolding his cittahip. and Grigorunico announced that he was sooldag asytumn in the United States.

IR cena, they agreed that Grigorate's d at was the route not of racional coaviction but, rather, of psychopo thology. According to their theory of his mental illness, Griporako was suffering troca a chronic paranoid condition that at times reached pey-, chode proportions and that caused him to act ia rays that had brought him into conflict with Soviet lav. Specifically, that illness caused in him a penchant for "Tetorratsa" a need to retorta society, to speak out and act out against authority and to focus himsel repeatedly and obettnately on dissident themea. In so acting and speaking, the theory held. Grigorenko was not in control of himself, was not responsible for the legal implications of his behavior and could be burned. as i, from attending his own onial and tesutying in ata owa defense. Grigorenko's illness. the Soviet psychiatrists also implied, may have been ag. gravated or partly caused by arteriosclerotic changes in the blood vessels supplying his brain.

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The Re-examination

Grigoria's anx marriage in s anded ta dvorca 15 I years later. There son trom | that marranow live ia the

Soviet Union. He second mar. naga, to his curreat otta, Zinaida, walted in the birth of an on, Andere, who cont grated to the United States several years ago

The Dissideat

r

The Maa

Pyotr Grigorteich Grips renko es barn in 1997 to a Rua Orthodox POR family ta the Ukraine. Hla mother died at typhus wota be val His father rumourned to 1913, but the row wite aber doned the household within a your, soon after the father was called to serve in World Worl.

Griportato wed the art in hade village to join the Commu stat Youth League. Al the ne of LS,

b ox to the city of Do outat, bere he found work as a locttth and machinist and commodo schooling at right; at age , be joined the Commune Party. And it was the party that was him to a

Grtsonako had some small nel with Soviet authorities - he protested, for wampie, na instance of and Sardin in M academy - but his first surtod cinda atted troca a speech ho dettvered in 1901 a dotate to party conter

no ta Morcow. He called for the democratizadoa a party rules. He w promapely sortoped of his colegas statu. N about the same time, he wrot as gpa lotter to Mar cow voten antaising the T onable and area harmful activity of Khrushchev and his team." Grigortalo io mediately lost his position at the military scademy and within a hall year, was ruas

In order to evaluate Griga runko's paychiatric starus as accurately and fully as possible, we arranged for an unusually elaborate camination procedure. The interviews, totaling some aight hours, were carried out separately by uch of the paychiatrists. One we held at Harvard Univer sity and two in the videotape studio at the New York Suate Psychiatric Institute in upper Manhattan.

The questions asked of Grigorenko touched upon al most every dimension of his life, including his family, his earty memories, his sexual, intellectual and moral develop ment, his idees, his impulses, his spectations, his feelings and the nature of his personal relationships. Inevitably, we paid particular attention to his political ideas and to the motinations for his dissident acts. All of the interviews were car ned out through an interpreter, and all were recorded, two on videotape.

The Patient

Tivo comienion of forensic psychiatrists, boch from the Serbuty Institute in Moscow had recommended that Grigo renco be committed. Their Madings are virtually identi.

Interviews and Findings

e here comes to

In addition, in order to inves date in depth those areas of poychopathology cited in the Soviet reports, three special animations were per formed. all by consultants from the Harvard Medical School. A three hour battery of poychological tests was ad ministered by Irene P. Stiver. including the kinds of interpre utve, projective tests (such as the Rorschach ink blot" test) that could reveal the presence of paranoid sin. And the queadon of an arteriosclerode brain condition affecting Grigorunko's thinking, also noted in the Soviet diagnostic reports, was investigated through a neurological caram! mtion by Norman Geschwind and an eight hour battery of

aropeychological tess by Barbara P. Jasn.

Finally, we subraitted video taped interviews to the start al the Blometria Research D. partenant at the New York State Psychiatric landanna Using the intormation on the tapes, the mornbers of the staff attempted to deterrain whether Grigorealo satisfied chatr roarch criteria for a diagnosts of mental illne, Por pront

Griportano dou not roedor speak English. Dr. Borts zou bok, who was in the midst of ma paychiatric reddency a Columbta atter having at orated from the Soviet Union in 1973, kope Grigorelo in formed of our procedures, ad vend us on special aspects of Soviet diagnostic definitions and provided us, as well as our contants, with translations during all examination. Iron cally, Dr. Zouboks had roostved part of his medical training in Moscow under the very same Dr. Soechnevsky who had

urged that Grigorenko boro ! examined. For all his exper. I tise, however, we were con 1 cerned that, as an emigrt, Dr.

Zoubok might be accused by the Soviets of having distorted Grigoronko's Deaning in order to cover any signs of ill

nen. We arranged for three I other Russian-speaking por ! soms to be present at the

acuminations or to review the tapes. In the end, all of them found Dr. Zoubok's translations fully retiable.

Grigorenko said that be all ways understood the possible consequence of his action. La forming his Unica for the Ro vival of Leninism, for example, he said that he had fully cocpected to be shot:

PSYCHIATRIST: "Why did you do that, then, if you thought you might be shot?"

GRIGORENKO: "It was be cause I couldn't acquiesce to the regime. I lew that I would not achieve anything by orpanizing (the union), that it vould be discovered very soon. But I thought that that would awaken a moral feeling in other people. ... Soviet psy. chiatrists considered this to be the main evidence for my mental disease, the fact that! entered into this activity lonowing of its fucility. 11 American paychiatrists should have the same opindon, I would have to say, I would have to insise, that they're wrong."

We tried to pred him about his motivacion for continuing in his dissent, despite the dar gers and the trustradons.

"It's not a personal cause, he said. "It's a social, commu

n caure Socca always has to start ... Tots (Soviet)

otom of governs should noc be tolerated by people, but it or beppes that everyone mtos apaink it. There always have to be people to startthen others will follow. And those who start, regardless of waacher or not they are talent

d. or have special abilities they become a slogan, a ban ger, for those who follow. ... During my life, in my faithful service to communism, I caused a lot of damage to my people, and I wanted, at least in my remaining days, to repair it... What's the sense of living one extn year if you continue in the traud of not facing things? It's better to live the rest of your life crua. tively so that you will not be ashamed in the eyes of your grandchildren. (At this point, Grigorenko appeared sad, but continued to speak carefully and deliberately.) I always considered the inner impulse to serve as a vocation inspired - instilled in my soul - by God.

PSYCHIATRIST: "Why in your soul? After all, only a few people did what you did."

GRIGORENKO: "No, this is not true. It's just that I becam. Innowa. I was just lucky that I became loow, mostly as a result of the campaign in my defense (organized by his wite). There are many who did more than I did, but no one lonows about them."

PSYCHIATRIST: "Did God put it in their souls, 100?"

GRIGORENKO: "I think so. I think that Providence plays a prencer role in the lives of peo ple then we think."

PSYCHIATRIST: "Do you think that you have some kind of special relationship with God?"

GRIGORENKO: "Nu. Even though I firmly believe that God exists in the world, and that there is some Supremne Reason, I untortunately cannot absorb myself fully in prayer...."

la exploring Grigorenko's way of relating to others and i interpreting their behavior, we were especially interested in the possibility that, like a paranoid individual, he might have tended to see all actions talons against him as part

a plat desioned to

Grigorenko isa larre man of distinguished bearing with a shaved head and a slow, some what shutting gait. Although sorded mes quiet and subdued during our interviews, be oftea displayed considerable inter est and animation. That was particularly true when he spoka about his political ideas and the change they had un deryone over the years and also, when he remembered previously for pottina Vents with special clarity, pain or satisfaction. He was able, in response to direct questions, to recount aspects of his history with prost precision, and he roncted to the wateat of his morbories with a broad and full spectrum of responses ranging from sdrepet to Ovideat enjoymeat, from whattu redaction to obvious rumor. He established a relationship with each of us quickly and easily, and was able to share with us his or discreasing concerns

b le Jolie about the roads, oturapha and ironde ahtaifa

Ha nad our question fully and pay ad artered up

ancora und reduce thes below, from bude apertenca wtca Soviec paychiatry, could be connued, under particular circumstance, as symptoms or star of cartato paychiatric condition

Most of our questions were aimed at resolving the issue of Grigorcaico's paranoid condi don the Sovie diagnoses

ere correct, then some signo of that condition should still be preocal And, too, we should be able to detect signs of it in his pest as he presented it.

We questioned Grigoreako at length about the motive' tions for his disa doat acts and ideas. Was he able to appreci ate the dangers inherent in his actiona? Did he have, or had he ever had, paranoid reform ist delusions? Was he driven; as paranoids oftea are, by some unshakable bellet about the world that had no corro spondence with reality? Did he have an exalted, innated view of his own powers, a prundlove sense of himself as superhu pan, perhaps a senger af God?

Finally, tried to clartty the ques tion of arteriosclerotic brain disease. It appears that in 1977 Grigorenko expertenced a small strate that affected vinica in his night eye. In addition, in his pbysical camination, our consult ant scurologist found evidence of arteriosclerosis of the night internal carotid artery. However, neither we nor our consultants, including our neuropsychological consultant, found any evidence that the arteriosclerosis w aftecting Grigorenko's thinking. mood, behavior of character, or had dows in the past.

Conclusions

persecute him. Knowing that he was, in fact, followed by the K.G.B.. and repeatedly investigated, we expected. at the least, that he would stress those coxperiences. We assumed he would emphasize the deviousness and viDdictiveness of the authorities in arrusting him, in hospitalizing him, in stripping him of his rank and his offcer's pension. Instead, be frequently pointed to the deceasy, sincerity, hoe wty and opens of some of his ad versaries, including members of the Central Committee of the Communig Party.

Since the Soviet poychiatrists had spended at length on Grigorenko's personality characterista, stressing those that were content with a dia monts of a parald condition made special attempo at identifying such characteristie

Wested him, for comple, about a confrontadoa he had had la 1900 art ing troon his master's dissertation in io first chapter, the dissertation bed contained implied criticisms of the nitary than d onmed, high racing con, banduca told to removed Wended how he had

pod do edota marchtag for evidena a typically paranoid

bility to comprometee Herowered thes, after while he had agreed to acto the criticis

We found other evidence of Grigo renko's flebility as well. During his tre hospitalization for comple, be rovised his polldal bellets, rejecting the very sme Lantats noded in whose name be had carried out his Wegal dissident acts and for whose

ale be bad boca amud and hoops talized

And we systematically sought other indications of any paranoid condition acher now or in the past - character ides, trait or strong ruging from the Dost mild to the DORH seven Our paychological consultaat made tlar attempt Sho, to a ccess

In reviewing our tests, interviews and other amtnadion, we could find

evidence of meatal illness in Grigo real, a conclusioa confirmed inde pendently by the biomoonia r uch start of the New York State Psychiatnic Institute on the basis of thetr standardized evaluation of our video taped interviews. Nor could we find vidence in Griginal's history como

omat with Dental ind in the past In particular, there is no evidence of

na ila to the paranoid Tag, avea of the mildest sort. While there is evidence, as the basis of his tory and physical finding, al arterio curodc disease, there is no so that the condition has significantly com provatnod Griportato's intellectual or emodonal capacities, or that it has in any way formed or determined his bevior or mood. (A special session

do contradana that led to those conclusions will be held Tuesday at the caveation of the American Psychlaric A cadea in Chicaga)

La bo pain, our task in mining Grigoronkowa to look for signs of il2. What we found, instead, we a DO - I was, ironically, reminded us in one ways of the patient in Soviet descripdon. But theatr verstom of Griportato was consistently storedFor where they claimed ob

on, found perseverance;

in the cited deluson, found ndosniity: sure they ideathed psychodc rude , we found committed devotion, and where they diag noued pathology, we found health. I

APPENDIX 2

REMARKS BY MAX KAMPELMAN, CHAIRMAN OF THE U.S. DELEGATION

TO THE PLENARY SESSION OF THE COMMISSION ON SECURITY AND COOPERATION IN EUROPE, IN MADRID, ENTITLED “PSYCHIATRIC ABUSE IN THE SOVIET UNION,” FEBRUARY 24, 1982

..

Since we reconvened these meetings on February 9 many important words have been spoken here about the most recent of a continued pattem of Helsinki Accord violations, the violence against the people of Poland. It is important to recall, however, that the excesses that disturb us in Poland are not only the result of Soviet military and political pressure, they reflect a pattern of even greater repression in Soviet society.

On Human Rights Day, in this Hall, the Soviet Delegate called our human rights concerns a "fuss being made over a bunch of dropouts"; he charged us with using "barefaced inventions" for the purpose of "danaging polemics." He obviously considers our expectation that the Soviet Union will observe its Helsinki commitments of 1975 to be an "undermining" of his country's "socio-political rights."

The Polish people understand, as the Final Act clearly directs, that human rights have directly to do with the individual's right to live in liberty and with dignity. Those who would redefine this concept by referring to economic and social rights of "masses" are attempting to obscure the absence of human rights in their own societies. Large groupings of people consist of individuals. Where the integrity of the human being is not respected, there are no human rights for the many. It is also noteworthy that those states who deny the human rights of the individual are unable to provide for his economic and social needs as well.

Recent news reports illustrate again with dramatic impact the consequences for a society and its people where there is a lack of concern and sensitivity for individual human rights. Allow me, Mr. Chairman, to give one vivid illustration of the extremes to which a failing society will go to suppress criticism of its own deficiencies.

In the Soviet Union, psychiatry, a healing science, has been perverted into an instrument of cruel political repression. Men and women, sane and exercising their rights as human beings under the Helsinki Final Act, have been, usually without trial, brutally condemned to the grotesque world of politically controlled psychiatric institution's, where they have been silenced

through drugs and violated in a manner reminiscent of the Middle Ages.

The logic of this travesty is cruel and simple: the authorities can commit a dissenter to a mental institution by administrative action. In the criminal commitment procedure, .. the defendant can be ruled "not accountable" and ordered by the court to receive compulsory psychiatric treatment, without the right to participate in his own defense or be present at his own trial. The trial itself is closed to the public.

Psychiatric incarceration spares the authorities the embarrassment of staging full-scale trials of political dissidents; a person's views are discredited by calling them crazy. Indefinite sentences without the de facto right of appeal are then thrust upon those whose continued activity is a nuisance to the state. Once in an institution, the victim is administered powerful drugs with painful and debilitating side effects in order to induce recantation. Others on the outside are then dissuaded from exercising their rights by 'the threat of psychiatric institutionalization.

No wonder this practice led the Sixth World Congress of the World Psychiatric Association in 1977 unprecedentedly to single out the Soviet Union for condemnation! In recent weeks, as a result of yet new disclosures, the Royal College of Psychiatrists in England has voted to ask the World Psychiatric Association to expel the Soviet Union when it next meets in 1983.

We are all here aware that the repression of human rights in the Soviet Union has increased in intensity--clearly an act of defiance and disdain for this meeting and the Helsinki process. As part of that repression, all of the founding members of the Working Commission for the Investigation of the Use of Psychiatry for Political Purposes have also been imprisoned or exiled.

Let us examine this abnormal phenomenon in human terms, using a few current examples:

- Dr. Anatoly Koryagin, a consulting psychiatrist with the Working Commission had examined numerous people confined for alleged psychiatric illness and found them to be normal, sane individuals. For such activity he was sentenced last June to seven years in strict regimen camp plus five years internal exile. In taking his moral stand, Dr. Koryagin knew that Dr.

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