of all paychiatrista towards resolving the professional tasks standing before it, however, the resl activities of the WPA have been geared to another direction. The leadership of the WPA, instead of taking the read to uniting psychiatxists, ba: embarked upon the path of splitting them, and has turned int: an obediant tool in the hands of the forces which are using psychiatry for their own political goals, aimed at fanning up contradictions and enmity among paychiatrists of differen

countries.

Consequently, it is quite apparent that the WPA losde: ship has allowed itself to become involved in outright political activity end hes supported the slander against the Soviet Union. We have no doubts rheteseve that the WPA lostexship, by áts setárivy, is deing ireparable harm to tử. common interesis, of world paychiatry and to the unity of psycaiatzists from different mountries on the world.

In connection with this, the ill-Union Scientific Society of Neuropathologists and Paychiatrists no longer considers it pazzible to remain a member of the WPA, and hereby officially notifies the leadership of its departure from the WPA.

At the same time, the All-Union Scientific Society of Neuropathologists and Psychiatrists has notified all the Kational Psychiatzic Societies of the reasons for its departure from the WPA,

Mr. YATRON. Thank you, Dr. Visotsky, for your statement.

Now, Dr. Reich, would you like to begin sir? I understand that you have some slides that you want to show. So at that time, we will turn out the lights so that we can better view your slides. STATEMENT OF DR. WALTER REICH, RESEARCH PSYCHIATRIST AND PROGRAM DIRECTOR, THE STAFF COLLEGE OF THE NATIONAL INSTITUTE OF MENTAL HEALTH, MEMBER, THE AMERICAN PSYCHIATRIC ASSOCIATION'S TASK FORCE ON HUMAN RIGHTS, AND FORMER FELLOW OF THE KENNAN INSTITUTE FOR ADVANCED RUSSIAN STUDIES OF THE WOODROW WILSON INTERNATIONAL CENTER FOR SCHOLARS

Dr. REICH. Before doing that, I should like to note that, though I am an employee of the National Institute of Mental Health, I am speaking here as a private citizen. I wish to indicate that the opinions I will express here are my own and not necessarily those of the NIMH.

I did prepare a statement which I distributed, but I thought that it might be useful to show some slides, two of which are also included in the prepared statement, in order to give a human dimension to the phenomenon we are discussing, and perhaps also to explain some facets of it that may be better explained by the use of audio/visual materials.

Mr. YATRON. Without objection, your entire statement will be made part of the record.

Dr. REICH. Thank you.

First slide, please.

This is Dr. Andrei Snezhnevsky who is, in effect the chief Soviet psychiatrist, though there is no such formal title. The photograph was taken by me in Moscow last year when I visited him and interviewed both him and other members of the staff of his Institute of Psychiatry of the U.S.S.R. Academy of Medical Sciences. A report of that experience was published in the New York Times Magazine, which I have submitted to the committee for the record.1

Dr. Snezhnevsky is important because he is the author the concepts of psychiatry, specifically the approach to the diagnosis of schizophrenia that are the concepts that are most frequently used in Soviet psychiatry and that in fact have been most frequently used in the diagnoses of dissidents. He is an extremely influential figure in Soviet psychiatry. He is now near retirement. His age, I believe, is 79.

He is important and influential not only because he has headed, for 21 years the main psychiatric research institute in the Soviet Union, the Institute of Psychiatry of the U.S.S.R. Academy of Medical Sciences, but also because he is the editor of the only psychiatric periodical, the Korsakov Journal of Psychiatry and Neuropathology, and was a very important and influential teacher for many years in the Central Post-Graduate Medical Institute's Department of Psychiatry, of which he was chairman before moving to the Institute of Psychiatry. As you can see, on the slide, Snezhnevsky has

1 See app. 1.

a large photo of Ernest Hemingway on his office wall; Hemingway is, Snezhnevsky has told me, his favorite writer.

May I have the next slide please.

Another important figure with whom I met, and who will probably be Dr. Snezhnevsky's successor, was Dr. Marat Vartanyan. Vartanyan who has himself never been involved, to my knowledge, in any way with the cases of dissidents. In many respects, he has been the diplomat of Soviet psychiatry and has represented his profession in the West. He is a very urbane figure, who insists that though he was trained as a psychiatrist, he is primarily a scientist. For many years he has headed the scientific laboratories of the Institute of Psychiatry.

May I have the next slide please.

Dr. Ruben Nadzharov is a close colleague of Dr. Snezhnevsky's, and was also present at the meeting; together with Dr. Snezhnevsky, he developed the theories that I will describe this morning. Next slide please.

This is a photo of the Serbsky Institute, which figures prominently in the reports of Soviet psychiatric abuse. It is the central forensic psychiatric institute of the Soviet Union; and it is the place to which many of the dissidents have been sent. It is not set up just to deal with dissidents. Rather, it is set up as a forensic psychiatric institute, and persons accused of all kinds of crimes-murder, rape, and other crimes-are sent here for evaluation if there is some doubt as to their mental health. But also sent here are persons accused of crimes related to dissents.

Next slide please.

This is a side view of the Serbsky institute. The gentleman in the foreground at the time that I was there was gesticulating to a patient inside the institute. When I raised my camera, he stopped gesticulating, not knowing who I was. This gives you a sense of the enclosed nature of this institution, which is in fact a kind of prison/hospital.

Next slide please.

This is Dr. Snezhnevsky in 1977, in Honolulu, at the Sixth World Congress of Psychiatry, the one that preceded the one that occurred last July in Vienna; the 1977 Congress was the one at which the Soviets were condemned for their abuse of psychiatry, and it was at the congress that I first met Snezhevsky. I interviewed him in his hotel room. This photograph was taken just before the meeting at which the Soviets were condemned.

Next slide please.

Just after I interviewed Snezhnevsky the Soviets held a press conference. I show this photograph of the press conference in order to identify not only Dr. Snezhnevsky, but also Dr. Georgi Morozov, the head of the Serbsky Institute; as it happens, Marozov is now also the head of the All Union Society of Neuropathologists and Psychiatrists of the Soviet Union. It is Marozov who, more than any other Soviet psychiatrist, has been identified with the practice of diagnosing dissidents as mentally ill.

Next slide please.

This is Dr. Eduard Babayan, another Soviet psychiatrist, who is pointing an accusing finger at the American delegate during the voting session of the 1977 Psychiatric Congress at which the Sovi

ets were condemned. At the time, he was accusing the American CIA of abusing psychiatry by administering LSD.

Next slide please.

What I want to focus on this morning is the diagnosis of schizophrenia in the Soviet Union, specifically the approach to that diagnosis that Dr. Snezhnevsky has developed. This slide shows that there have been many approaches to the diagnosis of schizophrenia in the world. It is a very difficult condition to describe and to define, but, traditionally, there have been two main categories of schizophrenia that have been described. One category has consisted of syndromes and symptoms that are chronic and that amount to a severe condition-"real". schizophrenia. And another category has consisted of syndromes and symptoms that are less chronic in nature, and that amount a schizophrenia that is less severe-and therefore less "real."

More recently, another category of psychiatric illness has been suggested by various psychiatrists around the world. But that category has not been defined as being necessarily, a part of schizophrenia itself, though it has been said to resemble schizophrenia in some ways. In general, it has been assumed that a diagnostic borderline can be drawn between, on the one hand, the schizophrenias, both the "real" and the "less real," and on the other hand, this other category of psychiatric illness, sometimes called "borderline." However, though this "borderline" condition has been considered to be similar in some of its clinical characteristics, to schizophrenia, it has not been considered, by most theoreticians, to be a part of the schizophrenia category itself, primarily because, while schizophrenia is characterized by plychosis-the inability to accurately assess reality-the borderline condition is not.

What is important in the Soviet approach to schizophrenia is that this borderline condition has become part of the schizophrenia category; the line between them has been erased.

And now that the nonpsychotic borderline category is merged with schizophrenia, it is possible to diagnose schizophrenia in a patient without having to show that that patient is out of touch with reality.

Next slide please.

This is Dr. Snezhnevsky's own rendition of his theories. I present it in order to show its wonderful aesthetic symmetry. [Laughter.] Next slide please [same as figure 1 in prepared statement].

This is my rendition of his theories. He believes that schizophrenia has three course-forms, a course-form being the clinical form that the illness takes during the course of the patient's life. He believes that there is a "continuous" form, a "periodic" form, and a "shift-like" form.

If you consider the lines on this figure to represent the state of the patient's health from birth through old age, you can see that what happens in the "continuous course-form is that, at some point, usually in adolescence or early adulthood, the patient is said to become ill, suffers a continuing form of the illness, and stays ill through the rest of his life.

In the "periodic" course form, the patient is said to suffer attacks of illness, but when he improves, he is more or less as well as he was before the attack took place.