Political Abuse of Psychiatry in The Soviet Union - Residual Problems

Residual Problems

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. 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. It demonstrated that the actual situation was much sorer and that many individuals had been affected. Millions of individuals were treated and stigmatized by an outdated biologically oriented and hospital-based mental health service. Living conditions in clinics were bad, sometimes even terrible, and violations of human rights were rampant.

According to Robert van Voren, although for several years, especially after the implosion of the USSR and during the first years of Boris Yeltsin's rule, the positions of the Soviet psychiatric leaders were in jeopardy, now one can firmly conclude that they succeeded in riding out the storm and retaining their powerful positions. In addition, they also succeeded in avoiding an inflow of modern concepts of delivering mental health care and a fundamental change in the structure of psychiatric services in Russia. On the whole, in Russia, the impact of mental health reformers has been the least. Even the reform efforts made in such places as St. Petersburg, Tomsk, and Kaliningrad have faltered or were encapsulated as centrist policies under Vladimir Putin brought them back under control.

At his press conference in 2008, Semyon Gluzman said that the surplus in Ukraine of hospitals for inpatient treatment of the mentally ill was a relic of the totalitarian communist regime and that Ukraine did not have epidemic of schizophrenia but somehow Ukraine had about 90 large psychiatric hospitals including the Pavlov Hospital where beds only in its children's unit were more than in the whole of Great Britain.

In 1994, there was organized a conference concerned with the theme of political abuse of psychiatry and attended by representatives from different former Soviet Republics — from Russia, Belarus, the Baltics, the Caucasus, and some of the Central Asian Republics. Dainius Puras made a report on the situation within the Lithuanian Psychiatric Association, where discussion had been held but no resolution had been passed. Yuri Nuller talked over how in Russia the wind direction was gradually changing and the systematic political abuse of psychiatry was again being denied and degraded as an issue of "hyperdiagnosis" or "scientific disagreement." It was particularly noteworthy that Tatyana Dmitrieva, the Director of the Serbsky Institute, was an active adherent of this view. This was not so queer, because she was a close friend of the key architects of "political psychiatry."

In the early 1990s, Tatyana Dmitrieva, the Director of the Serbsky Center, brought the required words of repentance for political abuse of psychiatry which had had unprecedented dimensions in the Soviet Union for discrediting, intimidation and suppression of the human rights movement carried out primarily in this institution. Her words were widely broadcasted abroad but were limitedly published in the St. Petersburg newspaper Chas Pik within the country. However, in her 2001 book Aliyans Prava i Milosediya (The Alliance of Law and Mercy), Dmitrieva wrote that there were no abuses in psychiatry and if there were those, they were no more than in the vaunted Western countries. Moreover, the mentioned book by Dmitrieva administers to the old and new national intellectuals the rebuke that professor Vladimir Serbsky and others were wrong not to cooperate with the police department because otherwise there would have been neither revolution nor bloodshed and that the current intellectuals are wrong to oppose the authorities.

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."

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

According to Savenko, the Serbsky Center has long labored to legalize its monopolistic position of the Main expert institution of the country. It turned out to be a considerable drop in the level of its expert reports. 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 and then to maximally degrade the role of a professional as a reviewer and critic of a presented expert report.

On 28 May 2009, Yuri Savenko wrote to the President of the Russian Federation Dmitry Medvedev an open letter, in which Savenko asked Medvedev to submit to the State Duma a draft law prepared by the Independent Psychiatric Association of Russia to address a sharp drop in the level of forensic psychiatric examinations, which Savenko attributed to a lack of competition within the sector and its increasing nationalization. The open letter says that the level of the expert reports has dropped to such an extent that it is often a matter of not only the absence of entire sections of a report, even such as the substantiation of its findings, and not only the gross contradiction of its findings to the descriptive section of the report, but it is often a matter of concrete statements which are so contrary to generally accepted scientific terms that doubts about the disinterestedness of the experts arise. According to the letter, courts, in violation of procedural rules, do not analyze expert report, its coherence and consistency in all its parts, do not check experts’ findings for their accuracy, completeness, and objectivity.

On 15 June 2009, the working group chaired by the Director of the Serbsky Center Tatyana Dmitrieva sent the Supreme Court of the Russian Federation a joint application whose purport was to declare appealing against the forensic expert reports of state expert institutions illegal and prohibit courts from receiving lawsuits filed to appeal against the reports. The reason put forward for the proposal was that appeals against expert reports are allegedly filed "without regard for the scope of case" and that one must appeal against an expert report "only together with a sentence." In other words, according to Yuri Savenko, all professional errors and omissions are presented as untouchable by virtue of the fact that they were infiltrated into the sentence. That is cynicism of administrative resources, cynicism of power, he says.

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 Elena Shchukina and Sergei Shishkov focusing on the inadmissibility of appealing against an expert report without regard for the scope of evaluated case. While talking about appealing against "reports", the authors of the paper, according to lawyer Dmitry Bartenev, mistakenly identify reports with actions of experts (or an expert institution) and justify the impossibility of "parallel" examination and evaluation of actions of experts without regard for the scope of evaluated case. Such a point of view taken by the authors appears clearly erroneous because abuse by experts of rights and legitimate interests of citizens including trial participants, of course, may be a subject for a separate appeal.

In 2010, when the outpatient forensic-psychiatric examination of Yulia Privedyonnaya, a member of a youth organization, was carried out in the Sebsky Center, its experts asked her the question "What do you think of Putin?" that Savenko called an inappropriate, unseemly, indelicate, and police one.

According to Russian psychiatrist Emmanuil Gushansky, today subjective position of the Russian patient in relation to the medical psychologist and psychiatrist is defensive in nature and prevents the attempt to understand the patient and help him assess his condition. Such position is related to constant, subconscious fear of psychiatrists and psychiatry. This fear is caused by not only abuse of psychiatry, but also constant violence in totalitarian and post-totalitarian society. Psychiatric violence and psychiatric arrogance as one of manifestations of such violence is related to a primary emphasis on symptomatology and biological causes of disease, while ignoring psychological, existential, and psychodynamic factors.