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Fifty Years of Political Abuse of Psychiatry

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Fifty Years of Political Abuse of Psychiatry Ethics, Medicine and Public Health (2015) 1, 44—51 Available online at ScienceDirect www.sciencedirect.com DOSSIER ‘‘ABUSE’’ /Studies Fifty years of political abuse of psychiatry — no end in sight 50 ans de maltraitance politique par la psychiatrie — pas de fin en vue R. van Voren Human Rights in Mental Health-FGIP, Postbus 1956, 1200 BZ Hilversum, The Netherlands Received 5 September 2014; accepted 7 December 2014 Available online 4 April 2015 KEYWORDS Summary In October 1989, the General Assembly of the World Psychiatric Association (WPA) Medical ethics; accepted the Soviet psychiatric association back conditionally, after having been forced to Human rights; leave the organization six years earlier because of systematic abuse of psychiatry for political International law; purposes. Three weeks later, the Berlin Wall came tumbling down, and in 1991, the Soviet Union Political repression; itself ceased to exist. However, over the past years, an increasing number of reports on the Soviet Union internment of political activists in former Soviet republics made people realize that 25 years after the decision of the WPA, political abuse of psychiatry still has not been eradicated. Using psychiatry as a means of repression has been a particular favorite of totalitarian regimes with a communist State ideology. Cases have been reported from other countries as well, including Western democratic societies, yet nowhere else has it been developed into a systematic method of repression. While probably the overwhelming majority of Soviet psychiatrists were unaware that they had become part of a perfidious system to treat dissenters as psychiatrically ill on the orders of the Party and the KGB, there is also ample evidence that the core group of architects of the system knew very well what they were doing. When the USSR disintegrated, the practice of using psychiatry against political opponents virtually ceased to exist. What came in its place, however, was a very disturbing collection of other forms of abuses, including human rights abuses due to lack of resources, outdated methods of treatment, lack of understanding of human individual rights and a growing lack of tolerance in society. Starting this century, the number of individual cases of political abuse of psychiatry has increased, in particular, over the past few years in Russia, Belarus and Kazakhstan. The issue of Soviet political abuse of psychiatry had a lasting impact on world psychiatry. It triggered the discussions on medical ethics and the E-mail address: [email protected] http://dx.doi.org/10.1016/j.jemep.2014.12.001 2352-5525/© 2015 Elsevier Masson SAS. All rights reserved. Psychological and legal interventions for domestic violence 45 professional responsibilities of physicians (including psychiatrists), resulting in both national and international declarations and ethical codes that address the interface between human rights, professional responsibilities of physicians and medical ethics. © 2015 Elsevier Masson SAS. All rights reserved. MOTS CLÉS Résumé En octobre 1989, l’Assemblée générale de l’Association mondiale de psychiatrie (WPA) acceptait le retour conditionnel de l’Association psychiatrique soviétique, après avoir Éthique médicale ; été forcée de quitter l’organisation six ans plus tôt pour abus systématique de la psychiatrie à Droits de l’Homme ; des fins politiques. Trois semaines plus tard, le mur de Berlin s’écroulait, et en 1991, l’Union Loi internationale ; soviétique elle-même cessait d’exister. Cependant, au cours des dernières années, un nombre Répression politique ; croissant de rapports sur l’internement de militants politiques dans les anciennes républiques Union soviétique soviétiques faisait prendre conscience que, 25 ans après la décision de la WPA, l’utilisation de la psychiatrie à des fins politiques était loin d’être éradiquée. Cette utilisation de la psychi- atrie comme moyen de répression a été particulièrement appréciée des régimes totalitaires d’obédience communiste. Des cas ont aussi été signalés dans d’autres pays, y compris dans les sociétés démocratiques occidentales, mais nulle part ailleurs n’ont été développés comme méthode systématique de répression. Bien que sans doute l’écrasante majorité des psychiatres soviétiques ne savaient pas qu’ils étaient devenus partie d’un système pervers pour traiter les dissidents comme malades mentaux sur les ordres du Parti et du KGB, de nombreuses preuves montrent que les architectes du système savaient très bien ce qu’ils faisaient. Lorsque l’URSS s’est désintégrée, l’utilisation de la psychiatrie contre les opposants politiques a pratique- ment cessé d’exister. À sa place, cependant, une série troublante d’autres formes d’abus, des violations des droits de l’homme dues au manque de ressources, des méthodes dépassées de traitement, un manque de compréhension des droits humains individuels et une baisse crois- sante de tolérance dans la société. Depuis quelques années, le nombre de cas individuels de maltraitance politique en psychiatrie a augmenté, en particulier en Russie, en Biélorussie et au Kazakhstan. La question de la maltraitance politique de la psychiatrie soviétique a eu un impact durable sur la psychiatrie mondiale. Il a déclenché des discussions sur l’éthique médicale et les responsabilités professionnelles des médecins (y compris les psychiatres). Il en a résulté des déc- larations à la fois nationales et internationales et des Codes d’éthique pour définir l’interface entre les droits, les responsabilités professionnelles des médecins et l’éthique médicale. © 2015 Elsevier Masson SAS. Tous droits réservés. Introduction After Athens, developments succeeded each other in a rapid succession. The USSR disintegrated; former Soviet Twenty-five years ago, in October 1989, the General Assem- republics became independent and in all of them new bly of the World Psychiatric Association (WPA) met in Athens psychiatric associations appeared. Most of them became with one main item on the agenda: the abuse of psychiatry members of the WPA within the next years. By the time the for political purposes in the USSR and the question whether General Assembly of the WPA convened in Madrid in August the Soviet association should be allowed to rejoin the orga- 1996, a dozen new associations had joined this international nization or not. Six years earlier, it had withdrawn from body. Political abuse of psychiatry seemed to be a matter of membership when it became clear it would otherwise be the past, now only a matter of research for historians and expelled because of Soviet psychiatry having been turned political scientists. into a systematic tool of repression. But now, times had However, over the past years an increasing number of changed: the USSR was opening up, political prisoners were reports on the internment of political activists in former being released in large numbers and the Soviets claimed the Soviet republics led to a resumed interest in the issue of abuse had come to an end. A large team of investigators sent the abuse of psychiatry for political purposes [2]. The fact by the US State Department did not confirm this claim alto- that all these years these abuses were a frequent and ongo- gether [1], but the winds of change called for leniency and ing practice in, for instance, the People’s Republic of China thus the Soviets were allowed back conditionally. Coinciden- [3], did not alert the world that this perversion of medical tally, yet very symbolically, the General Assembly took place science had not come to an end. Rather, it was reports on the day that GDR-leader Erich Honnecker resigned from his individual cases of such abuses in former Soviet republics position, and it would be only three weeks until the Berlin such as Belarus, Kazakhstan and Russia [2,4], which made Wall came tumbling down. people realize that 25 years after the World Congress in 46 R. van Voren Athens, political abuse of psychiatry still had not been erad- are followed as in the case when the person would be sen- icated. tenced to a term of imprisonment. Only in case of short-term hospitalizations, these procedures are sometimes bypassed, in particular, when the internment is somewhere in the provinces and carried out to ‘‘scare’’ a person into submis- Why psychiatry? sion or to settle an old dispute with a local authority. At the same time, declaring a person mentally ill pro- According to the definition of the foundation Human Rights vides a perfect opportunity to dismiss political or religious in Mental Health — FGIP (formerly the Global Initiative on beliefs, as they are the product of an ill mind and do not Psychiatry), ‘‘political abuse of psychiatry refers to the mis- have to be taken seriously. In particular, in the case of opin- use of psychiatric diagnosis, treatment and detention for ions that threaten the prevalent or only-correct ideology (or the purposes of obstructing the fundamental human rights religion), authorities find that such a way out is especially of certain individuals and groups in a given society. The welcomed, as one can maintain the view that there is no practice is common in, but not exclusive to, countries gov- opposition and one has full support of the population. As erned by totalitarian regimes. In these regimes, human Soviet leader Nikita Khrushchev stated in 1959: ‘‘a crime rights abuses of those politically opposed to the state are is a deviation from the generally recognized standards of often hidden under the guise of psychiatric treatment. In behavior frequently caused by mental disorder. Can there be democratic societies, ‘whistle blowers’ on covertly illegal diseases, nervous disorders among certain people in Commu- practices by major corporations have been subjected to the 1 nist society? Evidently yes. If that is so, then there will also political misuse of psychiatry.’’ be offences that are characteristic for people with abnormal A key question is why authorities resort to the intern- . minds [ . .]. To those who might start calling for opposition ment of political or religious dissenters, or other types of to Communism on this basis, we can say that [.
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