Russia's Political Hospitals. The Abuse of Psychiatry in the Soviet Union. Sidney Bloch and Peter Reddaway. Foreword by Vladimir Bukovsky. London: Victor Gollancz Ltd, I977.
Journal of Medical Ethics, 1978, 4, pp. 100-103.
On the 22 July 1975, The Times wrote in an editorial: 'There is now overwhelmingly convincing evidence that the Soviet authorities quite deliberately use their mental-health service to punish or intimidate political dissidents, a horrible and wicked act of state. Just as it is impossible for a national medical body to ignore irregular behaviour by individual members, it is also impossible for a world body to turn a blind eye to deliberate malpractice; the Soviet psychiatrists who lend themselves to this vile conduct are every bit as guilty as the politicians who order it." In the book under review Dr Bloch and Mr Reddaway provide a full documentation of the facts on which The Times based its strictures. It is compulsively readable from start to finish, and is supported by 114 pages of appendices detailing the facts, and 35 pages of references giving the sources. Dissidents are interned in psychiatric custody, the evidence of their mental illness being provided by their political views alone. In the special psychiatric hospitals for the criminal insane there are unnecessary and unjustifiable restrictions or deprivations of air and exercise, occupation, books, writing materials, visits, human contacts. The worst feature is that the orderlies are themselves nonpolitical criminals of a violent type; brutalities, beatings, forced medication and over-medication do occur.
Bloch and Reddaway mention the existence of some 15 or so of these special psychiatric hospitals; and they say there are no doubt others, as well as special criminal wards in ordinary psychiatric hospitals, and special psychiatric wards in ordinary prisons. They know of some 210 dissidents who have been interned in mental hospitals since 1962 for reasons connected with their beliefs. There are no doubt others they have never heard of. The cases of Grigorenko, Gorbanevskaya, Shimanov, Medvedev, Plyushch, Bukovsky and Borisov are discussed at length, and the 50 pages of Appendix I gave a catalogue resume of the victims of Soviet psychiatric abuse known to them.
Schizophrenia and paranoid psychopathy are the two principal diagnoses used to stigmatise the dissident. Professor Morozov has authoritatively stated that 'schizophrenia is a disease in which patients are, with rare exceptions, deemed not responsible'. According to Professor Lunts, another leading forensic psychiatrist, the 'sluggish' form of schizophrenia may have no clear symptoms. The disease may be 'theoretically' present even when not clinically demonstrable. It is not necessary for any change in personality to be noticeable to others. Morozov likes to say 'It's no secret to anyone that you can have schizophrenia without schizophrenia'. An emigré Russian psychiatrist has allowed Soviet teachers, such as Professor Snezhnevsky, an honest belief in the concept of dissent as mental illness. It is only the internment in special hospitals that he sees as utterly indefensible. Bloch and Reddaway do not agree. They find all too much evidence of cynical disbelief. For instance the more benign psychiatrists may be quite ready to certify recovery after only the most formal recantation of past 'erroneous' views. Again, in psychiatric reports to the courts there is much false evidence: the patient's words are twisted against him, and positive evidence in his favour, such as good social adjustment and a solid work record, strangely fail to find mention. Some psychiatrists may be mistakenly doing what they feel is the best thing for the patient, believing that a year or two in a mental hospital under reasonable conditions may be less punitive and less traumatic than a long period of imprisonment. But this cannot be so if it is a special psychiatric hospital.
The reviewer does not share the view of The Times in I975 that the psychiatrists are as guilty as the politicians; they are the slaves of the machine, not its masters. The system of ethics in a tyranny is not as ours, but runs along a different dimension. The state religion in Soviet Russia maintains that the particular variety of Marxism-Leninism which is the official guide contains all wisdom and truth, and any form of dissent is antisocial. It is the ideas that have to be crushed; the men who hold them are crushed too; incidentally, the danger of unorthodox ideas is that they may penetrate into the party leadership, causing political splits that might be disastrous to the machine. The armed forces are part of the machine, and their personnel are necessarily dehumanised. So are the police. So must be too the instruments of law and justice. Soviet judges commit every kind of illegality, even in the terms of existing Soviet law, to ensure that the dictates of the party machine are executed. It is little less than a miracle that advocates appearing for the defence are permitted to say as much as they do, even if cogent arguments are blandly ignored. The special hospital psychiatrist must inevitably be as much a creature of the machine as the Soviet judge, who for reasons unknown incurs far less obloquy in the West. 'But you had an apartment, a family, a job. Why did you do it?' The words, spoken by doctor to dissident, could just as well be said to anyone in an official position who took one step out of line.
The divided loyalties of the psychiatrist, to society as well as to his patient, put him at risk in the West as in Russia. The guilt of the prison doctors in Russia lies in lack of courage - and one can hardly expect them to show as much heroism as the dedicated dissident. The evil that they do is to imply that honest social and political criticism is so much lunacy. When all is said the cruelty and wickedness of the Soviet tyranny does not approach the monstrous cruelty and wickedness of the Nazi tyranny. Dr Bloch and Mr Reddaway hope that humane psychiatric values will ultimately prevail, when all imprisoned dissenters would be held in labour camps and none in hospitals. This would be very good for the fair name of psychiatry; but it might deprive the prisoners of some of their friends. Surely, our criticism of the Russian tyranny must go far deeper than this.