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.

Table 1

VULNERABLE STYLES

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

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 FOUR WINDS HOSPITAL, INSTRUCTOR IN PSYCHIATRY AT COLUMBIA UNIVERSITY, AND A FORMER SOVIET PSYCHIATRIST 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 percep

tion 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

ric Association in 1977 for their abuse of psychiatric knowledge, and power of a psychiatrist betraying their oath and commitment to the ethics of our profession.

I want to point out, Mr. Chairman, that even after the Second World War, when the uses and misuses of medicine, including experimentation on human beings, deprivation of life, frivolous experimentation of every kind, sterilization, and the like, conducted and controlled by German doctors, and doctors in several occupied territories, when these atrocities were publicized, I call to your attention the fact that not a single international or national medical society or specialty society of any kind condemned their colleagues for the practices in which they participated.

To my knowledge, the resolution adopted by the World Psychiatry Association with active participation of American Psychiatric Association in 1977, in Honolulu, was a historic landmark.

Thank you very much.

Mr. YATRON. Thank you, Dr. Zoubok, for your excellent statement.

Now we would like to call on Mr. Reddaway. Mr. Reddaway, you may proceed, sir.

STATEMENT OF PETER REDDAWAY, FELLOW AT THE KENNAN INSTITUTE OF ADVANCED RUSSIAN STUDIES, WOODROW WILSON CENTER, AND SENIOR LECTURER IN THE LONDON SCHOOL OF ECONOMICS

Mr. REDDAWAY. Thank you, Mr. Chairman.

I am grateful to have this opportunity to speak to your subcommittee. The main basis of what I have to say will be two books that I have published jointly with a psychiatrist, Dr. Sidney Bloch, one of which was referred to earlier by Mr. Fairbanks. The second volume is currently in the press.

It is also based on my active involvement in the Paris-based International Association on the Political Use of Psychiatry, which has existed for the last 3 years, and is rather active.

I will limit my statement to three aspects of the subject. Its size and scope, the political context of the U.S.S.R.'s forced resignation from the World Psychiatric Association [WPA] in January of this year, and my thoughts on possible future trends in official policy.

The practice of political psychiatry is based on the close collaboration between the police authorities of the U.S.S.R. and selected members of the psychiatric profession, the latter being regarded like other professions as a branch of the civil service. A careful selection has to be made, however, because although most Soviet psychiatrists have been trained in the dubious psychiatric theories of Dr. Snezhnevsky, which Dr. Reich has just presented to us and which justify the practice, and have not been trained in other theories-despite this, many of them instinctively sense that there is something wrong about the practice of political psychiatry and try to avoid personal involvement in it.

Moreover, a small, but apparently growing number resist it in various ways by refusing to assess individual dissenters as mentally ill, or by facilitating their early release, or by covertly supplying information on local cases to the Soviet human rights movement,

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