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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 Id 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.

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Table 1


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

Ideological formulations
Fear and suspiciousness
Ambivalence, guilt, internal conflicts

and behavioral disorganization
Attention to detail
Poor adaptation to the social environment
Shift of interests
Reformi sm

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


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 perception by the public continues to cause a psychiatric patient to be seen as a dangerous social menace.

Because of this perception of the potential danger of a psychiatric patient, psychiatrists are empowered to deprive persons of liberty, if only temporarily, and retain patients in the hospital against their will through the procedure of civil commitment, administer medications against the patient's will if their condition represents present and immediate danger to themselves or others, and render important judgments in adjudication of a person's ability to stand trial, be held responsible for their criminal action and considered competent to handle their own affairs.

The role of a psychiatrist in the Soviet Union is not unlike the predicament of his colleagues in the West. However, in the Soviet Union, psychiatric practice is conducted in a context radically different from the one we know in our society. Every Soviet psychiatrist has the same employer, the state. Private practice is forbidden. The state controls their education, training, and research in psychiatry. The state also controls the publication and dissemination of psychiatric knowledge.

The Ministry of Health has the responsibility to dictate the norms and standards of care, which in reality limit the therapeutic options available to psychiatrists. In several instances, even the dosages of medication are prescribed by these rules and regulations that are mandatory to every Soviet psychiatrist.

The diagnostic system used by the Soviet psychiatrist is centrally imposed and also controlled by the Ministry. No deviations from the prescribed methods of diagnosis and treatment are tolerated. It is virtually impossible not to use that system because each diagnosis has to be coded, and only that system is the official system. You cannot discharge a patient without assigning a code for discharge diagnosis. You are compelled to use the diagnostic system whether you believe in its scientific validity or not.

Soviet psychiatrists like any other citizen of the Soviet Union live in the atmosphere of fear and enforced complacency. Most Soviet psychiatrists sincerely share the state's ideology. The law does not provide even minimal protection of civil rights of psychiatric patients. Judicial review is nonexistent, and impartial legal representation is more frequently than not unavailable.

All the rules and regulations regarding civil commitment are promulgated by the Ministry of Health and not by the judiciary. The courts are state-controlled, and the patients cannot expect relief even from a sympathetic judge.

It is in this context that systematic misuse of psychiatric diagnosis, treatment, and involuntary hospitalization takes place. The most flagrant examples of such abuse of my profession were well publicized and are easy to condemn. It is far more difficult to investigate and understand the causes of this abhorrent practice.

Regardless of how different our society is from that which exists in the Soviet Union, we stand to learn a great deal about the inherent dangers in the dual role of a psychiatrist in the contemporary world. It is in such thoughtful, coolheaded, and comprehensive investigation of this issue that I see the goal of these hearings.

I would like to add that I feel proud that members of my profession condemned the fellow members of the International Psychiat

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