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Political Dissent and "Sluggish" Schizophrenia in the Soviet Union

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Political Dissent and Br Med J (Clin Res Ed): first published as 10.1136/bmj.293.6548.641 on 13 September 1986. Downloaded from LONDON, SATURDAY 13 SEPTEMBER 1986 MEDICAL JOURNAL Political dissent and "sluggish" schizophrenia in the Soviet Union "It is considered by some governments that if a person does the USSR, the criterion for differentiation within the group not agree with the views of the state, his sanity must be called of schizophrenias is the course of the illness."16" Three main into question. Extensive documentation exists on the misuse forms are distinguished depending on whether the course is of psychiatry and psychiatric drugs in the Soviet Union."' continuous, recurrent, or "mixed"; and these are thought to Amnesty International, Bloch and Reddaway, and the Inter- differ from each other in terms of symptoms, development, national Association on the Political Use of Psychiatry are response to treatment, and pathogenesis. The subtypes of others to have cited several hundred people who have continuous schizophrenia are (a) "sluggish," (b) "moderately recently been confined to psychiatric hospitals in the Soviet progressive (paranoid)," and (c) "malignant juvenile." Epi- Union for "dissident" activities rather than for medical demiologically the annual incidence of schizophrenia in the reasons. - In November 1985 the last of these published a Soviet Union has been estimated at 0-2 per 1000, with a point booklet containing details of "all dissenters believed to prevalence at 3-8 and at 5-3 per 1000-estimates that are be currently interned in psychiatric hospitals for political within the range of others for this disorder in the rest of reasons," in which they listed 133 cases in the Soviet Union Europe. " ("probably only a small proportion of the true total, as most Moscow was one of nine field research centres which took cases never become known in the outside world"). In part in the International Pilot Study of Schizophrenia." response to these widely publicised of the misuse of reports Some 18% ofthe patients with a diagnosis ofschizophrenia in http://www.bmj.com/ psychiatry in the Soviet Union for the repression of political the Moscow centre were classified as having sluggish schizo- dissent, a motion for the expulsion of the Soviet All-Union phrenia, a diagnosis, however, that was not recorded at any Society of Neurologists and Psychiatrists was tabled for the other field research centre. By the standards of the present meeting of the World Psychiatric Association in 1984; state examination (a structured psychiatric interview used in however, the Soviet bodyresigned from theWorld Psychiatric the international pilot study) the most prominent symptoms Association in 1983, thus pre-empting debate.8 among patients with sluggish schizophrenia were affect laden The issues surrounding this tortuous and emotive subject thoughts, incongruity of affect, flatness, and neurasthenic are raised again in a discussion of the political hazards in the complaints, with depressed or elated mood. Over four fifths on 30 September 2021 by guest. Protected copyright. diagnosis of "sluggish" schizophrenia-a diagnostic concept ofthese patients were rated as having thought blocking, more virtually limited to the Soviet Union and some other East than three fifths as showing lack of insight, and more than European countries.9 Mersky and Shafran review articles on halfas having stereotypes ofspeech. The CATEGO computer sluggish schizophrenia from Soviet publications between classification of their ratings on the present state examination 1980 and 1984. Though they acknowledge that the diagnosis placed virtually all in the classes of manic and depressive may be "genuine," they conclude that: "under the influence disorders. of an unscrupulous regime the observations put forward For comparison among the field research centres sluggish could serve as a ready means to label as psychotically ill many schizophrenia was assigned to the category of latent schizo- energetic and capable citizens who were in disagreement with phrenia in the International Classification of Diseases. Four authority.... They allow for psychiatric disposal, without of the other eight centres had patients in this category, all much other justification, of anyone whose social activism making up less than 6% of the total. The glossary to the is unacceptable to the psychiatrist who believes in the mental disorders section of the ninth revision of the Inter- officially approved system." In fact, this charge has been national Classification of Diseases describes latent schizo- laid before34 1012; more specifically, Koryagin has reported phrenia as follows: "It has not been possible to produce a that the "healthy people" he examined "were diagnosed in generally acceptable description of this condition. It is not one of two ways, as psychopaths (70%) or schizophrenics recommended for general use, but a description is provided (30%). 13 for those who believe it to be useful: a condition of eccentric In the classification of schizophrenia developed at the or inconsequent behaviour and anomalies of affect which Institute ofPsychiatry ofthe Academy ofMedical Sciences of give the impression of schizophrenia though no definite Co BRITISH MEDICAL JOURNAL 1986. All reproduction rights reserved. VOLUME 293 NO 6548 PAGE 641 Br Med J (Clin Res Ed): first published as 10.1136/bmj.293.6548.641 on 13 September 1986. Downloaded from 642 BRITISH MEDICAL JOURNAL VOLUME 293 13 SEPTEMBER 1986 present or past, 12 -Podrabinek A. PwAiive medicine- Ann Arbour: Krona Publishers, 1979; and characteristic schizophrenic anomalies, 13 Koryagin A. Unwilling patients. Lan 1981i:8214. have been manifest. The terms indicate that this is the 14 Snezhnevsky AV. The symptomatology, cinical forms and nosoogy of schizophrenia. In: HoweHsJG, ed. Modernperspectvesin uwkpsychiaty. London: Oliverand Boyd, 1968:425-47. best place to classify some other poorly defined varieties of 15 World Health Organisation. Report ofthe ianal pieot sn ofsc a. Vol 1. Geneva: schizophrenia."" World HealthOrganisation, 1973. 16 Berner P, Gabriel E, Katschnig H, et al. Diagsti c for sphrenic andaffective p . Although some Soviet psychiatrists manifestly resist what Washington: Distributed by American Psychiatc Press for the World Psychiatric Association, they find to be abuses of their profession,"3 9 in Britain and 1983. 17 Jablensky A. Epidemiology of schizophrenia: A European perspective. Schiophe BuU 1986;12: the West there is a range of opinion among psychiatrists, 52-73. from belief that their colleagues in the Soviet Union will 18 World Health Organisation. Mental disorders: glossa and guide to their classcation in accordance unth the Ninth Revisio of tIternational ClafWatiou of Dise . Geneva: Woeld Health knowingly incarcerate perfectly sane dissidents to belief that Organiation, 1978. 19 Working Group on the Internment of Dissenters in Mental Hospitals. Dr Semyon Gluznan: the at least some Soviet psychiatrists genuinely think that some nprisoned conscince of Soviet psychiaty. -London: W k*ing Guiup on the Internment of dissidents are suffering from a mental disorder. In the Dissenters in Mental Hospitals, 1977. f 20 Windholz G. Psychiatric commitments of religious disseniers is-Tsarist and Soviet Russia: two absence of independent information many will probably case studies. Psyckiatty 1985;4t329-40. agree with Windholz's assessment that "No final conclusion 21 Chekhov AP. Ward 6. In: Lady with lapdog and other storis. Harnondsworth: Penguin, 1964. 22 Kaser M. Health care in the Soviet Union and Eastemn Europe. London: Croom Helm, 1976. about the extent of political motivation in psychiatric com- 23 Ryan M. The organisaion ofSoviet medical care. Oxford: Basil BlackweHl and Martin Robertson, mitment cases in the Union can be made without a 1978. Soviet well 24 Galach'yan AG. Soviet Union. In: Kiev A, ed. Psychiatry in the commtunist uworld. New York: documented analysis of contemporary Soviet commitment Science House, 1968:29-50. 25 Brown BS, Kopin IJ, Kramer M, et al. The 1972 NIMH mission to assess schizophrenic research practices."' in the USSR. In: Brown BS, Torrey EF, eds. Innaotional collaboration in mental heakh. Two general aspects of this problem are, however, clear. Rockville: National Institute ofMental Health, 1973:17-25. 26 Corson SA, Corson EO'L, eds. Psychiat andpsychology in the USSR. New York: Plenum Press, Firstly, the ethical controversies aroused in all- countries by 1976. the compulsory detention and treatment ofpeople in 27 Mombour W. Comparison between different systems of psychiatrkc education including some psychi- aspects on the ideology of different mental health systems. .In: Alino JJL-I, Lenz G, eds. atric institutions are heightened when the Soviet Union is Training and education in psychiatry. Wien: Facultas Verlag, 1984:306-17. 28 Miller MA. The theory and practice ofpsychiatry in the Soviet Union. Psychiauy 1985;48: 13-24. considered, because literary2' and historical20 parallels-as 29 Babayan E. 7The structre ofpsychiatry in the Soviet Union. (In collaboration with YuG Shashina.) well as contemporary accounts2-7 10" -suggest that the New York: International Universities Press, 1985. 30 Brockington IF, Kendell RE, LeffJP. Definitions of schizophrenia: concordance and prediction misuse of psychiatry there is deep rooted and long estab- ofoutcome. Psychol Med 1978;8:387-98. lished; because of the cultural, political, legal, and social 31 Sartorius N, Jablensky A, Shapiro R. Two-year follow-up of the patients included
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