TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/103089/10308900.011

Text File | 1990-09-18 | 6KB | 103 lines

BEHAVIOR, Page 78

Here Come the Russian Shrinks!

The Soviets confess and are accepted by their colleagues

By Glenn Garelik


    After years of activists' complaints about abuses in Soviet
psychiatric facilities, 26 American psychiatrists, lawyers and
interpreters last March toured such institutions in the U.S.S.R.
and interviewed more than two dozen patients whose hospitalization
had been questioned. The watchdog group concluded that while
improvements had been made, disturbing evidence remained of
unjustified confinements and fundamental shortcomings in
psychiatric practice. Most troubling were the continued use of
drugs that appeared to have more punitive than therapeutic value
and the domination of the Soviet psychiatric establishment by some
of the very officials who ruled it when abuse was rampant.

    Thus, when the World Psychiatric Association met in Athens last
week, one of the most controversial issues on its agenda was
whether to readmit Soviet psychiatrists, who resigned in 1983
rather than face expulsion for human-rights abuses. Eager for
acceptance, the Soviets made an eleventh-hour acknowledgment that
"previous political conditions in the U.S.S.R. created an
environment in which psychiatric abuse occurred for nonmedical,
including political, reasons."

    Following a stormy final session that began after lunch and
lasted well past midnight, the W.P.A. voted to accept the Soviet
delegation, provided that the use of psychiatry for nonmedical
purposes is banned. Moreover, in a symbolic addendum, the
organization agreed unconditionally to admit a new independent
Soviet psychiatric union whose members are considered genuine
reformers.

    Human-rights advocates had looked to the Athens vote as a key
test for the W.P.A. Although the Soviet delegation announced no
specific personnel changes, it did call for "enlightened leadership
in the psychiatric community in the U.S.S.R." That failed to
appease the majority, which seemed unwilling to restore the
Soviets' membership. Then vice president-elect Felice Lieh Mak of
Hong Kong suggested a compromise: making readmission contingent on
a satisfactory W.P.A. visit to Soviet psychiatric facilities in the
next year. Only then did the majority swing to the Soviet side. The
vote was 291 to 45, with 19 abstentions.

    Nonetheless, there remained the central question regarding the
Soviet psychiatrists: whether admitting them or barring them was
more likely to encourage reform. For a year, outgoing W.P.A.
president Costas Stefanis of Greece had doggedly lobbied for
readmission on the grounds that it would encourage rehabilitation.
He contended that the Soviets as members of the W.P.A. would be
subject to greater scrutiny and influence from abroad than they
would be as outcasts. Others who favored readmission, including
U.S. psychiatrists Alfred Freedman and Abraham Halpern, argued that
during the past few years -- especially in the months preceding the
Americans' March visit -- the Soviets had satisfied the criteria
established for readmission in 1983, which called simply for
"amelioration" of past abuses. In the year since the last W.P.A.
meeting, for instance, the Soviets have released more than a
hundred "patients." In July they purportedly banned the use of
pain-inducing sulfazine, the most notorious of the contested drugs.

    But that was not enough for the opponents of readmission, who
included independent Soviet psychiatrists as well as the Dutch and
West Germans. They charged that the Soviets had not even made the
limited changes they claimed. The West German-based International
Society for Human Rights listed scores of cases of improper
confinement. Other critics noted that Soviet diagnostic categories
still include "sluggish schizophrenia," a condition whose
officially defined symptoms include "delusions of reformism."

    Earlier this month, the Soviets had made an unprecedented play
for respectability with the Americans, who have been among their
most outspoken critics. Speaking before Congressman Henry Waxman's
Health and the Environment Subcommittee, a senior Soviet embassy
official testified that his government had created an independent
commission to ensure that its hospitals would be used for
psychiatric purposes only. But other congressional witnesses,
including one victim of past abuse, countered that the changes in
the Soviet mental-health establishment have been little more than
cosmetic.

    Not surprisingly, several members of the U.S. delegation came
to Athens unconvinced that readmission was justified. Ellen Mercer,
director of the American Psychiatric Association's international
affairs office, argued that the Soviets' dubious psychiatric
theories and their basic lack of medical sophistication made for
at least inadvertent abuse. In many cases, explains Dr. Walter
Reich, an expert in Soviet psychiatry at Washington's Woodrow
Wilson International Center, the Soviets are not intentionally
engaging in what the West considers abuse. Instead, because of
culture and history, they "actually believe that the dissidents
they are hospitalizing, or keeping in hospitals, are ill."

    It is partly for that reason, says George Washington University
political scientist Peter Reddaway, next year's review by the "more
sober-minded" new leadership of the W.P.A. will be especially
crucial. In the end, though, the biggest improvement in Soviet
psychiatric practice may come not from W.P.A. acceptance or
ostracism but from continued changes in the culture, politics and
legal structure of Soviet society. Admitted Stefanis after the
vote: "It is not just a question of psychiatry. Deeper changes must
take place." Until this happens, says Reich, "there are no
assurances that can satisfy one fully and eternally that the
Soviets won't return to abusive practices."