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cess to a lawyer. Amnesty International knows of no case in which a dissenter confined in this way has been permit' ted to see a lawyer. Outside the psychiatric service only the police are given a formal role under these procedures and they are administered by the Ministry of Internal Affairs. Moreover, retention on the lists of local psychiatric dispensaries makes dissenters particularly vulnerable to reconfinement.

The criminal procedurt for compulsory confinement is applicable to those who have been accused of a criminal offense, and whose mental health is called into question. The procedure is laid down in the code of criminal procedure of each union republic of the USSR.

Under this procedure the accused loses virtually all of his or her procedural rights and is left only with the passive right to an honest psychiatric examination and a fair court hearing.

It is the investigator (who may be from the Procuracy, the Ministry of Internal Affairs, or the Committee of State Security) who decided whether the accused should undergo psychiatric examination. The accused is then sent for examination by a forensic psychiatric commission. If the commission finds that for reasons of mental illness the suspect is "not accountable" for his or her offense, it submits this finding to a court together with a recommendation as to what medical measures should be taken with regard to the individual. Instead of a trial there is a court hearing in which the court decides three questions: (a) whether the individual has committed a socially dangerous action; (b) whether to accept the commission's findings on the individual's "accountability"; and (c) what measures to apply.

Throughout these stages of the procedure the accused need not be informed that an examination is to be carried out "if bis mental state makes this impossible." The accused also has no right to know the results of the examination or the recommendations of the psychiatrists. Furthermore the accused loses the right to be informed of any fresh charges brought against him or her, to be told the results of the criminal investigation of the case or to be shown the materials compiled in the investigation. Nor

does the accused have any special right to have visits from relatives. Normally dissenters undergoing psychiatric examination have no visits from their families until after the cases have been heard in court, usually between 6 to 12 months after the arrest. Lastly, the accused has no right to be present at the court hearing of his or her case. This is left to the discretion of the court. In very few cases have prisoners of conscience been permitted to attend the hear-( ing which ruled on whether or not they were accountable.

In one of the few procedural guarantees given to the accused person whose mental health is in question, the law states that participation of a defense counsel is "mandatory" at the court hearing. However, this provision of the law is often violated. It is common for prisoners of conscience who have undergone psychiatric diagnosis, and their families to be denied access to their lawyers and to have no say in their selection.

Soviet courts in political cases almost invariably accept not only the findings of the forensic psychiatric commissions, but also their recommendations as to what should be done with the accused.

The court has three options open to it: it may order that the accused be put in the care of a guardian; that he or she be confined for an indefinite period to an ordinary psychiatric hospital; or that he or she may be confined indefinitely to a special psychiatric hospital.

Putting the accused in the care of relatives or a guardian does not involve incarceration. In no political case known to Amnesty International has a court exercised this option. This is especially significant when the subject is not even accused of a violent offense—as in virtually all the cases cited in this report. The other two alternatives involve compulsory in-patient confinement. According to the RSFSR Criminal Code, ordinary psychiatric hospitals are intended for those who have not committed especially dangerous crimes; special psychiatric hospitals are designated for people who "represent a special danger to society." It has been common for Soviet courts to order that dissenters be confined to special psychiatric hospitals even when there is no record of violence on their part, and no evidence has been produced by psychiatrists or the courts to show that they represented a "special danger" to society.

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In hundreds of coses of forcible confinement of dissenters to psychiatric hospitals there has been no suggestion, even by authorities, that the subjects were physically violent or dangerous to themselves or others. In their persistent denials of political abuses of psychiatry Soviet officials, propagandists and spokesmen for the pyschiatric profession have not addressed themselves to this elementary principle of psychiatric practice, insisting invariably that well-known nonconformists who had been confined were mentally ill but rarely attempting to show that they were in any way "violent" or "dangerous."

Dr. Anaioly Koryagin, a Soviet psychiatrist who has actively opposed the political abuse of psychiatry in his country, addresses this question in an article called "Unwilling Patients," published in the The Lancet (London) in April 1981. From December 1979 to February 1981, Dr. Koryagin worked as a consultant to the unofficial Working Commission to Investigate the Use of Psychiatry for Political Purposes, based in Moscow. During that time he examined

I5 people of known nonconformist views who had been forcibly confined to psychiatric hospitals, and concluded that in no case was compulsory confinement justified on medical grounds. In February 1981 he was imprisoned on a charge of "anti-Soviet agitation and propaganda." In his article he writes:

"The clinical meaning of the term 'socially dangerous' is that the person is in danger of committing acts which endanger his own health or that of people around him (such as murder, suicide, and personal injury.) There was no question of the people I examined being dangerous in this sense. It must be clearly stated that each time a decision was taken to put into hospital the people under discussion, the clinical meaning of 'socially dangerous' was replaced (consciously or unconsciously?) by its judicial meaning—i.e. that the patient was capable of harming the social system as a whole."

Recent Evidence

of Political Abuse

of Psychiatry in the USSR

Since the Sixth Congress of the WPA met in 1977 allegations of Soviet psychiatric abuse have been substantiated by a number of victims of the practice who have emigrated from the USSR. Some have been met by foreign psychiatrists and have given detailed accounts of their treatment. In 1979, for example. Major General Petro Grigorenko underwent psychiatric examination in New York.

Petro Grigorenko, who was formerly a commanding officer in the Soviet Army, was arrested in 1969 following public speeches he made in support of the movement of Crimean Tatars deported during the Second World War to return to the Crimea. He was ruled not responsible and then spent five years forcibly confined to a special psychiatric hospital under criminal procedures, until he was released in 1974. One Soviet psychiatrist who challenged the official diagnosis made of Grigorenko's mental condition. Dr. Semyon Gluzman. was himself arrested in 1972 and sentenced to 10 years' imprisonment and internal exile for "anti-Soviet agitation and propaganda."

The team of psychiatrists and psychologists who examined Major General Grigorenko in New York in 1979 included the President of the American Psychiatric Association, Professor Alan Stone. The team concluded:

"In reviewing our tests, interviews and examina-
tions, we could find no evidence of mental illness

in Grigorenko... Nor could we find evidence in [his] history consistent with mental illness in the past," INew York Times Magazine May 13, 1979).

In 1980 another former victim of psychiatric abuse emigrated from the USSR. He was Evgeny Nikolaev, a 43-year-old linguist. During the ten years leading up to his emigration he had been forcibly confined to psychiatric hospitals on five separate occasions, in the absence of any evidence that he was "socially dangerous." After his fourth confinement he voluntarily underwent an independent examination in 1977 by the Moscow psychiatrist Dr. Alexander Voloshanovich, an active opponent of psychia trie abuse. Dr. Voloshanovich concluded that there were no medical grounds to justify his forcible confinement either then or previously. Nevertheless, in February 1978 Evgeny Nikolaev was taken from his home and reconfined under civil procedures to Moscow's Kashchenko ordinary psychiatric hospital, for a period of seven months. His confinement took place one month after he had helped form an unofficial trade union in Moscow. Contrary to the regulations governing compulsory confinement, he was given no preliminary psychiatric examination; no team of doctors visited him within 24 hours to decide whether prolongation of confinement was justified; and he was not examined by a monthly medical commission. While in the hospital Evgeny Nikolaev reports that he was treated with tablets of aminarin and haloperidol, and after an exercise book of his hospital diary notes had been confiscated, he was punished with injections of stelazin and cyclodol. Doctors in charge of his case reportedly asked him if he "still had ideas about reforming society?" and told him "You can forget about Honolulu and Helsinki." Throughout his confinement, members of the unofficial Working Commission to Investigate the Use of Psychiatry for Political Purposes and of the Moscow Helsinki monitoring group addressed appeals for his immediate release to the director of the hospital, and visited hospital staff to discuss his case. On May 29.1978 Evgeny Nikolaev's wife appealed to the World Psychiatric Association to intervene and secure his release. Mr. Nikolaev was let out of the Kashchenko hospital on September 12, 1978.

Since he left the Soviet Onion Evgeny Nikolaev has compiled a 54-page account of his psychiatric confinements, partly based on contemporaneous notes he made in the Kashchenko psychiatric hospital in 1978. He was first confined in September 1970 when, as a researcher in the AllUnion Institute for Scientific Research into Disinfection and Sterilization, he refused to take part in compulsory political meetings to honor the one hundredth anniversary of Lenin's birth. He was committed under civil procedures to Moscow's ordinary psychiatric hospital No. I5, where he remained until January 1971. On his release he was retained on the list of a psychiatric dispensary. One month later he was reconfincd under the civil procedure and remained in ordinary psychiatric hospitals in Moscow region for 17 months, with only a six week interval, when he was temporarily discharged. He was finally released in July 1972. During these two confinements Evgeny Nikolaev reports that his examining doctors questioned him about his political beliefs and urged him to change his opinions. In February 1974 Evgeny Nikolaev was once again arrested, two days after a group of Soviet Germans who had come to Moscow to demonstrate for their right to emigrate had spent the night at his flat. He was put in Kashchenko psychiatric hospital and released after three months.

In the summer of 1980 Vladimir Borisov, another victim of the political abuse of psychiatry was expelled from the Soviet Union. Before his emigration, Vladimir Borisov, an electrician and campaigner against violations of human rights, had spent a total of nine years in forcible psychiatric confinement, despite protests from his wife and family that he was not mentally ill. Borisov who is now 49-years-old, was first arrested in Leningrad in 1964 in connection with organizing an unofficial group of young socialists. He was charged with "anti-Soviet agitation and propaganda" but was ruled not-responsible for his actions. A court ordered him to be forcibly confined to a special psychiatric hospital, where he remained for three years. After he was released, he became a founding member of the unofficial Initiative Group for the Defense of Human Rights in the USSR in 1969, and was a signatory to a letter which the group sent to the United Nations appealing for the release of victims of psychiatric abuse, in particular Major General Pctro Grigorenko referred to above,

who at that time was forcibly confined in a special psychiatric hospital. Seven of the Initiative Group's members were arrested on a charge of "circulating antiSoviet slander," among them Vladimir Borisov. He was subsequently ruled not-responsible and, despite the lack of any evidence to show thai he was socially dangerous, reconfined to Leningrad Special Psychiatric hospital under . the criminal procedure, where he remained for five years v until his release in 1974. At the time of his second confinement his wife, Irina Kaplun, herself a prominent campaigner against the violation of human rights, protested to a psychiatrist that Borisov was not mentally ill. She was told: "Maybe, he was unlucky; he is down on our register. What may be a symptom of opinions in a normal person is a sign of illness in your husband." Vladimir Borisov himself was told by a psychiatrist: "Listen Borisov, you're a normal fellow and I am sure that you don't want to be sent to a madhouse. Why don't you change your views?" At the end of March 1980 Vladimir Borisov was once again committed to a psychiatric hospital in Leningrad, on this occasion under the civil procedure. He was discharged on May 3 and one month later was arrested and deported from the country.

In April 1978 a member of the British Royal College of Psychiatrists, Dr. Gary Low-Beer, visited Moscow and at their own request examined nine Soviet citizens of known nonconformist views, who feared that the authorities might put them in psychiatric hospitals against their will. Eight of the group had already been forcibly confined on ( previous occasions. Dr. Low-Beer was denied access to a tenth individual, Evgeny Nikolaev, who had also requested an independent examination. Mr. Nikolaev was at that time confined to the Kashchenko ordinary psychiatric hospital in Moscow. In a report made to the British Royal College of Psychiatrists in May 1978. after his visit, Dr. Low-Beer said:

"I examined the nine cases in the course of three
days. In my opinion none of these cases showed
any evidence of mental illness. Five of them were
completely healthy. Four showed minor abnormal-
ities only. The criteria for normality were unusually
high; minor depression or gestures of despair due
to family separation of long-standing being con-
sidered 'abnormal.' In no cases were these abnor-
malities sufficiently pronounced to justify com-
pulsory treatment either at the time of examination
or at any previous time. In my professional opin-
ion, therefore, these people must have been detain-
ed in psychiatric hospitals for reasons other than
psychiatric illness."

Three of those examined by Dr. Low-Beer—Yury Belov, Vladimir Borisov and Vladimir Gershuni—were all reconfincd in ordinary psychiatric hospitals for several weeks in 1979 and 1980. Yury Bclov and Vladimir Borisov have subsequently emigrated from the Soviet Union. Vladimir Gershuni, 52, who is an editor of an unofficial cultural journal, Poiski (Searches), and a member of SMOT, an in

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dependent trade union grouping in the Soviet Union, was rearrested on June 16, 1982. H.s is currently awaiting trial on a charge of "anti-Soviet agitation and propaganda."

Since 1977 fresh evidence about the political abuse of psychiatry has come not only from former victims and foreign psychiatrists, but also from members of the Soviet psychiatric profession. One psychiatrist who has spoken 1 out against such practices is Dr. Yury Novikov, who, until he left the USSR in June 1977, was the first secretary of the Association of Soviet Psychiatrists, and for six yean headed a section of the Serbsky Institute of Forensic Psychiatry in Moscow. In 1978 he made a public statement in which he said:

"Political abuses of psychiatry take place in the USSR, It is not the scale of this that matters, but the fact that it exists. The abuse of psychiatry for political purposes is a horrible and brutal practice, even were it limited to one person. There can be no doubt that psychiatric knowledge is abused in the USSR. There have been so many witnesses to this before me. I can only confirm that this is so."

Dr. Novikov also stated that the psychiatric diagnoses of certain prominent prisoners of conscience, including Major General Petro Grigorenko, had been falsified in the early 1970's in order to conceal the fact of their wrongful confinement from foreign psychiatrists and journalists visiting the Serbsky Institute.

In February 1980 another Soviet psychiatrist, Dr. Alexander Voloshanovich, emigrated from the Soviet Union. Dr. Voloshanovich was a member of the All-Union Society of Neurologists and Psychiatrists and had practiced in hospitals in the Moscow region for 10 years, until he resigned from his post in 1979 in protest against instances of the political abuse of psychiatry which he had witnessed. During the three years leading up to his emigration Dr. Voloshanovich personally examined 40 Soviet citizens of known nonconformist views who feared that the authorities might intern or retntem them in psychiatric hospitals. The 40 included members of unofficial trade union groups, a "dissenting" Baptist, members of the Russian Orthodox Church and others. He concluded thai none was in need of complusory confinement and publicized his conclusions at a press conference in Moscow in August 1978.

He was joined as a consultant to the Working Commission in December 1979 by a psychiatrist from the Kharkov Regional Psycho-Neurological Clinic in the Ukraine, Dr. Anatoly Koryagin. In the next 12 months. Dr. Koryagin examined at their own request a further I5 victims of psychiatric abuse, who included a citizen who had tried to cross the Soviet border without official permission; individuals who had renounced their Soviet citizenship; and an individual who was put in a mental hospital after complaining about his dismissal from work on a collective farm. In the article entitled "Unwilling Patients" which was published in The Lancet (London) in April 1981, Dr. Koryagin wrote:

"All the people I examined had joined the ranks of

the mentally ill because they did or said things which in our country are considered 'ami-Soviet...' These people were involved with the psychiatric service, although when I examined them they showed no signs of psychiatric illness, psychic defects or psychopathy."

Dr. Koryagin publicized the conclusions of his examination at a press conference in Moscow in January 1981, and was arrested the following month. He was subsequently sentenced to 12 years' imprisonment and internal exile for "anti-Soviet agitation and propaganda."

The principles established by the Serbsky Institute of Forensic Psychiatry in Moscow have an important place in Soviet psychiatric method. Particularly relevant to psychiatric abuse are the theories of Dr. A. V. Snezhnevsky, a leading psychiatrist ai the Institute and a member of the Academy of Science of the USSR. Dr. Snezhnevsky's concept of "sluggish schizophrenia"—a mental illness with no visible symptoms—has been used in psychiatric diagnoses that have secured the compulsory confinement of scores of known dissenters since the 1960S. Dr. Snezhnevsky has repeatedly denied that Soviet citizens have been wrongfully confined for political or any other reasons. In August 1973 he said in response to complaints of psychiatric abuses that "In 50 years of work in the Soviet public health service I know of no case in which a healthy man was put in a psychiatric hospital."

A statement which tended to corroborate the complaints, however, was made by the Chief Psychiatrist of the Soviet Ministry of Health, Dr. Zoya Serebryakova. Speaking at a congress of Soviet psychiatrists in Moscow in May 1981, she presented statistics about the inmates of one unidentified psychiatric hospital in the capital. According to her report, which was circulated in advance of the congress, around 90% of the inmates were confined because of "worsening long-term menial illnesss." Another 8fl» had been committed because they had shown themselves to be socially dangerous. In this category were classed individuals with suicidal tendencies, those who threatened others, or those who had shown "lapses of sexual restraint." One point two per cent of the hospital inmates, however, were confined because they had presented "groundless" and "slanderous" complaints against the Government. The report gave no indication that these individuals had shown themselves to be mentally ill or socially dangerous before confinement.

In recent years there has also been evidence that Dr. Snezhnevsky's theories are being challenged within the Soviet psychiatric profession on the grounds that they open the door to abuses. In 1979 an article written by Dr. Eiely Kazanets, a colleague of Dr. Snezhnevsky's at the Serbsky Institute, was published by the American Medical Association in Archives of General Psychiatry in which the author said that "the criteria of the Snezhevsky school arc "over-extended." Dr. Kazanets concluded that many were "incorrectly diagnosed" or "over-diagnosed." He went on to suggest that "many long-standing diagnoses need revision" and concluded that "over-diagnosis" and long retention of patients on psychiatric out-patient lists "constitute a real treat to their individual rights." After his article was published abroad Dr. Kazanets was dismissed from his post at the Scrbsky Institute. His article is not known to have been published officially in the Soviet Union.

By far the most prolific new evidence of political abuse of psychiatry has come from individuals within the USSR concerned with the protection of human rights. Since 1977 the reporting of A Chronicle of Current Events and individual human rights' activists has been supplemented by detailed documentation produced by the Working Commission to Investigate the Use of Psychiatry for Political Purposes, formed in January 1977. The Working Commission was set up as a branch of the unofficial Moscow Helsinki monitoring group, and had as one of its founding members Alexander Podrabinek, who was then a 23-yearold medical assistant in Moscow's public ambulance service. (The ambulance service frequently carries out forcible confinements under civil procedures.) Before joining the Commission Mr. Podrabinek had made a three-year independent study of allegations of psychiatric abuse, in the course of which be traveled to psychiatric hospitals in various republics of the Soviet Union, interviewed staff and spoke with former patients. Part of his study was confiscated by KGB officials in March 1977, but the remainder was published in samitdat form in May 1977 under the title Punitive Medicine. The book, which is 265 pages long, is based on material collected from more than 200 victims of psychiatric abuse, confined for political rather than genuine medical reasons since the 1950's. It also includes a "Black List" of 102 Soviet doctors whom the author said had participated in psychiatric abuse, and analyzes aspects of the official confinement procedures which facilitate abuse.

The other founding members of the Working Commission were Vyacheslav Bakhmin, a computer specialist; Dr. Leonard Ternovsky, a radiologist at Moscow's Sechonov Clinic; Felix Serebrov, a skilled metal-worker; and two long-standing campaigners against the abuse of human rights: Irina Kaplun (the wife of Vladimir Borisov, whose repeated confinements are mentioned above), and Dzhemma Babich from Leningrad. Within a year of in formation lrina Kaplun and Dzhemma Babich left the group. In 1980, another computer specialist from Moscow, lrina Grivnina, joined it.

The group outlined its threefold task as follows:
I."To publicize those cases where people are
wrongfully confined in mental hospitals against their
will, and to aid their speedy release.

2. To give help to people wrongfully put into mental hospitals and also to their families.

3. To assist in the general humanization of conditions for people in psychiatric hospitals."

The group explained further: "Here it is necessary to emphasize that the Commission does not claim that all the people whose release it ts seeking have no psychic abnormalities and are completelv healthy. (Working Commission's own emphasis—AI). The important thing is that they are in psychiatric hospitals for ideological reasons and not on the basis of medical evidence. The Commission considers complusory confinement and forcible treatment as justified only in regard to people who have committed aggressive acts, or ill people whose psychic condition gives grounds for a doctor to presume they may commit acts dangerous to themselves or to others."

The Working Commission aims were stated in their Information Bulletin Number 9 (dated June 9, 1978). In its three years' existence the group produced 24 of these Information Bulletins, consisting of over 700 pages, in which they chronicled the cases of over 70 victims of psychiatric abuse; reporting 260 further allegations of political abuse of psychiatry and highlighted the procedures involved in the punitive use of psychiatry. The group also wrote appeals to Soviet officials on behalf of individual people who had been confined, and published letters and accounts of their confinement written by victims who had been released. Friends and relatives of victims came frequently to Moscow to inform members of the Commission about individual cases, and the Commission's members supplemented this flow of information by trips to the provinces and visits to hospitals and courtrooms, in order to obtain information on the spot.

The scope and accuracy of the research carried out by the Working Commission was strengthened by the close collaboration of the psychiatrists. Dr. Alexander Voloshanovich and Dr. Anatoly Koryagin, and also of a lawyer, Sofia Kalistratova. Sofia Kalistratova, who is now 75-years-old, was also a member of the now defunct Moscow Helsinki monitoring group. In the I960's and early 1970's she acted as defense counsel in numerous political trials, and in 1970 defended Major General Grigorenko and the poet Natalya Gorbanevskaya at two separate trials. Both were subsequently confined to psychiatric hospitals against their will.

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