Political abuse of psychiatry in the Soviet Union

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There was systematic political abuse of psychiatry in the Soviet Union,^[1] based on the interpretation of political opposition or dissent as a psychiatric problem.^[2] It was called "psychopathological mechanisms" of dissent.^[3]

During the leadership of General Secretary Leonid Brezhnev, psychiatry was used to disable and remove from society political opponents (Soviet dissidents) who openly expressed beliefs that contradicted the official dogma.^[4][5] The term "philosophical intoxication", for instance, was widely applied to the mental disorders diagnosed when people disagreed with the country's Communist leaders and, by referring to the writings of the Founding Fathers of Marxism–Leninism—Karl Marx, Friedrich Engels, and Vladimir Lenin—made them the target of criticism.^[6] Another common pseudo-diagnosis was "sluggish schizophrenia".

The "anti-Soviet" political behavior of some individuals – being outspoken in their opposition to the authorities, demonstrating for reform, and writing critical books – were defined simultaneously as criminal acts (e.g., a violation of Articles 70 or 190–1), symptoms of mental illness (e.g., "delusion of reformism"), and susceptible to a ready-made diagnosis (e.g., "sluggish schizophrenia").^[8] Within the boundaries of the diagnostic category, the symptoms of pessimism, poor social adaptation and conflict with authorities were themselves sufficient for a formal diagnosis of "sluggish schizophrenia".^[9]

The psychiatric incarceration of certain individuals was prompted by their attempts to emigrate, to distribute or possess prohibited documents or books, to participate in civil rights protests and demonstrations, and become involved in forbidden religious activities.^[10] In accordance with the doctrine of state atheism, the religious beliefs of prisoners, including those of well-educated former atheists who had become adherents of a religious faith, was considered to be a form of mental illness that required treatment.^[11][12] The KGB routinely sent dissenters to psychiatrists for diagnosis, in order to discredit dissidence as the product of unhealthy minds and to avoid the embarrassment caused by public trials.^[13] Highly classified government documents that became available after the dissolution of the Soviet Union confirm that the authorities consciously used psychiatry as a tool to suppress dissent.^[14]

According to the "Commentary" to the post-Soviet Russian Federation Law on Psychiatric Care, individuals forced to undergo treatment in Soviet psychiatric medical institutions were entitled to rehabilitation in accordance with the established procedure and could claim compensation. The

In his book Punitive Medicine (1979) Alexander Podrabinek defined the term "punitive medicine", which is identified with "punitive psychiatry," as "a tool in the struggle against dissidents who cannot be punished by legal means."^[22] Punitive psychiatry is neither a discrete subject nor a psychiatric specialty but, rather, it is an emergency arising within many applied sciences in totalitarian countries where members of a profession may feel themselves compelled to serve the diktats of power.^[23] Psychiatric confinement of sane people is uniformly considered a particularly pernicious form of repression^[24] and Soviet punitive psychiatry was one of the key weapons of both illegal and legal repression.^[25]

As

The diagnosis of mental disease can give the state license to detain persons against their will and insist upon therapy both in the interest of the detainee and in the broader interests of society.[27] In addition, receiving a psychiatric diagnosis can itself be regarded as oppressive.^[28] In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.^[27]

In the period from the 1960s to 1986, the abuse of psychiatry for political purposes was reported to have been systematic in the Soviet Union and episodic in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.^[29] The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.^[30] Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.^[31] As scholars have long argued, governmental and medical institutions have at times classified threats to authority during periods of political disturbance and instability as a form of mental disease.^[32] In many countries, political prisoners are still sometimes confined and abused in mental institutions.^[33]

In the Soviet Union,

Punitive psychiatry was not simply an inheritance from the Stalin era, however, according to Alexander Etkind. The Gulag, or Chief Administration for Corrective Labor Camps, was an effective instrument of political repression. There was no compelling requirement to develop an alternative and more expensive psychiatric substitute.^[43] The abuse of psychiatry was a natural product of the later Soviet era.^[43] From the mid-1970s to the 1990s, the structure of the USSR mental health service conformed to the double standard in society, being represented by two distinct systems which co-existed peacefully for the most part, despite periodic conflicts between them:

1. system one was that of punitive psychiatry. It directly served the authorities and those in power, and was headed by the
   Moscow Institute for Forensic Psychiatry named in honour of Vladimir Serbsky
   ;
2. system two was made up of elite, psychotherapeutically oriented clinics. It was headed by the Leningrad Psychoneurological Institute named in memory of Vladimir Bekhterev.^[43]

The hundreds of hospitals in the provinces combined elements of both systems.^[43]

If someone was mentally ill then, they were sent to psychiatric hospitals and confined there until they died.

In the 1950s, the psychiatrists of the Soviet Union turned themselves into the medical arm of the Gulag State.^[45] A precursor of later abuses in psychiatry in the Soviet Union, the "Joint Session" of the USSR Academy of Medical Sciences and the Board of the All-Union Neurological and Psychiatric Association took place from 10 to 15 October 1951. The event was dedicated, supposedly, to the great Russian physiologist Ivan Pavlov, and alleged that several of the USSR's leading neuroscientists and psychiatrists of the time (among them Grunya Sukhareva, Vasily Gilyarovsky, Raisa Golant, Aleksandr Shmaryan, and Mikhail Gurevich) were guilty of practicing "anti-Pavlovian, anti-Marxist, idealistic [and] reactionary" science, and this was damaging to Soviet psychiatry.^[46]

During the Joint Session, these eminent psychiatrists, motivated by fear, had to publicly admit that their scientific positions were erroneous and they also had to promise to conform to "Pavlovian" doctrines.^[46] These public declarations of obedience proved insufficient. In the closing speech, Andrei Snezhnevsky, the lead author of the Session's policy report, stated that the accused psychiatrists "have not disarmed themselves and continue to remain in the old anti-Pavlovian positions", thereby causing "grave damage to the Soviet psychiatric research and practice". The vice president of the USSR Academy of Medical Sciences accused them of "diligently worshipping the dirty source of American pseudo-science".^[47] Those who articulated these accusations at the Joint Session – among them Irina Strelchuk, Vasily Banshchikov, Oleg Kerbikov, and Snezhnevsky – were distinguished by their careerist ambition and fear for their own positions.^[46] Not surprisingly, many of them were promoted and appointed to leadership posts shortly after the session.^[46]

The Joint Session also had a negative impact on several leading Soviet academic neuroscientists, such as

The incarceration of free thinking healthy people in madhouses is spiritual murder, it is a variation of the gas chamber, even more cruel; the torture of the people being killed is more malicious and more prolonged. Like the gas chambers, these crimes will never be forgotten and those involved in them will be condemned for all time during their life and after their death."

Alexander Solzhenitsyn

)

Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.^[52] It was the diagnosis of "sluggish schizophrenia" that was most prominently used in cases of dissidents.^[53] Sluggish schizophrenia as one of the new diagnostic categories was created to facilitate the stifling of dissidents and was a root of self-deception among psychiatrists to placate their consciences when the doctors acted as a tool of oppression in the name of a political system.^[54] According to the Global Initiative on Psychiatry chief executive Robert van Voren, the political abuse of psychiatry in the USSR arose from the conception that people who opposed the Soviet regime were mentally sick since there was no other logical rationale why one would oppose the sociopolitical system considered the best in the world.^[55] The diagnosis "sluggish schizophrenia", a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Snezhnevsky, furnished a very handy framework for explaining this behavior.^[55]

The weight of scholarly opinion holds that the psychiatrists who played the primary role in the development of this diagnostic concept were following directives from the Communist Party and the Soviet secret service, or KGB, and were well aware of the political uses to which it would be put. Nevertheless, for many Soviet psychiatrists "sluggish schizophrenia" appeared to be a logical explanation to apply to the behavior of critics of the regime who, in their opposition, seemed willing to jeopardize their happiness, family, and career for a reformist conviction or ideal that was so apparently divergent from the prevailing social and political orthodoxy.^[55]

Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences, developed a novel

In the 1960s and 1970s, theories, which contained ideas about reforming society and struggling for truth, and religious convictions were not referred to delusional paranoid disorders in practically all foreign classifications, but Soviet psychiatry, proceeding from ideological conceptions, referred critique of the political system and proposals to reform this system to the delusional construct.[58] Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union and several Eastern European countries.^[59]

On the covert orders of the

The campaign to declare political opponents mentally sick and to commit dissenters to mental hospitals began in the late 1950s and early 1960s.[39] As Vladimir Bukovsky commented on the emergence of the political abuse of psychiatry,^[65] Nikita Khrushchev reckoned that it was impossible for people in a socialist society to have an anti-socialist consciousness. Whenever manifestations of dissidence could not be justified as a provocation of world imperialism or a legacy of the past, they were self-evidently the product of mental disease.^[39] In a speech published in the Pravda daily newspaper on 24 May 1959, Khrushchev said:

A crime is a deviation from generally recognized standards of behavior frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offences, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal.^[39]

The now available evidence supports the conclusion that the system of political abuse of psychiatry was carefully designed by the KGB to rid the USSR of undesirable elements.^[66] According to several available documents and a message by a former general of the Fifth (dissident) Directorate of the Ukrainian KGB to Robert van Voren, political abuse of psychiatry as a systematic method of repression was developed by Yuri Andropov along with a selected group of associates.^[67]

Andropov was in charge of the wide-ranging deployment of psychiatric repression from the moment he was appointed to head the KGB.

In 1929, the USSR had 70 psychiatric hospitals and 21,103 psychiatric beds. By 1935, this had increased to 102 psychiatric hospitals and 33,772 psychiatric beds, and by 1955 there were 200 psychiatric hospitals and 116,000 psychiatric beds in the Soviet Union.[78] The Soviet authorities built psychiatric hospitals at a rapid pace and increased the quantity of beds for patients with nervous and mental illnesses: between 1962 and 1974, the number of beds for psychiatric patients increased from 222,600 to 390,000.^[79] Such an expansion in the number of psychiatric beds was expected to continue in the years up to 1980.^[80] Throughout this period the dominant trend in Soviet psychiatry ran counter to the vigorous attempts in Western countries to treat as many as possible as out-patients rather than in-patients.^[80]

On 15 May 1969, a Soviet Government decree (No. 345–209) was issued "On measures for preventing dangerous behavior (acts) on the part of mentally ill persons."^[81] This decree confirmed the practice of having undesirables hauled into detention by psychiatrists.^[81] Soviet psychiatrists were told whom they should examine and were assured that they might detain these individuals with the help of the police or entrap them into coming to the hospital.^[81] The psychiatrists thereby doubled as interrogators and as arresting officers.^[81] Doctors fabricated a diagnosis requiring detention and no court decision was required for subjecting the individual to indefinite confinement in a psychiatric institution.^[81]

By the end of the 1950s, confinement to a psychiatric institution had become the most commonly used method of punishing leaders of the political opposition.

Political dissidents were usually charged under Articles 70 (agitation and propaganda against the Soviet state) and 190-1 (dissemination of false fabrications defaming the Soviet state and social system) of the RSFSR Criminal Code.[9] Forensic psychiatrists were asked to examine offenders whose mental state was considered abnormal by the investigating officers.^[9]

In almost every case, dissidents were examined at the Serbsky Central Research Institute for Forensic Psychiatry

The accused had no right of appeal.[9] The right was given to their relatives or other interested persons but they were not allowed to nominate psychiatrists to take part in the evaluation, because all psychiatrists were considered fully independent and equally credible before the law.^[9]

According to dissident poet

A well-documented practice was the use of psychiatric hospitals as temporary prisons during the two or three weeks around the 7 November (October Revolution) Day and May Day celebrations, to isolate "socially dangerous" persons who otherwise might protest in public or manifest other deviant behavior.^[88]

In the 1960s, a vigorous movement grew up protesting against abuse of psychiatry in the USSR.^[89] Political abuse of psychiatry in the Soviet Union was denounced in the course of the Congresses of the World Psychiatric Association in Mexico City (1971), Hawaii (1977), Vienna (1983) and Athens (1989).^[9] The campaign to terminate political abuse of psychiatry in the USSR was a key episode in the Cold War, inflicting irretrievable damage on the prestige of medicine in the Soviet Union.^[60]

Upon analysis of over 200 well-authenticated cases covering the period 1962–1976, Sidney Bloch and Peter Reddaway developed a classification of the victims of Soviet psychiatric abuse. They were classified as:^[90]

1. advocates of human rights or democratization;
2. nationalists;
3. would-be emigrants;
4. religious believers;
5. citizens inconvenient to the authorities.

The advocates of human rights and democratization, according to Bloch and Reddaway, made up about half the dissidents repressed by means of psychiatry.^[90] Nationalists made up about one-tenth of the dissident population dealt with psychiatrically.^[91] Would-be emigrants constituted about one-fifth of dissidents victimized by means of psychiatry.^[92] People detained only because of their religious activity made up about fifteen per cent of dissident-patients.^[92] Citizens inconvenient to the authorities because of their "obdurate" complaints about bureaucratic excesses and abuses accounted for about five per cent of dissidents subject to psychiatric abuse.^[93]

In 1985, Peter Reddaway and Sidney Bloch provided documented data on some five hundred cases in their book Soviet Psychiatric Abuse.^[94]

On basis of the available data and materials accumulated in the archives of the

The scale of the application of methods of repressive psychiatry in the USSR is testified by inexorable figures and facts. A commission of the top Party leadership headed by

Kuibyshev, Novosibirsk, and other parts of the Soviet Union. In the course of the changes that the country underwent in 1988, five prison hospitals were transferred from the MVD to the jurisdiction of the Ministry of Health, while another five were closed down. There was a hurried covering of tracks through the mass rehabilitation of patients, some of whom were mentally disabled (in one and the same year no less than 800,000 patients were removed from the psychiatric registry). In Leningrad alone 60,000 people with a diagnosis of mental illness were released and rehabilitated in 1991 and 1992. In 1978, 4.5 million people throughout the USSR were registered as psychiatric patients. This was equivalent to the population of many civilized countries.^[106]

In Ukraine, a study of the origins of the political abuse of psychiatry was conducted for five years on the basis of the State archives.[107] A total of 60 people were again examined.^[107] All were citizens of Ukraine, convicted of political crimes and hospitalized on the territory of Ukraine. Not one of them, it turned out, was in need of any psychiatric treatment.^[107]

From 1993 to 1995, a presidential decree on measures to prevent future abuse of psychiatry was being drafted at the Commission for Rehabilitation of the Victims of Political Repression.^[108] For this purpose, Anatoly Prokopenko selected suitable archival documents and, at the request of Vladimir Naumov, the head of research and publications at the commission, Emmanuil Gushansky drew up the report.^[108] It correlated the archival data presented to Gushansky with materials received during his visits, conducted jointly with the commission of the Independent Psychiatric Association of Russia, to several strict-regime psychiatric hospitals (former Special Hospitals under MVD control).^[108] When the materials for discussion in the Commission for Rehabilitation of the Victims of Political Repression were ready, however, the work came to a standstill.^[108] The documents failed to reach the head of the Commission Alexander Yakovlev.^[108]

The report on political abuse of psychiatry prepared at the request of the commission by Gushansky with the aid of Prokopenko lay unclaimed and even the Independent Psychiatric Journal (Nezavisimiy Psikhiatricheskiy Zhurnal)^[102] would not publish it. The Moscow Research Center for Human Rights headed by Boris Altshuler and Alexey Smirnov and the Independent Psychiatric Association of Russia whose president is Yuri Savenko were asked by Gushansky to publish the materials and archival documents on punitive psychiatry but showed no interest in doing so.^[108] Publishing such documents is dictated by present-day needs and by how far it is feared that psychiatry could again be abused for non-medical purposes.^[109]

In its 2000 report, the Commission for Rehabilitation of the Victims of Political Repression included only the following four phrases about the political abuse of psychiatry:^[110]

The Commission has also considered such a complex, socially relevant issue, as the use of psychiatry for political purposes. The collected documents and materials allow us to say that the extrajudicial procedure of admission to psychiatric hospitals was used for compulsory hospitalization of persons whose behavior was viewed by the authorities as "suspicious" from the political point of view. According to the incomplete data, hundreds of thousands of people have been illegally placed to psychiatric institutions of the country over the years of Soviet power. The rehabilitation of these people was limited, at best, to their removal from the registry of psychiatric patients and usually remains so today, due to gaps in the legislation.

In the 1988 and 1989, about two million people were removed from the psychiatric registry at the request of Western psychiatrists. It was one of their conditions for the re-admission of Soviet psychiatrists to the World Psychiatric Association.^[111] Yury Savenko has provided different figures in different publications: about one million,^[112] up to one and a half million,^[113] about one and a half million people removed from the psychiatric registry.^[114] Mikhail Buyanov provided the figure of over two million people removed from the psychiatric registry.^[115]

In 1990, Psychiatric Bulletin of the Royal College of Psychiatrists published the article "Compulsion in psychiatry: blessing or curse?" by Russian psychiatrist Anatoly Koryagin. It contains analysis of the abuse of psychiatry and eight arguments by which the existence of a system of political abuse of psychiatry in the USSR can easily be demonstrated. As Koryagin wrote, in a dictatorial State with a totalitarian regime, such as the USSR, the laws have at all times served not the purpose of self-regulation of the life of society but have been one of the major levers by which to manipulate the behavior of subjects. Every Soviet citizen has constantly been straight considered state property and been regarded not as the aim, but as a means to achieve the rulers' objectives. From the perspective of state pragmatism, a mentally sick person was regarded as a burden to society, using up the state's material means without recompense and not producing anything, and even potentially capable of inflicting harm. Therefore, the Soviet State never considered it reasonable to pass special legislative acts protecting the material and legal part of the patients' life. It was only instructions of the legal and medical departments that stipulated certain rules of handling the mentally sick and imposing different sanctions on them. A person with a mental disorder was automatically divested of all rights and depended entirely on the psychiatrists' will. Practically anybody could undergo psychiatric examination on the most senseless grounds and the issued diagnosis turned him into a person without rights. It was this lack of legal rights and guarantees that advantaged a system of repressive psychiatry in the country.^[116]

According to American psychiatrist Oleg Lapshin, Russia until 1993 did not have any specific legislation in the field of mental health except uncoordinated instructions and articles of laws in criminal and administrative law, orders of the

According to Yuri Savenko, the president of the Independent Psychiatric Association of Russia (the IPA), punitive psychiatry arises on the basis of the interference of three main factors:[118]

1. The ideologizing of science, its breakaway from the achievements of world psychiatry, the party orientation of Soviet forensic psychiatry.
2. The lack of legal basis.
3. The total nationalization of mental health service.

Their interaction system is principally sociological: the presence of the Penal Code article on slandering the state system inevitably results in sending a certain percentage of citizens to forensic psychiatric examination.^[23] Thus, it is not psychiatry itself that is punitive, but the totalitarian state uses psychiatry for punitive purposes with ease.^[23]

According to Larry Gostin, the root cause of the problem was the State itself.^[119] The definition of danger was radically extended by the Soviet criminal system to cover "political" as well as customary physical types of "danger".^[119] As Bloch and Reddaway note, there are no objective reliable criteria to determine whether the person's behavior will be dangerous, and approaches to the definition of dangerousness greatly differ among psychiatrists.^[120]

Richard Bonnie, a professor of law and medicine at the University of Virginia School of Law, mentioned the deformed nature of the Soviet psychiatric profession as one of the explanations for why it was so easily bent toward the repressive objectives of the state, and pointed out the importance of a civil society and, in particular, independent professional organizations separate and apart from the state as one of the most substantial lessons from the period.^[121]

According to Norman Sartorius, a former president of the World Psychiatric Association, political abuse of psychiatry in the former Soviet Union was facilitated by the fact that the national classification included categories that could be employed to label dissenters, who could then be forcibly incarcerated and kept in psychiatric hospitals for "treatment".^[122] Darrel Regier, vice-chair of the DSM-5 task force, has a similar opinion that the political abuse of psychiatry in the USSR was sustained by the existence of a classification developed in the Soviet Union and used to organize psychiatric treatment and care.^[123] In this classification, there were categories with diagnoses that could be given to political dissenters and led to the harmful involuntary medication.^[123]

According to Moscow psychiatrist Alexander Danilin, the so-called "nosological" approach in the Moscow psychiatric school established by Snezhnevsky boils down to the ability to make the only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept "sluggish schizophrenia" introduced some time once by an academician Snezhnevsky, whom Danilin called a state criminal.^[124]

According to American psychiatrist Walter Reich, the misdiagnoses of dissidents resulted from some characteristics of Soviet psychiatry that were distortions of standard psychiatric logic, theory, and practice.[53]

According to

Gluzman says that there, of course, may be a different approach to the issue expressed by Michel Foucault.^[127] According to

In 1977, British psychiatrist David Cooper asked Foucault the same question which Claude Bourdet had formerly asked Viktor Fainberg during a press conference given by Fainberg and Leonid Plyushch: when the USSR has the whole penitentiary and police apparatus, which could take charge of anybody, and which is perfect in itself, why do they use psychiatry? Foucault answered it was not a question of a distortion of the use of psychiatry but that was its fundamental project.^[129] In the discussion Confinement, Psychiatry, Prison, Foucault states the cooperation of psychiatrists with the KGB in the Soviet Union was not abuse of medicine, but an evident case and "condensation" of psychiatry's "inheritance", an "intensification, the ossification of a kinship structure that has never ceased to function."^[130] Foucault believed that the abuse of psychiatry in the USSR of the 1960s was a logical extension of the invasion of psychiatry into the legal system.^[131] In the discussion with Jean Laplanche and Robert Badinter, Foucault says that criminologists of the 1880—1900s started speaking surprisingly modern language: "The crime cannot be, for the criminal, but an abnormal, disturbed behavior. If he upsets society, it's because he himself is upset".^[132] This led to the twofold conclusions.^[132] First, "the judicial apparatus is no longer useful." The judges, as men of law, understand such complex, alien legal issues, purely psychological matters no better than the criminal. So commissions of psychiatrists and physicians should be substituted for the judicial apparatus.^[132] And in this vein, concrete projects were proposed.^[132] Second, "We must certainly treat this individual who is dangerous only because he is sick. But, at the same time, we must protect society against him."^[132] Hence comes the idea of mental isolation with a mixed function: therapeutic and prophylactic.^[132] In the 1900s, these projects have given rise to very lively responses from European judicial and political bodies.^[133] However, they found a wide field of applications when the Soviet Union became one of the most common but by no means exceptional cases.^[133]

According to American psychiatrist Jonas Robitscher, psychiatry has been playing a part in controlling deviant behavior for three hundred years.^[134] Vagrants, "originals," eccentrics, and homeless wanderers who did little harm but were vexatious to the society they lived in were, and sometimes still are, confined to psychiatric hospitals or deprived of their legal rights.^[134] Some critics of psychiatry consider the practice as a political use of psychiatry and regard psychiatry as promoting timeserving.^[134]

As Vladimir Bukovsky and Semyon Gluzman point out, it is difficult for the average Soviet psychiatrist to understand the dissident's poor adjustment to Soviet society.^[135] This view of dissidence has nothing surprising about it—conformity reigned in Soviet consciousness; a public intolerance of non-conformist behavior always penetrated Soviet culture; and the threshold for deviance from custom was similarly low.^[135]

An example of the low threshold is a point of Donetsk psychiatrist Valentine Pekhterev, who argues that psychiatrists speak of the necessity of adapting oneself to society, estimate the level of man's social functioning, his ability to adequately test the reality and so forth.^[136] In Pekhterev's words, these speeches hit point-blank on the dissidents and revolutionaries, because all of them are poorly functioning in society, are hardly adapting to it either initially or after increasing requirements.^[136] They turn their inability to adapt themselves to society into the view that the company breaks step and only they know how to help the company restructure itself.^[136] The dissidents regard the cases of personal maladjustment as a proof of public ill-being.^[136] The more such cases, the easier it is to present their personal ill-being as public one.^[136] They bite the society's hand that feed them only because they are not given a right place in society.^[136] Unlike the dissidents, the psychiatrists destroy the hardly formed defense attitude in the dissidents by regarding "public well-being" as personal one.^[136] The psychiatrists extract teeth from the dissidents, stating that they should not bite the feeding hand of society only because the tiny group of the dissidents feel bad being at their place.^[136] The psychiatrists claim the need to treat not society but the dissidents and seek to improve society by preserving and improving the mental health of its members.^[136] After reading the book Institute of Fools by Viktor Nekipelov, Pekhterev concluded that allegations against the psychiatrists sounded from the lips of a negligible but vociferous part of inmates who when surfeiting themselves with cakes pretended to be sufferers.^[136]

According to the response by Robert van Voren, Pekhterev in his article condescendingly argues that the Serbsky Institute was not so bad place and that Nekipelov exaggerates and slanders it, but Pekhterev, by doing so, misses the main point: living conditions in the Serbsky Institute were not bad, those who passed through psychiatric examination there were in a certain sense "on holiday" in comparison with the living conditions of the Gulag; and all the same, everyone was aware that the Serbsky Institute was more than the "gates of hell" from where people were sent to specialized psychiatric hospitals in

According to Fedor Kondratev, an expert of the Serbsky Center and supporter of Snezhnevsky and his colleagues who developed the concept of sluggish schizophrenia in the 1960s,[139] those arrested by the KGB under RSFSR Criminal Code Article 70 ("anti-Soviet agitation and propaganda"), 190-1 ("dissemination of knowingly false fabrications that defame the Soviet state and social system") made up, in those years, the main group targeted by the period of using psychiatry for political purposes.^[140] It was they who began to be searched for "psychopathological mechanisms" and, therefore, mental illness which gave the grounds to recognize an accused person as mentally incompetent, to debar him from appearance and defence in court, and then to send him for compulsory treatment to a special psychiatric hospital of the Ministry of Internal Affairs.^[140] The trouble (not guilt) of Soviet psychiatric science was its theoretical overideologization as a result of the strict demand to severely preclude any deviations from the "exclusively scientific" concept of Marxism–Leninism.^[3] This showed, in particular, in the fact that Soviet psychiatry under the totalitarian regime considered that penetrating the inner life of an ill person was flawed psychologization, existentionalization.^[3] In this connection, one did not admit the possibility that an individual can behave "in a different way than others do" not only because of his mental illness but on the ground alone of his moral sets consistently with his conscience.^[3] It entailed the consequence: if a person different from all others opposes the political system, one needs to search for "psychopathological mechanisms" of his dissent.^[3] Even in cases when catamnesis confirmed the correctness of a diagnosis of schizophrenia, it did not always mean that mental disorders were the cause of dissent and, all the more, that one needed to administer compulsory treatment "for it" in special psychiatric hospitals.^[3] What seems essential is another fact that the mentally ill could oppose the totalitarianism as well, by no means due to their "psychopathological mechanisms", but as persons who, despite having the diagnosis of schizophrenia, retained moral civic landmarks.^[141] Any ill person with schizophrenia could be a dissident if his conscience could not keep silent, Kondratev says.^[142]

According to St Petersburg psychiatrist Vladimir Pshizov, with regard to punitive psychiatry, the nature of psychiatry is of such a sort that using psychiatrists against opponents of authorities is always tempting for the authorities, because it is seemingly possible not to take into account an opinion by the person who received a diagnosis.^[143] Therefore, the issue will always remain relevant.^[143] While we do not have government policy of using psychiatry for repression, psychiatrists and former psychiatric nomenklatura retained the same on-the-spot reflexes.^[143]

As Ukrainian psychiatrist Ada Korotenko notes, the use of punitive psychiatry allowed of avoiding the judicial procedure during which the accused might declare the impossibility to speak publicly and the violation of their civil rights.^[144] Making a psychiatric diagnosis is insecure and can be based on a preconception.^[145] Moreover, while diagnosing mental illness, subjective fuzzy diagnostic criteria are involved as arguments.^[145] The lack of clear diagnostic criteria and clearly defined standards of diagnostics contributes to applying punitive psychiatry to vigorous and gifted citizens who disagree with authorities.^[145] At the same time, most psychiatrists incline to believe that such a misdiagnosis is less dangerous than not diagnosing mental illness.^[145]

German psychiatrist Hanfried Helmchen says the uncertainty of diagnosis is prone to other than medical influence, e.g., political influence, as was the case with Soviet dissenters who were stifled by a psychiatric diagnosis, especially that of "sluggish schizophrenia," in order to take them away from society in special psychiatric hospitals.^[146]

According to Russian psychologist Dmitry Leontev, punitive psychiatry in the Soviet Union was based on the assumption that only a madman can go against public dogma and seek for truth and justice.^[147]

K. Fulford, A. Smirnov, and E. Snow state: "An important vulnerability factor, therefore, for the abuse of psychiatry, is the subjective nature of the observations on which psychiatric diagnosis currently depends."

As Michael Robertson and Garry Walter suppose, psychiatric power in practically all societies expands on the grounds of public safety, which, in the view of the leaders of the USSR, was best maintained by the repression of dissidence.[155] According to Gwen Adshead, a British forensic psychotherapist at the Broadmoor Hospital, the question is what is meant by the word "abnormal."^[156] Evidently it is possible for abnormal to be identified as "socially inappropriate."^[156] If that is the case, social and political dissent is turned into a symptom by the medical terminology, and thereby becomes an individual's personal problem, not a social matter.^[156]

According to Russian psychiatrist Emmanuil Gushansky, psychiatry is the only medical specialty in which the doctor is given the right to violence for the benefit of the patient.^[157] The application of violence must be based on the mental health law, must be as much as possible transparent and monitored by representatives of the interests of persons who are in need of involuntary examination and treatment.^[157] While being hospitalized in a psychiatric hospital for urgent indications, the patient should be accompanied by his relatives, witnesses, or other persons authorized to control the actions of doctors and law-enforcement agencies.^[157] Otherwise, psychiatry becomes an obedient maid for administrative and governmental agencies and is deprived of its medical function.^[157] It is the police that must come to the aid of citizens and is responsible for their security.^[102] Only later, after the appropriate legal measures for social protection have been taken, the psychiatrist must respond to the queries of law enforcement and judicial authorities by solving the issues of involuntary hospitalization, sanity, etc.^[102] In Russia, all that goes by opposites.^[102] The psychiatrist is vested with punitive functions, is involved in involuntary hospitalization, the state machine hides behind his back, actually manipulating the doctor.^[102] The police are reluctant to investigate offences committed by the mentally ill.^[102] After receiving the information about their disease, the bodies of inquiry very often stop the investigation and do not bring it to the level of investigative actions.^[102] Thereby psychiatry becomes a cloak for the course of justice and, by doing so, serves as a source for the rightlessness and stigmatization of both psychiatrists and persons with mental disorders.^[102] The negative attitude to psychiatrists is thereby supported by the state machine and is accompanied by the aggression against the doctors, which increases during the periods of social unrest.^[102]

Vladimir Bukovsky, well known for his struggle against political abuse of psychiatry in the Soviet Union, explained that using psychiatry against dissidents was usable to the KGB because hospitalization did not have an end date, and, as a result, there were cases when dissidents were kept in psychiatric prison hospitals for 10 or even 15 years.^[158] "Once they pump you with drugs, they can forget about you", he said and added, "I saw people who basically were asleep for years."^[159]

In the opinion of the Moscow Helsinki Group chairwoman Lyudmila Alexeyeva, the attribution of a mental illness to a prominent figure who came out with a political declaration or action is the most significant factor in the assessment of psychiatry during the 1960–1980s.^[160] The practice of forced confinement of political dissidents in psychiatric facilities in the former USSR and Eastern Europe destroyed the credibility of psychiatric practice in these countries.^[30] When the psychiatric profession is discredited in one part of the world, psychiatry is discredited throughout the world.^[161] Psychiatry lost its professional basis entirely when it was abused to stifle dissidence in the former USSR and in the euthanasia program in Nazi Germany.^[162] There is little doubt that the capacity for using psychiatry to enforce social norms and even political interests is immense.^[30] Now psychiatry is vulnerable because many of its notions have been questioned, and the sustainable pattern of mental life, of boundaries of mental norm and abnormality has been lost, director of the Moscow Research Institute for Psychiatry Valery Krasnov says, adding that psychiatrists have to seek new reference points to make clinical assessments and new reference points to justify old therapeutical interventions.^[160]

As Emmanuil Gushansky states, today subjective position of a Russian patient toward a medical psychologist and psychiatrist is defensive in nature and prevents the attempt to understand the patient and help him assess his condition.^[163] Such a position is related to constant, subconscious fear of psychiatrists and psychiatry.^[163] This fear is caused by not only abuse of psychiatry, but also constant violence in the totalitarian and post-totalitarian society.^[163] The psychiatric violence and psychiatric arrogance as one of manifestations of such violence is related to the primary emphasis on symptomatology and biological causes of a disease, while ignoring psychological, existential, and psychodynamic factors.^[163] Gushainsky notices that the modern Russian psychiatry and the structure of providing mental health care are aimed not at protecting the patient's right to an own place in life, but at discrediting such a right, revealing symptoms and isolating the patient.^[102]

The psychiatrist became a scarecrow attaching psychiatric labels.

Robert van Voren noted that after the fall of the Berlin Wall, it became apparent that the political abuse of psychiatry in the USSR was only the tip of the iceberg, the sign that much more was basically wrong.^[167] This much more realistic image of Soviet psychiatry showed up only after the Soviet regime began to loosen its grip on society and later lost control over the developments and in the end entirely disintegrated.^[167] It demonstrated that the actual situation was much sorer and that many individuals had been affected.^[167] Millions of individuals were treated and stigmatized by an outdated biologically oriented and hospital-based mental health service.^[167] Living conditions in clinics were bad, sometimes even terrible, and violations of human rights were rampant.^[167] According to the data of a census published in 1992, the mortality of the ill with schizophrenia exceeded that of the general population by 4–6 times for the age of 20–39 years, by 3–4 times for the age of 30–39 years, by 1.5–2 times for the age over 40 years (larger values are for women).^[168]

According to Robert van Voren, although for several years, especially after the implosion of the USSR and during the first years of

Throughout the post-communist period, the pharmaceutical industry has mainly been an obstacle to reform.[170] Aiming to explore the vast market of the former USSR, they used the situation to make professionals and services totally dependent on their financial sustenance, turned the major attention to the availability of medicines rather than that of psycho-social rehabilitation services, and stimulated corruption within the mental health sector very much.^[170]

At the turn of the century, the

At his press conference in 2008,

In the Soviet times, mental hospitals were frequently created in former monasteries, barracks, and even concentration camps.

While speaking of the Serbsky Center, Yuri Savenko alleges that "practically nothing has changed. They have no shame at the institute about their role with the Communists. They are the same people, and they do not want to apologize for all their actions in the past." Attorney Karen Nersisyan agrees: "Serbsky is not an organ of medicine. It's an organ of power."^[193] According to human rights activist and former psychiatrist Sofia Dorinskaya, the system of Soviet psychiatry has not been destroyed, the Serbsky Institute is standing where it did, the same people who worked in the Soviet system are working there.^[194] She says we have a situation like after the defeat of fascism in Germany, when fascism officially collapsed, but all governors of acres, judges and all people remained after the fascist regime.^[194]

In his article of 2002,

Robert van Voren also says Russian psychiatry is now being headed by the same psychiatrists who was heading psychiatry in Soviet times.[199] Since then Russian psychiatric system has not almost changed.^[199] In reality, we still see a sort of the Soviet psychiatry that was in the late 1980s.^[199] Russian psychiatrists do not have access to specialized literature published in other countries and do not understand what is world psychiatry.^[199] Staff training has not changed, literature is inaccessible, the same psychiatrists teach new generations of specialists.^[199] Those of them who know what is world psychiatry and know it is not the same as what is happening in Russia are silent and afraid.^[199] The powerful core of the old nomenklatura in psychiatry was concentrated in Moscow, and it was clear that the struggle inside their fortress would be not only difficult, but also it would be a waste of time, energy and resources, so the Global Initiative on Psychiatry has been avoiding Moscow almost completely for all the years.^[200] Instead, the Global Initiative on Psychiatry took active part in projects for reforming the mental health service in Ukraine, donated a printing plant to Ukrainian public, organized a publishing house, helped print a huge amount of medical and legal literature distributed for free, but the Ukrainian tax police accused the publishing house of manufacturing counterfeit dollars, and a significant part of humanitarian aid that the Global Initiative on Psychiatry had gathered in the Netherlands for Ukrainian psychiatric hospitals was stolen in Kyiv.^[200]

Many of the current leaders of Russian psychiatry, especially those who were related to the establishment in Soviet period, have resiled from their avowal read at the 1989 General Assembly of the WPA that Soviet psychiatry had been systematically abused for political purposes.

In 2007, Mikhail Vinogradov, one of the leading staff members of the Serbsky Center, strongly degraded the human rights movement of the Soviet era in every possible way and tried to convince that all political dissidents who had been to his institution were indeed mentally ill.[204] In his opinion, "now it is clear that all of them are deeply affected people."^[204] In 2012, Vinogradov said the same, "Do you talk about human rights activists? Most of them are just unhealthy people, I talked with them. As for the dissident General Grigorenko, I too saw him, kept him under observation, and noted oddities of his thinking. But he was eventually allowed to go abroad, as you know... Who? Bukovsky? I talked with him, and he is a completely crazy character. But he too was allowed to go abroad! You see, human rights activists are people who, due to their mental pathology, are unable to restrain themselves within the standards of society, and the West encourages their inability to do so."^[205] In the same year, he offered to restore Soviet mental health law and said it "has never been used for political persecution." Human rights activists who claim it did, in Vinogradov's words, "are not very mentally healthy."^[206]

Russian psychiatrist Fedor Kondratev not only denied accusations that he was ever personally engaged in Soviet abuses of psychiatry; he stated publicly that the very conception of the existence of Soviet-era "punitive psychiatry" was nothing more than: "the fantasy [vymysel] of the very same people who are now defending totalitarian sects. This is slander, which was [previously] used for anti-Soviet ends, but is now being used for anti-Russian ends."

In 2004, Savenko stated that the passed law on the state expert activity and the introduction of the profession of forensic expert psychiatrist actually destroyed adversary-based examinations and that the Serbsky Center turned into the complete monopolist of forensic examination, which it had never been under Soviet rule.[212] Formerly, the court could include any psychiatrist in a commission of experts, but now the court only chooses an expert institution.^[212] The expert has the right to participate only in commissions that he is included in by the head of his expert institution, and can receive the certificate of qualification as an expert only after having worked in a state expert institution for three years.^[212] The Director of the Serbsky Center Dmitrieva was, at the same time, the head of the forensic psychiatry department which is the only one in the country and is located in her Center.^[212] No one had ever had such a monopoly.^[212]

According to Savenko, the Serbsky Center has long labored to legalize its monopolistic position of the main expert institution of the country.^[213] The ambition and permissiveness—which, due to proximity to power, allow the Serbsky Center to get in touch over the telephone with the judges and explain to them who is who and what is the guideline, although the judges themselves have already learned it—have turned out to be a considerable drop in the level of the expert reports on many positions.^[213] Such a drop was inevitable and foreseeable in the context of the Serbsky Center efforts to eliminate adversary character of the expert reports of the parties, then to maximally degrade the role of the specialist as a reviewer and critic of the presented expert report, and to legalize the state of affairs.^[213] Lyubov Vinogradova believes there has been a continuous diminution in patients' rights as independent experts are now excluded from processes, cannot speak in court and can do nothing against the State experts.^[173]

On 28 May 2009, Yuri Savenko wrote to the then

The draft of the application to the Supreme Court of the Russian Federation was considered in the paper "Current legal issues relevant to forensic-psychiatric expert evaluation" by Yelena Shchukina and Sergey Shishkov^[215] focusing on the inadmissibility of appealing against the expert report without regard for the scope of the evaluated case.^[213] While talking about appealing against "the reports", the authors of the paper, according to lawyer Dmitry Bartenev, mistakenly identify the reports with actions of the experts (or an expert institution) and justify the impossibility of the "parallel" examination and evaluation of the actions of the experts without regard for the scope of the evaluated case.^[213] Such a conclusion made by the authors appears clearly erroneous because abuse by the experts of rights and legitimate interests of citizens including trial participants, of course, may be a subject for a separate appeal.^[213]

According to the warning made in 2010 by Yuri Savenko at the same Congress, prof.

According to the commentary by the Independent Psychiatric Association of Russia on the 2007 text by Vladimir Rotstein, a doctrinist of Snezhnevsky's school, there are sufficient patients with delusion of reformism in psychiatric inpatient facilities for involuntary treatment.[112] In 2012, delusion of reformism was mentioned as a symptom of mental disorder in Psychiatry. National Manual edited by Tatyana Dmitrieva, Valery Krasnov, Nikolai Neznanov, Valentin Semke, and Alexander Tiganov.^[218] In the same year, Vladimir Pashkovsky in his paper reported that he diagnosed 4.7 percent of 300 patients with delusion of reform.^[219] As Russian sociologist Alexander Tarasov notes, you will be treated in a hospital so that you and all your acquaintances get to learn forever that only such people as Anatoly Chubais or German Gref can be occupied with reforming in our country; and you are suffering from "syndrome of litigiousness" if in addition you wrote to the capital city complaints, which can be written only by a reviewing authority or lawyer.^[220]

According to Doctor of Legal Sciences Vladimir Ovchinsky, regional differences in forensic psychiatric expert reports are striking.^[221] For example, in some regions of Russia, 8 or 9 percent of all examinees are pronounced sane; in other regions up to 75 percent of all examinees are pronounced sane.^[221] In some regions less than 2 percent of examinees are declared schizophrenics; in other regions up to 80 percent of examinees are declared schizophrenics.^[221]

In April 1995, the State Duma considered the first draft of a law that would have established a State Medical Commission with a psychiatrist to certify the competence of the President, the Prime Minister, and high federal political officials to fulfill the responsibilities of their positions.

The evidence for the misuse of psychiatry for political purposes in the Soviet Union was documented in a number of articles and books.[230] Several national psychiatric associations examined and acted upon this documentation.^[230]

The widely known sources including published and written memoirs by victims of psychiatric arbitrariness convey moral and physical sufferings experienced by the victims in special psychiatric hospitals of the USSR.^[231]

In August 1969, Natalya Gorbanevskaya completed Noon ("Полдень"), her book about the case of the 25 August 1968 Demonstration on Red Square^[232] and began circulating it in samizdat.^[233] It was translated into English and published under the title Red Square at Noon.^[234] Parts of the book describe Special Psychiatric Hospitals and psychiatric examinations of dissidents. The book includes "On Special Psychiatric Hospitals", an article written by Pyotr Grigorenko in 1968.^[235][236]

In 1971, twin brothers Zhores Medvedev and Roy Medvedev published in London their joint account of Zhores' incarceration in a psychiatric hospital and the Soviet practice of diagnosing political oppositionists as the mentally ill in London, in both English A Question of Madness: Repression by Psychiatry in the Soviet Union and Russian (Who is Mad? "Кто сумасшедший") editions.^[237]

Yury Maltsev's Report from a Madhouse, his memoirs in Russian ("Репортаж из сумасшедшего дома"), were issued by the New York-based Novy zhurnal publishing house in 1974.^[238]

1975 saw the article "My Five Years in Mental Hospitals" by Viktor Fainberg, who had emigrated to France the previous year after four years in the Leningrad Special Psychiatric Hospital.^[239]

In 1976, Viktor Nekipelov published in samizdat his book Institute of Fools: Notes on the Serbsky Institute^[240] documenting his personal experiences during two months' examination at the Serbsky Institute in Moscow.^[241] In 1980, the book was translated and published in English.^[242] The book was first published in Russia in 2005.^[243]

Various documents and reports were published in the Information Bulletin of the Working Commission on the Abuse of Psychiatry For Political Purposes, and circulated in the samizdat periodical Chronicle of Current Events.^[244] Other sources were documents by the Moscow Helsinki Group and in books by Alexander Podrabinek (Punitive Medicine, 1979)^[245] Anatoly Prokopenko (Mad Psychiatry, 1997, "Безумная психитрия")^[246] and Vladimir Bukovsky (Judgment in Moscow, 1994).^[247] To these may be added Soviet psychiatry – fallacies and fantasy by Ada Korotenko and Natalia Alikina ("Советская психиатрия. Заблуждения и умысел")^[248] and Executed by Madness, 1971 ("Казнимые сумасшествием").^[249]

In 1972, 1975, 1976, 1984, and 1988 the

In 1992, the British Medical Association published certain some documents on the subject in Medicine Betrayed: The Participation of Doctors in Human Rights Abuses.^[253]

In 1978, the book I Vozvrashchaetsa Veter... (And the Wind Returns...) by Vladimir Bukovsky, describing the dissident movement, their struggle or freedom, practices of dealing with dissenters, and dozen years spent by Bukovsky in Soviet labor camps, prisons and psychiatric hospitals, was published^[254] and later translated into English under the title To Build a Castle: My Life as a Dissenter.^[255]

In 1979, Leonid Plyushch published his book Na Karnavale Istorii (At History's Сarnival) in which he described how he and other dissidents were committed to psychiatric hospitals.^[256] The same year, the book was translated into English under the title History's Carnival: A Dissident's Autobiography.^[257]

In 1980, the book by Yuri Belov Razmyshlenia ne tolko o Sychovke: Roslavl 1978 (Reflections not only on Sychovka: Roslavl 1978) was published.^[258]

In 1981, Pyotr Grigorenko published his memoirs V Podpolye Mozhno Vstretit Tolko Krys (In Underground One Can Meet Only Rats), which included the story of his psychiatric examinations and hospitalizations.^[259] In 1982, the book was translated into English under the title Memoirs.^[260]

In 1982, Soviet philosopher Pyotr Abovin-Yegides published his article "Paralogizmy politseyskoy psikhiatrii i ikh sootnoshenie s meditsinskoy etikoy (Paralogisms of police psychiatry and their relation to medical ethics)."^[261]

In 1983,

In 1983, Yuri Vetokhin published his memoirs Sklonen k Pobegu[264] translated into English under the title Inclined to Escape in 1986.^[265]

In 1987, Robert van Voren published his book Koryagin: A man Struggling for Human Dignity telling about psychiatrist Anatoly Koryagin who resisted political abuse of psychiatry in the Soviet Union.^[266]

In 1988, Reportazh iz Niotkuda (Reportage from Nowhere) by Viktor Rafalsky was published.^[267] In the publication, he described his confinement in Soviet psychiatric hospitals.^[268]

In 1993, Valeriya Novodvorskaya published her collection of writings Po Tu Storonu Otchayaniya (Beyond Despair) in which her experience in the prison psychiatric hospital in Kazan was described.^[269]

In 1996, Vladimir Bukovsky published his book Moskovsky Protsess (Moscow trial) containing an account of developing the punitive psychiatry based on documents that were being submitted to and considered by the

In 2002, St. Petersburg forensic psychiatrist Vladimir Pshizov published his book Sindrom Zamknutogo Prostranstva (Syndrome of Closed Space) describing the hospitalization of Viktor Fainberg.^[274]

In 2003, the book Moyа Sudba i Moyа Borba protiv Psikhiatrov (My Destiny and My Struggle against Psychiatrists) was published by Anatoly Serov, who worked as a lead design engineer before he was committed to a psychiatric hospital.^[275]

In 2010, Alexander Shatravka published his book Pobeg iz Raya (Escape from Paradise) in which he described how he and his companions were caught after they illegally crossed the border between Finland and the Soviet Union to escape from the latter country and, as a result, were confined to Soviet psychiatric hospitals and prisons.^[276] In his book, he also described methods of brutal treatment of prisoners in the institutions.^[276]

In 2012, Soviet dissident and believer Vladimir Khailo's wife published her book Subjected to Intense Persecution.^[277]

2014 saw the book Zha Zholtoy Stenoy (Behind the Yellow Wall) by Alexander Avgust, a former inmate of Soviet psychiatric hospitals who in his book describes the wider circle of their inhabitants than literature on the issue usually does.^[278]

In 1965, Valery Tarsis published in the West his book Ward 7: An Autobiographical Novel^[279] based upon his own experiences in 1963–1964 when he was detained in the Moscow Kashchenko psychiatric hospital for political reasons.^[280] The book was the first literary work to deal with the Soviet authorities' abuse of psychiatry.^[281]

In 1968, the Russian poet Joseph Brodsky wrote Gorbunov and Gorchakov, a forty-page long poem in thirteen cantos consisting of lengthy conversations between two patients in a Soviet psychiatric prison as well as between each of them separately and the interrogating psychiatrists.^[282] The topics vary from the taste of the cabbage served for supper to the meaning of life and Russia's destiny.^[282] The poem was translated into English by Harry Thomas.^[282] The experience underlying Gorbunov and Gorchakov was formed by two stints of Brodsky at psychiatric establishments.^[283]

In 1977, British playwright Tom Stoppard wrote the play Every Good Boy Deserves Favour that criticized the Soviet practice of treating political dissidence as a form of mental illness.^[284] The play is dedicated to Viktor Fainberg and Vladimir Bukovsky, two Soviet dissidents expelled to the West.^[285]

In the 1983 novel