Political Abuse of Psychiatry in The Soviet Union - Sluggish Schizophrenia

Sluggish Schizophrenia

"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."

Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes. It was the diagnosis of "sluggish schizophrenia" that was most prominently used in cases of dissidents. The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and this diagnosis to make political dissent into a mental disease. According 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. The diagnosis "sluggish schizophrenia," a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Andrei Snezhnevsky, furnished a very handy framework for explaining this behavior. 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.

A. 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 classification of mental disorders postulating an original set of diagnostic criteria. The Soviet model of schizophrenia is based on the hypothesis that a single fundamental characteristic, by which schizophrenia spectrum disorders are distinguished clinically, is their longitudinal course. The hypothesis implies that there are three main types of schizophrenia:

1. the continuous type that is defined as unremitting, proceeding with either a rapid ("malignant") or a slow ("sluggish") progression and has a poor prognosis in both instances;
2. the periodic, or recurrent type that is characterized by an acute attack followed by full remission with minimal progression, if any;
3. the mixed, or shift-like, type ("schubweise" — in German "schub" means phase or attack), a mixture of continuous and periodic types that occurs periodically and is characterized by only partial remission.

This systematization of schizophrenia types attributed to Snezhnevsky is still used in Russia and refers sluggish schizophrenia to the continuous type.

A carefully crafted description of sluggish schizophrenia established that psychotic symptoms were non-essential for the diagnosis, but symptoms of psychopathy, hypochondria, depersonalization or anxiety were central to it. Symptoms referred to as part of the "negative axis" included pessimism, poor social adaptation, and conflict with authorities, and were themselves sufficient for a formal diagnosis of "sluggish schizophrenia with scanty symptoms." According to Snezhnevsky, patients with sluggish schizophrenia could present as quasi sane yet manifest minimal but clinically relevant personality changes which could remain unnoticed to the untrained eye. Thereby patients with non-psychotic mental disorders, or even persons who were not mentally sick, could be easily labelled with the diagnosis of sluggish schizophrenia. Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters. As per the theories of Snezhnevsky and his colleagues, schizophrenia was much more prevalent than previously considered since the illness could be presented with comparatively slight symptoms and only progress afterwards. As a consequence, schizophrenia was diagnosed much more often in Moscow than in cities of other countries, as the World Health Organization Pilot Study on Schizophrenia reported in 1973. In particular, the scope was widened by sluggish schizophrenia because according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of functioning almost normally in the social sense. Their symptoms could be like those of a neurosis or could assume a paranoid character. The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society. Thereby, sluggish schizophrenia could have such symptoms as "reform delusions," "perseverance," and "struggle for the truth." As Vladimir Stayzhkin reported, Snezhnevsky diagnosed a reformation delusion for every case when a patient "develops a new principle of human knowledge, drafts an academy of human happiness, and many other projects for the benefit of mankind."

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. 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.

Someone of those present at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute once asked him a rather provocative question: "Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?" Since the question was asked with an ironical smile, in the debate, Morozov replied, smiling ironically as well, "You know, dear colleagues, this is a very peculiar disease: there are not delusional disorders, there are not hallucinations, but there is schizophrenia!"

American psychiatrist Alan A. Stone stated that Western criticism of Soviet psychiatry aimed at Sneznevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia with a "sluggish type" manifestation by "reformerism" including other symptoms. One can readily apply this diagnostic scheme to dissenters. Snezhnevsky was long attacked in the West as an exemplar of psychiatric abuse in the USSR. He was charged with cynically developing a system of diagnosis which could be bent for political purposes, and he himself diagnosed or was involved in a series of famous dissident cases, including those of the biologist Zhores Medvedev, the mathematician Leonid Plyushch, and Vladimir Bukovsky whom Snezhnevsky diagnosed as schizophrenic on 5 July 1962. In 1980, the Special Committee on the Political Abuse of Psychiatry, established by the Royal College of Psychiatrists in 1978, charged Snezhnevsky with involvement in the abuse and recommended that Snezhnevsky, who had been honoured as a Corresponding Fellow of the Royal College of Psychiatrists, be invited to attend the College's Court of Electors to answer criticisms because he was responsible for the compulsory detention of this celebrated dissident, Leonid Plyushch. Instead Snezhnevsky chose to resign his Fellowship.