"Beyond this, what we now see to be the phony theories and psychiatric dictatorship of Professors Snezhnevsky and Morozov have brought morale and efficiency to a low level throughout Soviet psychiatry. We have recently become concerned at such deplorable aspects of our public health performance as the sharply rising rate of infant mortality. We now appreciate the serious consequences of such things for the labour force and thus for the economy.

"Last year we issued a long decree criticizing the inefficency and corruption in the health service (Pravda, 26 August 1982). But we failed to single out psychiatry as one of the worst areas. Now our policy review shows that thoroughgoing reforms in psychiatry would, simultaneously, cut costs in the health service and improve the health of our work force. clearly boost fulfilment of the Five-Year Plan.

They would

"So now we must do what we did to Lysenko and his empire in the 1960s, and prepare for the following reforms. Morozov, Snezhnevsky et al. must be quietly retired or demoted, and replaced by psychiatrists respected abroad. The theoretical and organizational stranglehold of the former on Soviet psychiatry must be gradually ended by a wide range of personnel changes in institutes, hospitals, medical schools, ministerial bodies, publishing-houses, societies and journals. The dissidents interned in mental hospitals must be unobtrusively released. And Dr. Koryagin and his colleagues must be free from jail. Then we will have no difficulty rejoining the WPA.

"All of this will take time, as of course no clearcut admission of past guilt can be made, and everything must seem to be happening routinely and naturally, not in response to foreign pressure.

"But it must be done. For if it is not; if more workers like Aleksei Nikitin are psychiatrically interned for organizing free trade unions; if the KGB continues to have Dr. Koryagin tortured in prison in its attempt to force him to recant; and if those compromised bunglers Morozov and Vartanian are left in charge of our psychiatry's foreign relations; then our forced resignation from the WPA seems likely to be only the first of a mounting series of international reversals in the World Health Organization, in other UN bodies, in professional associations, and in our international diplomacy as a whole."

Conclusion

My conclusion is

that medical, lay and governmental bodies in the West

should do everything possible in the years ahead to assist the above arguments of

the Soviet would-be reformers. That clearly means sticking to our

our A

principles and increasing the pressure on the Soviets in forums of the types just mentioned. from

WPA

The Soviet resignation the

is a step forward, if not of course the most desirable one. Very little has been lost by it, as virtually no exchanges with honourable Soviet psychiatrists had in any case been allowed to take place by the corrupt leaders.

Sooner or later, the Soviet political leadership will, in my view, feel an irresistible need to come out of its present semi-isolationism, as Mr Khrushchev did in the mid-1950s and Mr Brezhnev in the early 1970s. Then, if not before, the reforms sketched above will have their chance. In the meanwhile the best home of accelerating the process lies in our asserting our universally approved principles, with mounting resolution, in both medical and lay forums. If we can do that, the moral victory of forcing the USSR's resignation from the WPA should eventually be translated into the substantive achievement of bringing to an end a deeply anti-human- and potentially contagious - perversion of medicine.

Mr. YATRON. Thank you, Professor Reddaway.

Before I ask each panelist some specific questions, I would like to ask one general question of all four witnesses. What more can the administration and the Congress do to bring these abuses to an

end?

Dr. VISOTSKY. Let me try to answer your question, Mr. Chairman. I think this particular body, the body that you represent and its reports are a very important part of the response of one nation to another. There are more issues at stake than mere politics. The United Nations and its representation on human rights should continue their activities. Then, I think, it is up to individual professional organizations, whether they be scientific or otherwise.

Recently, the World Medical Association has received a resolution from the American Medical Association on this very issue, again a resolution through a body which is not a specialty body but a general medical body.

I think trade unions, and other organizations which deal in the international bodies with the Russians should also make their voice known on the issue of human rights, if not the issue of a medical subspecialty.

Mr. YATRON. Thank you, Dr. Reich.

Dr. REICH. I should note that, first of all, our Government has been active to a significant extent in various arenas, particularly at the Helsinki followup talks in Madrid. Ambassador Kampelman has spoken out on this issue on a number of occasions with great force and intelligence.

Congressman Lantos' suggestion is worthy of some interest and consideration. Certainly the Congress has expressed its views very forcefully and almost unanimously with regard to the Korean Airlines disaster. Perhaps it might have some interest in focusing on this issue in a wider way than just through the subcommittee.

Other than those methods, I am not sure whether there are any more ways in which the Government, or any part of it, can address this matter.

Mr. YATRON. Thank you, Dr. Reich.

Dr. Zoubok.

Dr. ZOUBOK. As you know, Mr. Chairman, I am a former Soviet psychiatrist, so I keep thinking of those colleagues of mine who still have to practice in the Soviet Union, and I would think that for them the dissemination of information in regard to this issue through the Voice of America, and other publications and other means, including the Congressional Record, and periodic hearings of this kind, that will be enormously important intervention in order to protect those in the profession who abhor the practice and refuse to participate in it, but are subject to all the pressures that were so eloquently outlined here by everybody.

I would think that that is a very good thing to do.

Mr. YATRON. Thank you, Doctor.

Professor Reddaway.

Mr. REDDAWAY. I would just like to add a word to reinforce Dr. Zoubok's remark about the importance of radio broadcasting to the Soviet Union. That is one way in which the U.S. Government can get across the message to Soviet doctors and psychiatrists, as well as the population at large.

The CSCE process, as Dr. Reich said, is of course another channel, but I think to some extent that is burning itself out as an effective forum. It is attracting less and less attention, as it seems to become increasingly ritualized. I think that it is perhaps more useful in the future to look to some other international bodies, possibly the one I mentioned, the World Health Organization.

Here is a professional health issue which is being seriously abused in one member country of the World Health Organization. WHO is an organization of governments, and that seems to me a very suitable forum for the United States and its allies to press this issue in a systematic and serious way.

I am under no illusion about the likelihood of achieving some sort of clear-cut victory in that forum in a short period of time, but I think the attempt will have the effect I suggested of definitely increasing the pressure on the Soviet authorities, increasing the strength of the would-be reformers, that is if the Soviets can constantly be subjected to sharp criticism in that particular forum and to demands for an investigation by WHO.

Also, of course, the Human Rights Commission is another forum where certain investigations are already underway, and where the American Government can press its case strongly. I would finally mention bilateral medical relations between the United States and the U.S.S.R. These are not very extensive at the moment, but great care should be taken in those relations not to give any approval, perhaps unconsciously, to some of these appalling abuses of medical ethics, as has unfortunately been done by the American Government once or twice in the past.

Mr. YATRON. Thank you. I feel that all four of you have made some excellent suggestions.

Dr. Zoubok, can we look for an even darker period in Soviet psychiatry as a result of the absence of outside peer review?

Dr. ZOUBOK. I think that it is unlikely because thanks to many individuals, professional organizations, governments, and so on, a load of light was already shed on this issue. Many people in the profession know much more about how widespread that practice was and is, how pervasive it is, what are the implications of it for both victims and those who perpetrate this crime.

My guess is that it is impossible to stuff the demon back into the bottle, but Russia is a large country, people retire early. Most Russian doctors are women, and they retire 5 years earlier than men. If you do not educate or expose in front of a new generation of doctors the crimes of such type, you will certainly lose.

My hope is that even if we get one case a year that will receive equal attention as 200 cases receive or 400 cases received in the past because, as Mr. Fairbanks suggested to you, Mr. Chairman, it is awfully important for us to understand how a Soviet man or a Soviet person thinks, what makes a person go by the book knowing that 37 seconds after he pushes the button, there will be no more 269 lives. What makes it happen, things like that. That, I think, is awfully important, and that is a part of the issue that we have not discussed yet.

I think that looking at the incidence of abuse of human rights in another country should be treated by most of us as a window on the psychy, on the mentality, thinking, healing our counterpart.

We are not in a position to choose our counterparts, so we might as well start learning more about them.

Mr. YATRON. Thank you, Dr. Zoubok.

Dr. Visotsky, in the World Psychiatric Association, the Soviet psychiatrists submitted the case histories of hospitalized dissidents requested by a committee investigating psychiatric abuse. What means do we currently have, or do we have any, of monitoring the treatment of dissidents and would be emigrees in the Soviet Union? Dr. VISOTSKY. Unfortunately, we have no official body. With the Russian withdrawal from the World Psychiatry Association, we cannot ask them officially through that organization for responses on alleged abuses. I must tell you, however, that Committee of the American Psychiatric Association has continued to write, I think it is a matter of sensitizing the Russian hierarchy that is making decision on this issue that we are aware of certain cases, whether they respond or not.

I think we will continue to write to indicate to them that there is an element of our profession that is astounded and is continuing to make inquiry, what was referred to before by yourself as peer review. We will continue to be their peers and to review their issues until such time that we get a response.

Mr. YATRON. Thank you.

Professor Reddaway, do we have any estimate of how many individuals are in these hospitals who do not suffer from any form of mental illness?

Mr. REDDAWAY. It is a difficult question. Dr. Bloch and I have worked on it for the last 7 or 8 years, and we have collected what we regard as reliable data on about 500 cases over the last 20 years or so. It is our belief that this number is in fact only a very small percentage of the total number interned for nonmedical reasons in psychiatric hospitals over that period. Perhaps the number interned at any one time, say, this year, might be a matter of a few thousand, but that is a very, very rough estimate.

Mr. YATRON. Thank you.

Dr. Reich, even one accepts the Soviet rationale, how do you reconcile the very harsh treatment that is given to the dissidents who are diagnosed as having sluggish schizophrenia?

Dr. REICH. I think that that is a very good and complicated question, the answer to which is even more complicated. I think it is important to understand that dissent is not viewed with equanimity in the Soviet Union. Not only by the leadership, but also many people who are involved in official matters find dissent extremely disturbing.

The leadership finds it disturbing for reasons that could be understood by anyone-because it is a challenge to authority. But challenges to authority and questions raised about the ultimate basis of the state are also disturbing to ordinary members of that state because, among other reasons, they lead their lives as if life is normal in that country; when someone raises questions about whether, in fact, life is normal, whether in fact it is as rational as it is officially stated to be, then those questions are in fact being raised about their own lives and about their own beliefs, and that is indeed disturbing. So the dissidents do in fact represent disturbances in the Soviet universe.

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.