TIME: Almanac 1993/TIME Almanac 1993.iso/time/041089/04108900.015

Text File | 1992-09-23 | 7.4 KB | 141 lines

                                                                                MEDICINE, Page 94

A PROFESSION UNDER STRESS


Long ostracized by colleagues around the world, Soviet
psychiatrists try to show that they are not instruments of
oppression


    Soviet doctors called it psychiatry, but sometimes it
seemed decidedly unscientific. For decades, sane Soviet citizens
were branded as lunatics because they defied the government.
They were hospitalized for years under prison-like conditions
and put on powerful drugs that turned them into zombies.
Particularly unruly patients were sometimes wrapped in wet
canvas and nearly suffocated. As word of such abuses spread
outside the Soviet Union, the country's psychiatrists became
outcasts in the international medical community.

    Now the Soviets have mounted a concerted campaign to regain
respectability. While never admitting that Soviet doctors had
ever been instruments of political oppression, the Kremlin has
released scores of dissidents from mental wards and reformed
laws that govern the rights of psychiatric patients. The Soviets
have also permitted Western psychiatrists to come to the
U.S.S.R. and see for themselves whether mental patients are
being mistreated. Those efforts seem to be bearing fruit: last
week, the executive committee of the World Psychiatric
Association voted to readmit the Soviets, who had withdrawn from
the organization in 1983 under threat of expulsion. If that
decision is approved at a meeting of the W.P.A.'s full
membership in Athens next October, Soviet psychiatry will have
scored a substantial victory.

    Last month a team of 26 U.S. mental-health experts made an
unprecedented two-week tour of Soviet psychiatric facilities.
Armed with a list compiled by human rights activists of present
or former mental patients believed to have been hospitalized
unjustly, the delegation interviewed 27 people. The American
group, which included psychiatrists, attorneys and a
psychologist, has agreed not to discuss its findings publicly
until the official report on the trip is issued later this year.
At a press conference, the only revealing comment from Dr. Loren
Roth, the University of Pittsburgh psychiatrist who led the
group, was that the two weeks had been "stressful and difficult
for both sides." Nevertheless, there were indications that at
least a few Soviet mental patients could still be considered
victims of psychiatric abuse.

    Soviet psychiatry began to take shape in the 1920s and drew
especially on the work of physiologist Ivan Pavlov (whose
experiments on conditioning, particularly with dogs, gave the
term Pavlovian response to the English language). His followers
largely rejected the work of Sigmund Freud and other Western
theorists and looked for physical rather than psychological
causes of mental problems. That emphasis led Soviet
psychiatrists to rely on drug treatment, work therapy and
re-education rather than psychotherapy.

    The practice of classifying dissidents as disturbed was
facilitated by the work of Dr. Andrei Snezhnevsky, who was
director of the Institute of Psychiatry of the U.S.S.R. Academy
of Medical Sciences and who dominated Soviet psychiatry from the
early 1950s until his death two years ago. Snezhnevsky
considerably broadened the definition of schizophrenia by adding
the category "sluggish schizophrenia." He defined the disorder
as a slow-developing illness without the hallucinations that are
a classic element in the Western definition of many
schizophrenias. Instead, the "symptoms" could be nearly all
forms of behavior -- unsociability, mild pessimism, stubbornness
-- that deviated from the social or political ideal.

    Hard evidence of Soviet psychiatric abuses first reached
the West in the 1970s, and international outrage began to build.
At the W.P.A. meeting in 1977, the delegates voted to condemn
Soviet practices, and pressure mounted to expel the country's
psychiatrists from the organization. Just before the 1983
W.P.A. meeting, the Soviets withdrew from the association.

    Eager to rejoin the international psychiatric
establishment, the Soviets have spared little effort to show
their good faith. In the past two years, the government has
released more than 100 dissidents from hospitals and carried out
several legal and procedural reforms. The new regulations
provide that mental patients or their relatives can appeal an
involuntary hospitalization in court. Moreover, control of
special psychiatric hospitals for the criminally insane has been
shifted from the Ministry of Internal Affairs, which oversees
the police, to the Ministry of Health. And in a break with the
Soviets' monolithic tradition, a few articles discussing
psychoanalysis have started to appear in periodicals.

    Despite all the ferment, there is some reason to question
whether fundamental change has taken place. The psychiatric
leadership is still old line. The All-Union Scientific Center
for Mental Health is headed by Dr. Marat Vartanyan, a longtime
protege of Snezhnevsky's. And Moscow's Serbsky Institute of
Forensic Psychiatry, which has been responsible for many of the
forced hospitalizations, remains under the command of Dr. Georgi
Morozov, as it has for decades. Critics doubt there can be any
real reform until those two leaders and others trained by
Snezhnevsky are replaced.

    Alexander Podrabinek, an underground-newspaper editor who
was once exiled to Siberia for nearly six years for examining
Soviet psychiatry in a book titled Punitive Medicine, contends
that the changes are strictly cosmetic. Even though the special
psychiatric hospitals are nominally controlled by the civilian
Ministry of Health, he notes, the guards are still military
personnel and the doctors commissioned officers. Says
Podrabinek: "The only thing that has changed is the label." He
claims that new language in the regulations has actually given
the government even greater latitude to misuse psychiatry. Under
the old rules, "mentally ill" people could be forcibly
hospitalized if they were judged to pose a physical threat to
themselves or society. That remains unchanged, according to
Podrabinek, but now people can also be put away if they threaten
"the rules of the socialist community."

    No one knows how many patients are being held in Soviet
mental hospitals solely because of their political beliefs. In
the past few weeks alone, a visitor encountered several possible
cases. One man, for example, claimed that his son had been
hospitalized for resisting the draft. Another young man said he
had just been released after spending two months in a mental
ward for refusing on religious grounds to enter the military.
While hospitalized, he said, he was given sulfazine, a powerful
drug that has no apparent effect other than inducing a high
fever.

    Despite their reluctance to comment, the U.S. psychiatrists
who traveled to Moscow last month seemed far from reassured by
their tour. Some of the visitors said Soviet psychiatrists
still appeared to use drugs of dubious medical value. Many
Western experts will no doubt oppose readmitting the Soviet
Union to the W.P.A. until Moscow shakes up the psychiatric
leadership and unequivocally renounces past practices. Though
grounds for skepticism remain, there are signs that the current
Soviet reform wave will lead to more humane and enlightened
forms of psychiatric care.