Our answer in all cases was yes—even to the point of tilting in the direction of finding illness, and even at the risk of harming Grigorenko. We would have to alter our usual hierarchy of values, placing our duty to our profession and to the project above our duty to the patient; and we knew that we would have to take steps that would demonstrate -to Grigorenko, to others and to ourselves that we had done so. Before anything, however, we would have to obtain from Grigorenko, in advance, his informed consent.

We explained to him what we had in mind, and what the potential dangers were for him, since we were insisting that he grant us permission not only to carry out the examination, but also to publicize it in any way we wished. He acknowledged our warnings and accepted our conditions with complete approval. After all, he said, he had nothing more to lose. He had already been labeled insane.

And so we prepared a document for Grigorenko's signaChero that

embodied these -a document that, under ordinary circum stance none of us would have asised a patient to sign. In this case, however, we felt we had to forestall any future objection that we had been bound to Grigorenko by the usual medical oaths and obligations and that, in effect, we had proceeded under conditions of advance censorship. Grigorenko read the document in Russian and signed it with, he said, no

The Man

Pyotr Grigorievich Grigorenko was born in 1907 to a Russian Orthodox peasant family in the Ukraine. His mother died of typhus when he was 3. His father remarried in 1913, but the new wife abandoned the household within a year, soon after the father was called up to serve in World War I.

Grigorenko was the first in his village to join the Communist Youth League. At the age of 15, he went to the city of Donetsk, where he found work as a locksmith and machinist and continued his schooling at night; at age 20, he joined the Communist Party. And it was the party that sent him to a

military engineering academy, from which he was graduated with distinction in 1934. Drafted into the Red Army, he saw his first military action in 1939 against the Japanese, and his back was injured in a grenade explosion. He was injured twice more in battle against the Germans.

After the war, Grigorenko joined the staff of the Frunze Military Academy in Moscow; in 1949, he was appointed deputy chairman of the department of scientific research and then, in 1958, chairmen of the department of cybernetics. Meanwhile he was winning the degree of Master of Military Sciences.

In 1959, Grigorenko achieved his highest military rank, major general. By the end of his military career five years later, he was the author of more than 60 articles in military science, most of them classified, and possessed numerous decorations, including the Order of Lenin, two Orders of the Red Banner, the Order of the Red Star, the Order of the Second World War, as well as seven military medals.

Grigorenko's first marriage in 1927 ended in divorce 15 years later. Three sons from that marriage now live in the Soviet Union. His second marriage, to his current wife, Zinaida, resulted in the birth of one son, Andrei, who emigrated to the United States several years ago.

The Dissident

Grigorenko had some sunali n-ins with Soviet authorities - he protested, for example, an instance of anti-Semitism in his academy-but his first serious clash resulted from a speech he delivered in 1961 as a delegate to a party conference in Moscow. He called for the democratization of party rules. He was promptly stripped of his delegate status. At about the same time, he wrote an open letter to Moscow voters criticizing the "unreasonable and often harmful activities of Khrushchev and his team." Grigorenko immediately lost his position at the military academy and, within a half year, was trans

ferred to a lesser post in the Far East.

There, Grigorenko founded a 13-member "Union for the Revival of Leninism” in 1983 and prepared and distributed leaf. lets calling for a return to Leninist tenets and principles. He was arrested and sent for his first psychiatric examination at the Serbsky Institute of Forensic Psychiatry in Moscow, where he was judged to be mentally ill. Hospitalized, be was not released until the spring of 1965, after Khrushchev's fall.

Unable to obtain any position in his own fleld, having lost his officer's pension, be was forced to find work, at age 58, as a porter and longshoreman. He sent protest letters to Prime Minister Kosygin, Pravda and the K.G.B.; be openly complained about the loss of his position and his title, and he publicly demonstrated against the trials of prominent dissidents.

In 1989, in response to an ap peal, he flew to Tashkent to be a defense witness in a trial of dissident leaders. He was arrested and sent to a Tashkent psychiatric commission for examination. That commis sion found him to be without mental illness. However, in an Unusua move, Grigorenko was transferred across the country to the Serbsky Insticute in Moscow for a second examination, where he was, again, found to be mentally ill. Once more he was forcibly hospitalized, this time for more than four years.

In 1974 he was released, and resumed his dissident activities. In 1977, he received the six-month visa to visit his son in New York, where he said he could obtain medical treat ment that was unavailable to him at home. Three months later, the Supreme Soviet issued a decree, signed by Leonid Brezhnev, revoking his citizenship, and Grigorenko announced that be was seeking asylum in the United States.

The Patient

Two commissions of forensic psychiatrists, both from the Serbsky Institute in Moscow, had recommended that Grigorenko be committed. Their findings were virtually identical.

In essence, they agreed that Grigorenko's dissent was the result not of rational conviction but, rather, of psychopathology. According to their theory of his mental illness, Grigorenko was suffering from a chronic paranoid condition that at times reached paychotic proportions and that caused him to act in ways that had brought him into conflict with Soviet law. Specifically. that illness caused in him a penchant for "reformism" — a need to reform society, to speak out and act out against authority and to focus himself repeatedly and obstinately on dissident themes. 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 barred. as ill, from attending his own trial and testifying in his own defense. Grigorenko's illness. the Soviet psychiatrists also implied, may have been aggravated or partly caused by arteriosclerotic changes in the blood vessels supplying his brain.

The Re-examination

In order to evaluate Grigorenko's psychiatric status as accurately and fully as possible, we arranged for an unusually elaborate re-examination procedure. The interviews. totaling some eight hours, .were carried out separately by ach of the psychiatrists. One was held at Harvard University and two in the videotape studio at the New York State Psychiatric Institute in upper Manhattan.

The questions asked of Grigorenko touched upon almost every dimension of his life, including his family, his early memories, his sexual, intellectual and moral development, his ideas, his impulses. his expectations, his feelings and the nature of his personal relationships. Inevitably, we paid particular attention to his political ideas and to the motivations for his dissident acts. All of the interviews were carried out through an interpreter, and all were recorded, two on videotape.

In addition, in order to investigate in depth those areas of psychopathology cited in the Soviet reports, three special examinations were performed, all by consultants from the Harvard Medical School. A three-hour battery of psychological tests was administered by Irene P. Stiver, including the kinds of interpretive, projective tests (such as the Rorschach "ink blot" test) that could reveal the presence of paranoid signs. And the question of an arteriosclerotic brain condition affecting Grigorenko's thinking, also noted in the Soviet diagnostic WES reports, investigated through a neurological examination by Norman Geschwind and an eight-hour battery of

neuropsychological tests by Barbara P. Jones.

Finally, we submitted videotaped interviews to the staff of the Biometrics Research Department at the New York State Psychiatric Institute. Using the information on the tapes, the members of the staff attempted to determine whether Grigorenko satisfied their research criteria for a diagnosis of mental illness, past or present.

Grigorenko does not read or speak English. Dr. Boris Zoubok, who was in the midst of his psychiatric residency at Columbia after having emigrated from the Soviet Union in 1973, kept Grigorenko informed of our procedures, advised us on special aspects of Soviet diagnostic definitions and provided us, as well as our consultants, with translations during all examinations. Ironcally, Dr. Zoubok had received part of his medical training in Moscow under the very same Dr. Snezhnevsky who had urged that Grigorenko be reexamined. For all his expertise, however, we were concerned that, as an émigré, Dr. Zoubok might be accused by the Soviets of having distorted Grigorenko's meaning in order to cover any signs of illness. We arranged for three other Russian-speaking persons to be present at the examinations or to review the tapes. In the end, all of them found Dr. Zoubok's transiations fully reliable.

Interviews

and Findings

Grigorenko is a large man of distinguished bearing with a shaved head and a slow, somewhat shuffling gait. Although sometimes quiet and subdued during our interviews, he often displayed considerable interest and animation. That was particularly true when he spoke about his political ideas and the changes they had undergone over the years and. also, when he remembered previously forgotten events with special clarity, pain or satisfaction. He was able, in response to direct questions, to recount aspects of his history with great precision, and he reacted to the content of his memories with a broad and full spectrum of responses. ranging from sad regret to evident enjoyment, from wistful reflection to obvious humor. He established a relationship with each of us quickly and easily, and was able to share with us his most distressing concerns as well as his jokes about the reversals, triumphs and ironies of his life.

He answered our questions fully and openly and offered up memories and reflecti that he knew, from his experience with Soviet psychiatry, could be construed, under particular circumstances, as symptoms or signs of certain psychiatric conditions.

Most of our questions were aimed at resolving the issue of Grigorenko's paranoid condition. If the Soviet diagnoses were correct, then some signs of that condition should still be present. And, too, we should be able to detect signs of it in his past as he presented it.

We questioned Grigorenko at length about the motivations for his dissident acts and ideas. Was he able to appreciate the dangers inherent in his actions? Did he have, or had he ever had, paranoid reformist delusions? Was he driven, as paranoids often are, by some unshakable belief about the world that had no correspondence with reality? Did he have an exalted, inflated view of his own powers, a grandiose sense of himself as superhuman, perhaps a messenger of God?

Grigorenko said that be always understood the possible consequences of his actions. In forming his Union for the Revival of Leninism, for example, he said that he had fully expected to be shot:

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

GRIGORENKO: "It was because I couldn't acquiesce to the regime. I knew that I would not achieve anything by organizing [the union], that it would be discovered very soon. But I thought that that would awaken a moral feeling in other people.... Soviet psychiatrists considered this to be the main evidence for my mental disease, the fact that I entered into this activity knowing of its futility. If American psychiatrists should have the same opinion, I would have to say, I would have to insist, that they're wrong."

We tried to press him about his motivations for continuing in his dissent, despite the dangers and the frustrations.

"It's not a personal cause." be said. "It's a social, commuSomeone always has to start.... This [Soviet] system of government should not be tolerated by people, but it never happens that everyone rises against it. There always have to be people who start — then others will follow. And those who start, regardless of whether or not they are talented, or have special abilities — they become a slogan, a banner, 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 extra year if you continue in the fraud of not facing things? It's better to live the rest of your life creatively 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.

GRIGORENKO: "No, this is not true. It's just that I became known. I was just lucky that I became known, mostly as a result of the campaign in my defense (organized by his wife]. There are many who did more than I did, but no one knows about them." PSYCHIATRIST: "Did God put it in their souls, too?" GRIGORENKO: "I think so. I think that Providence plays a greater role in the lives of people than we think." PSYCHIATRIST: "Do you think that you have some kind of special relationship with God?"

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

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

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 experiences. We assumed he would emphasize the deviousness and vindictiveness of the authorities in arresting him, in hospitalizing him, in stripping him of his rank and his officer's pension. Instead, he frequently pointed to the decency, sincerity, honesty and openness of some of his adversaries, including members of the Central Committee of the Communist Party.

Since the Soviet psychiatrists had expanded at length on Grigorenko's personality characteristics, stressing those that were consistent with a diagnosis of a paranoid condition, we made special attempts at identifying such characteristics.

We asked him, for example, about a confrontation he had had in 1949 arising from his master's dissertation. In its first chapter, the dissertation had contained implied criticisms of the military theories of unnamed, highranking officers, and he had been told to remove them. We asked how he had

responded to that advice, searching for evidence of a typically paranoid inability to compromise. He answered that, after a while, he had agreed to excise the criticisms.

We found other evidence of Grigorenko's flexibility as well. During his first hospitalization, for example, he revised his political beliefs, rejecting the very same Leninist notions in whose name he had carried out his illegal dissident acts and for whose sake he had been arrested and hospitalized.

And we systematically sought other indications of any paranoid condition either now or in the past — characteristics, traits or signs ranging from the most mild to the most severe. Our psychological consultant made a similar attempt. She, too, was unsuccessful.

Finally, we tried to clarify the question of arteriosclerotic brain disease. It appears that in 1972 Grigorenko experienced a small stroke that affected vision in his right eye. In addition, in his physical examination, our consuitant neurologist found evidence of arteriosclerosis of the right internal carotid artery. However, neither we nor our consultants, including our neuropsychological consultant, found any evidence that the arteriosclerosis was affecting Grigorenko's thinking, mood, behavior or character, or had done so in the past.

Conclusions

In reviewing our tests, interviews and other examinations, we could find no evidence of mental illness in Grigorenko, a conclusion confirmed independently by the biometrics research staff of the New York State Psychiatric Institute on the basis of their standardized evaluation of our videotaped interviews. Nor could we find evidence in Grigorenko's history consistent with mental illness in the past. In particular, there is no evidence of any mental illness in the paranoid range, even of the mildest sort. While there is evidence, on the basis of history and physical findings, of arteriosclerotic disease, there is no sign that this condition has significantly compromised Grigorenko's intellectual or emotional capacities, or that it has in any way formed or determined his behavior or mood. (A special session on the examinations that led to those conclusions will be held Tuesday at the convention of the American Psychiatric Association in Chicago.)

In the main, our task in examining Grigorenko was to look for signs of illness. What we found, instead, was a man — a man who, ironically, reminded us in some ways of the patient in Soviet descriptions. But their version of Grigorenko was consistently skewed. For where they claimed obsessions, we found perseverance; where they cited delusions, we found rationality; where they identified psychotic recklessness, we found committed devotion, and where they diagnosed pathology, we found health.