COLD WAR in PSYCHIATRY Soviet Political Abuse of Psychiatry and the World Psychiatric Association (WPA)

Home , Jacques Presser, Robert van Voren, Viktor Chebrikov, Vladimir Bukovsky

VYTAUTAS MAGNUS UNIVERSITY

Robert VAN VOREN

COLD WAR IN PSYCHIATRY Soviet political abuse of psychiatry and the World Psychiatric Association (WPA)

Summary of Doctoral Dissertation Social sciences, political sciences (02 S)

Kaunas, 2010 The thesis of doctoral dissertation was prepared at the Vytautas Magnus University, Kaunas, Lithuania The dissertation is being defended at the Scientific Council of the Depart- ment of Political Sciences, Vytautas Magnus University, Kaunas, Lithuania

Academic supervisor: Prof. Dr. Gintautas Mažeikis

Council of Defense: Chairman: Prof. Dr. Leonidas Donskis (Vytautas Magnus University, Kaunas, Humani- ties Sciences, History of Ideas – 01 H)

Members: Prof. Dr. David Aphrasidze, Professor of Politics at Ilia State University and Dean of Graduate Studies, Tbilisi, Georgia Prof. Dr. Dick Raes, Professor emeritus Free University of Amsterdam and University of Groningen, Netherlands (Forensic psychiatry, criminal law and criminology) Prof. Dr. Rudolf M. Rizman, Full Professor of Sociology and Political Science, University of Ljubljana, Slovenia Dr. Elizabeth Teague, PhD, Eastern Research Group, Research Analysts, UK Foreign & Commonwealth Office, United Kingdom

Opponents: Prof. Dr. Stefano Bianchini, Professor of East European Politics and History at the University of Bologna, School of Political Science Dr. Ben de Jong,PhD, senior lecturer, Eastern Europe Institute, University of Amsterdam The public defense of the dissertation will be held at 17.00 PM. On October 7, 2010, at Vytautas Magnus University (The Small Hall, Daukanto Street 28, Kaunas).

Address of the Faculty of Political Science and Diplomacy, Vytautas Magnus University: Gedimino Street 44, LT-44246, Kaunas, Lithuania, tel.: + 370 37 206704, fax: +370 37 206709

The summary of this doctoral dissertation was sent out on August 25, 2010

The dissertation is available at the library of Vytautas Magnus University (Kaunas, K. Donelaičio 52) and the Lithuanian national M.Mažvydas Library (Vilnius, Gedimino pr. 51).

2 VYTAUTO DIDŽIOJO UNIVERSITETAS

Robert VAN VOREN

ŠALTASIS KARAS PSICHIATRIJOJE Sovietų politinis piktnaudžiavimas psichiatrija Ir Pasaulio Psichiatrų Asociacija (PPA)

Daktaro disertacijos santrauka Socialiniai mokslai, politikos mokslai (02 S)

Kaunas, 2010

3 Disertacija parengta Vytauto Didžiojo Universitete, Kaunas, Lietuva.

Disertacija ginama Vytauto Didžiojo Universtiteto Politikos mokslų ir diplomatijos fakulteto mokslo taryboje.

Mokslinis vadovas: Prof. Gintautas Mažeikis

Taryba:

Pirmininkas: Prof. Leonidas Donskis (Vytauto Didžiojo Universitetas, Kaunas, Humanitariniai mokslai, Filosofija – 01 H)

Nariai: Prof. David Aphrasidze, Politikos mokslų profesorius, Magistro studijų dekanas (Ilia Valstybinis Universitetas, Tbilisis, Gruzija).

Prof. Dick Raes, profesorius emeritas (Teismo psichiatrija, baudžiamoji teisė ir kriminologija) (Laisvas Amsterdamo Universiteto ir Groningeno Universitetas, Nyderlandų Karalystė).

Prof. Rudolf M. Rizman, Sociologijos ir Politikos mokslų profesorius (Liublijanos Universitetas, Slovėnija).

Dr. Elizabeth Teague, Tyrimų analitikė (Jungtinės Karalystės Užsienio ir Britanijos tautų sandraugos Ofisas, Rytų Tyrimų grupė, Jungtinės Karalystė).

Oponentai: Prof. Stefano Bianchini, Rytų Europos Politikos ir Istorijos profesorius (Bolonijos Universiteto Politikos mokslų mokykla)

Dr. Ben de Jong, PhD, docentras, Rytų Europos Institutas (Amsterdamo Universitetas)

Disertacija bus ginama viešame Politikos mokslų ir diplomatijos fakulteto mokslų tarybos posėdyje, kuris įvyks 2010 m. spalio 7 d. 17.00 val. Vytauto Didžiojo Universiteto Mažojoje salėje (Daukanto g. 28, Kaunas).

Vytauto Didžiojo Universiteto Politikos mokslų ir diplomatijos fakulteto adresas: Gedimino g. 44, LT-44246, Kaunas, Lietuva, tel.: + 370 37 206704, fax: +370 37 206709

Disertacijos santrauka išsiųsta 2010 m. rugpjučio 25 d. Su disertacija galima susipažinti Vytauto Didžiojo Universiteto bibliotekoje (K. Donelaičio 52, Kaunas) ir Lietuvos nacionalinėje Martyno Mažvydo bibliotekoje (Gedimino pr. 5, Vilnius).

4 TABLE OF CONTENTS

INTRODUCTION ...... 7 I. SCIENTIFIC WORK TO DATE ...... 10 New elements ...... 12 II. AIM OF THE DISSERTATION...... 14 III. OBJECTIVES...... 15 IV. CHRONOLOGICAL FRAMEWORK...... 15 V. THEORETICAL APPROACH OF THE INVESTIGATION...... 18 Introduction ...... 18 METHODS AND SOURCES ...... 20 Political science...... 20 Social history...... 22 Oral history...... 23 The author and oral history...... 25 Oral history and the subject of research...... 29 Participatory historiography ...... 31 Feedback...... 33 Archival research ...... 34 Literature...... 35 VI. THE SUBJECT OF RESEARCH ...... 36 VI.A. THE CONTEXT: THE TOTALITARIAN...... 39 ENVIRONMENT ...... 39 The totalitarian state...... 42 Homo Sovieticus and the totalitarian state ...... 54 Andrei Snezhnevsky – a short political biography...... 66 The DDR and the Soviet Union: not exactly brothers ...... 74 Jochen Neumann – a short political biography...... 78 VI.D. POLITICAL ABUSE OF PSYCHIATRY – AN ANGLO- AMERICAN PERSPECTIVE AND THE INFLUENCE OF EAST- WEST POLITICS ...... 83

5 The role of the US State Department...... 88 Melvin Sabshin – a short political biography...... 96 VI.E. POLITICAL ABUSE OF PSYCHIATRY – A GREEK PERSPECTIVE ...... 102 Costas Stefanis – a short political biography ...... 108 VI.F. POLITICAL ABUSE OF PSYCHIATRY – THE TIP OF THE ICEBERG ...... 113 VII. CONCLUSIONS ...... 124 VIII. BIBLIOGRAPHY ...... 129 IX. MAJOR WORKS PUBLISHED BY THE AUTHOR ON THE SUBJECT ...... 133

6 INTRODUCTION

For more than forty years the issue of political abuse of psychiatry in the Soviet Union dominated the agenda of the world psychiatric community. The issue has on one hand resulted in angry exchanges, yet on the other hand it has stimulated an ongoing debate on human rights and professional ethics. During those years the World Psychiatric Association (WPA), around which most of the discussions evolved, adopted a series of ethical codes and declarations on human rights that condemn the use of psychiatry for non-medical purposes, and also installed mechanisms to investigate complains of violations of these regulations.1

Political abuse of psychiatry refers to the misuse of psychiatric diagnosis, treatment and detention for the purposes of obstructing the fundamental human rights of certain individuals and groups in a given society. The practice is common to but not exclusive to countries governed by totalitarian regimes. In these regimes abuses of the human rights of those politically opposed to the state are often hidden under the guise of psychiatric treatment. In democratic societies “whistle blowers” on covertly illegal practices by major corporations have been subjected to the political misuse of psychiatry.

In totalitarian states, the victims are usually those who are politically and ethically opposed to the restrictions imposed by the state, those who hold religious beliefs or who form other independent groups and those who attempt to organize unions. In democratic societies there are still individuals who are indirectly punished by the

1 E.g. the WPA Hawaii Declaration of 1977. One of the principles stated in the Decla- ration was that a psychiatrist must not participate in compulsory psychiatric treatment in the absence of psychiatric illness, and also there were other clauses that could be seen as having a bearing on the political abuse of psychiatry. The Declaration was amended in Vienna in 1983, and in 1996 succeeded by the Madrid Declaration of 1996, which was further expanded in 1999. In addition, the organization set up Committees on Ethics and on the Review of Abuse of Psychiatry.

7 state when they expose actions of government that they believe not to be in the interests of society. Whistle blowers and those who protest against harassment by prominent figures are sometimes victims of the state directly or indirectly where the state is the accomplice of major industry. Psychiatry is usually drawn into the abuse when the behavior is attributed to mental illness.

The case of political abuse of psychiatry in the Soviet Union is internationally the most famous example, specifically because it is well-documented, because it strongly influenced the concept of medical ethics and its application internationally, and because with maybe a few exceptions it is generally accepted that psychiatry in the Soviet Union was abused for political purposes in a systematic manner and in the course of several decades. However, the Soviet Union is certainly not the only country where political abuse of psychiatry has taken place. Over the past decades a lot of documentation has been published on similar abuses in other countries as well. One of the countries where systematic political abuse of psychiatry took place was Romania; in 1997 the International Association on the Po- litical Use of Psychiatry (IAPUP) organized an investigative committee to research what actually happened.2 The same organization also received information on cases in Czechoslovakia, Hungary and Bul- garia, but all these cases were individual and there was no evidence that any systematic abuse took place. An extensive research on the situation in Eastern Germany came to the same conclusion, although in this socialist country politics and psychiatry appeared to have been very closely intermingled.3 Later, information appeared on the political abuse of psychiatry in Cuba, which was however short-lived and

2 Psychiatry under Tyranny, An Assessment of the Political Abuse of Romanian Psy- chiatry During the Ceausescu Years, Amsterdam, IAPUP, 1989. 3 Süss, S., Politisch Missbraucht? Psychiatrie und Staatssicherheit in der DDR, Berlin, Ch. Links Verlag, 1998.

8 never developed into a full-scale means of repression.4 In the 1990s, the successor organization of IAPUP, the Geneva (later: Global) Ini- tiative on Psychiatry (GIP), was involved in a case of political abuse of psychiatry in The Netherlands, in the course of which the Ministry of Defense tried to silence a social worker by falsifying several psychiatric diagnoses.5 And, finally, since the beginning of this century the issue of political abuse of psychiatry in the People’s Republic of China is again high on the international agenda and has caused repeated debates within the international psychiatric community.6

4 Brown, Ch.A., and Lago, A., The Politics of Psychiatry in Revolutionary Cuba, New York 1991 5 For the case of Fred Spijkers see Nijeboer, A., Een man tegen de Staat, Papieren Tijger, Breda, 2006. The case took many years to be resolved, and although the victim was compensated and even knighted by the Dutch Queen, it is still not fully closed, and Fred Spijkers is still trying to have his false psychiatric diagnosis revoked. 6 Munro, R., Judicial Psychiatry in China and its Political Abuses, GIP, Amsterdam, 2001, and Munro, R., China’s Psychiatric Inquisition, Wildy, Simmonds & Hill, Lon- don., 2006.

9 I. SCIENTIFIC WORK TO DATE As noted above, the case of political abuse of psychiatry in the Soviet Union is unique because it strongly influenced the concept of medical ethics and its application internationally, and also because it was very well-documented thanks to the vibrant and well-organized dissident movement in the Soviet Union. In the course of several years, the Moscow Working Commission on the Political Use of Psy- chiatry published two-dozen Information Bulletins with hundreds of pages of documentation on more than 400 cases of political abuse of psychiatry,7 and also other dissident publications, such as the Chronicle of Current Events (Khronika Tekushchikh Sobityi),8 regularly documented cases of political abuse of psychiatry. One of the founders of the Working Commission, Aleksandr Podrabinek, was the first to write an analysis of the political abuse in the USSR, Puni- tive Medicine,9 yet the information - collected under the most difficult conditions - was still too haphazard and the sources too limited to consider it a product of scientific research. The same counts for many of the publications of the International Association on the Po- litical Use of Psychiatry, of which the defendant was one of the authors, as well as for publications issued by other human rights organizations.

The number of scholarly publications on the issue was therefore hitherto very limited, the two main ones being co-authored by the psychiatrist Sidney Bloch and political scientist (and Sovietologist)

7 Van Voren, R., Soviet Psychiatric Abuse in the Gorbachev Era, IAPUP, Amsterdam, 1989, p. 27 8 The information bulletin Chronicle of Current Events (Хроника текущих событий) was one of the longest-running and best-known samizdat periodicals in the USSR dedicated to the defense of human rights. For fifteen years from 1968 to 1983, a total of 63 issues of the Chronicle were published. 9 Podrabinek, A., Punitive Medicine, Karoma Publishers, Ann Arbor, 1980. The book was written in 1977, but published only three years later.

10 Peter Reddaway and published in 1977 and 1984 respectively.10 How- ever, also their sources were mainly dissident ones, and on top of that their publications saw the light at a time when the abuse was still in full swing and the campaign against it was reaching its peak. A review in the British Medical Journal correctly stated that “the authors are particularly well placed to give a detailed and accurate account of the political maneuvers that went on (…) Their very close- ness to the events they describe appears to have prevented their plac- ing the events in a historical and political context. The state of conflict between the Soviet bloc and the West simply cannot be ignored. (…) The future of the political abuse of psychiatry in the Soviet Union is inextricably linked with the political and military confrontation between that state and the West.”11 On the Soviet side, the only publications that dealt with the issue of political abuse of psychiatry were part of a propaganda campaign and limited to either articles in the (Soviet) press or pseudo-scientific propagandistic publications such as S Chuzhogo Golosa published in 1982 in the USSR.12

The collapse of the Communist regimes in Eastern Europe and the Soviet Union resulted not only in an end to the political abuse of psychiatry, but also in many new sources of information becoming available. As indicated earlier, the political abuse of psychiatry in Romania was analyzed in 1998 by a team of researchers led by crimi- nologist Prof. G.O.W. Mueller,13 and Dr. Sonja Süss published an im-

10 Bloch, S. and Reddaway, P., Russia’s Political Hospitals, London, Gollancz, 1977, and Bloch, S. and Reddaway, P., Soviet Psychiatric Abuse – the Shadow overt World Psy- chiatry, London, Gollancz, 1984. Other books that could be included in this category are Fireside, H., Soviet Psychoprisons, Norton 1982, and Smith, Th., No Asylum, New York University Press, 1996. However, they also based themselves exclusively on dissident sources. 11 Leff, J., Russian political dissenters, in British Medical Journal, Vol 289, 13 October 1984. 12 S Chuzhogo Golosa, Moskovskii Rabochii, Moscow, 1982 13 Adler, N., Ayat, M. and Mueller, G.O.W., Psychiatry under Tyranny, An Assessment of the Political Abuse of Romanian Psychiatry During the Ceausescu Years, Amster- dam, IAPUP, 1989.

11 pressive research into the interconnection between psychiatry and the state in the German Democratic Republic (Deutsche Demokra- tische Republik, DDR), based on five years of research in the archives of the former Stasi.14 However, on the political abuse of psychiatry in the Soviet Union only few new publications appeared, and all of them still using the same sources of information.

New elements This dissertation is the first attempt to describe the issue in all its complexity and by making use of all the data currently available and accessible. It combines political scientific approaches with extensive historical research (both archival and oral historical research), describing and analyzing the political context as well as the (consequences of the) political behavior of those involved. The dissertation deals with a variety of issues of national politics and their impact on the course of history, political concepts and the views of the various actors that play a role in the dissertation (e.g. the persecution of Jews in Tsarist Russia, the destruction and desolation in Germany following the end of the Second World War as well as the ever-dominant issue of the Cold War).

Never before has this issue been researched in such minute detail, in the course of which not only a wealth of new evidence and documentation was collected but also older publications from the time of the Cold War were revisited and their contents reanalyzed. In fact, of the more than 50 year history of the World Psychiatric Asso- ciation no part has until now been seriously researched and documented, and this book is the first that is (partially) based on the ar-

14 See footnotes 3 and 4.

12 chives of the WPA, which are currently stored in a cellar in Geneva and in much disarray.15

Undoubtedly, there are important data stored in archives of Western intelligence agencies as well as in those of the KGB (of which some were available and included in the research) and other Eastern European secret services, however they remain inaccessible and it is a question whether this will change in the foreseeable future.16 These archives might provide data that can influence this historical record (e.g. with regard to attempts by Western intelligence agencies to influence the course of events), yet until these records become available one cannot even guess in what way the picture might be different.

An important factor is that now, twenty years after the fall of the Berlin Wall, many of the actors who were involved in the political abuse of psychiatry in the USSR and the struggle to bring this means of repression to an end, are still alive. This counts not only for those who were representatives of the Soviet side and those who were opposing the political abuse of psychiatry, both in the USSR and abroad, but also for those who were in leadership positions within the world psychiatric community that was facing this highly complex ethical dilemma: whether to exclude the Soviets from the interna-

15 As far as the author could ascertain, Vera Sartorius was the only person who attempted to write a history of the World Psychiatric Association and she interviewed some of the leading figures of the organization. However, she gave up her attempt and the materials were never published. Communication with Norman and Vera Sartorius, October 6, 2009. The author thanks Prof. Mario Maj, President of the World Psychiatric Association, for getting access to the WPA archives in spite of their current condition. 16 On August 24, 1991, Russian President Boris Yeltsin ordered the transfer of the KGB archives to the repositories of the Russian Federation. However, the KGB successfully resisted their transfer and it never materialized. However, part of the KGB archives were for a short period open to selected researchers, and some managed to copy documents, e.g. Vladimir Bukovsky, who did research there for the trial against the Communist Party of the Soviet Union (CPSU), which however never took place. After a brief period of openness they were closed again, and considering the political climate in Russia it is quite unlikely they will be opened again soon.

13 tional community (and in particular from the World Psychiatric As- sociation) because of their constant violation of the Hippocratic Oath,17 or to maintain relations with them hoping that such interaction would help them to mend their ways. However, in several years from now, many key persons will no longer be accessible for interviews, and many private archival collections will have been discarded. In that sense this undertaking could not be better timed.

And, last but not least, this work is the first research on the subject that departs from the standard black-and-white picture and instead tries to understand the positions from all sides, both through archival research and through oral historiography. Actually, the process of retracing the history and the personal interactions between the various main actors proved to be a crucial element in creating this common understanding and the departure from set positions that hitherto seemed to be certain and unchangeable. This process is, for that reason, not only of interest from a political scientific and historical point of view, but also from a psychological one: opposite sides finding common ground and finding a common understanding of what actually happened.

II. AIM OF THE DISSERTATION The aim of the dissertation is to examine the issue of political abuse of psychiatry in the Soviet Union and its impact on the world psychiatric community in general and the World Psychiatric Associa- tion (WPA) in particular, and specifically during the years 1983- 1989, both from a political scientific and a historiographic point of

17 The Hippocratic Oath is an oath traditionally taken by doctors swearing to ethically practice medicine. It is perhaps the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards. One of the best known prohibitions is "to do no harm".

14 view, as well as to understand the “human dimension” and the role key persons on all sides played in the course of the debate.

III. OBJECTIVES The objective of this research is to put the issue of Soviet psychiatric abuse and the WPA in a broader socio-political and historical context in order to understand the origins, the scope and the impact that the issue had on world psychiatry. In doing so, the author makes use of a combination of political scientific and historical approaches.

In addition, the dissertation focuses on the human dimension on all sides of the barricades, in order to achieve an as balanced picture as possible of what happened during the years 1983-1989, when the issue dominated the international psychiatric agenda, and on how the political abuse of psychiatry in the USSR was brought to an end. The events are placed in the broader context of the Cold War, which resulted in harsh rhetoric on both sides and in images of each other that increasingly became caricatures rather than realistic views on the opponents’ views and convictions, and the socio-political and cultural factors that determined human behavior on both sides of the “barricades”.

IV. CHRONOLOGICAL FRAMEWORK The past is not a one-dimensional sequence of events, but a whirlwind of many processes that run in parallel, contrary, or briefly meet and continue their own course. It is also a product of mankind, both because of mankind being a crucial element in shaping the course of events, but equally because mankind is shaped by these events themselves, both those of the past and when they take their course. Socio-cultural factors as well as political-historical contexts are essential elements in forming the human being to what he or she

15 is, and at the same time the product of this itself influences the course of events as they develop.

When embarking on the path to write this dissertation, the author tried to stress this human dimension by taking the lives of two active participants in the events - an East German and an American - as threads of DNA, meandering through the socio-political developments of the twentieth century, which formed the background to the events that are the main object of research, and without which it is impossible to explain to its full extent what really happened, and why things happened the way they did. Apart from allowing the author to use the course of their lives as a context in which the issue discussed is put, both men also played a prominent role in the issue at hand and as members of the Executive Committee of the World Psychiatric Association personifying the opposing Western and Soviet Blocs, they were key actors in the years 1983-1989 that form the core period of the dissertation. In the course of the events, a third – Greek – “thread” acquires some prominence and helps to complete the com- position.

The two main persons that were chosen as the “core” of the dissertation indeed seemed to be from opposing sides. One was an exponent of the communist Eastern Bloc who not only believed in the communist system but also actively defended it, among others through his voluntary intelligence work for the Ministry of State Se- curity (Stasi). The other was the epitome of American psychiatry, one of the most influential psychiatrists in the United States of the twentieth century, who had a key influence on the development of psychiatric diagnostic concepts both in the USA and on a global level. And although they came from opposing sides, it gradually became clear that there was more that connected than separated them. However, only in the course of writing the dissertation the author discovered how much they had in common, and to what extent they shared

16 norms and values, and their assessments of the historical past. The all-American psychiatrist turned out to have his roots in Russia, was raised in a socialist environment and was himself a former member of the American Communist Party, while the prototype of an East German communist turned out to be a highly principled and moral man who thoroughly analyzed the system he believed in, and did not refrain from criticizing it openly on many occasions, thereby jeopard- izing his own professional career. In the end the American retired from his position in full glory, while the East German lost everything and until this very day remains in Germany a non-person, emotion- ally exiled within his own country.

The third person, a prominent Greek intellectual who led the World Psychiatric Association during the years that form the key period covered in the dissertation, seemed to be prejudiced and pro- Soviet, engaged in “clandestine negotiations” to realign his organization with the WPA, yet gradually in the course of research it became clear that he was much more an independent and liberal minded exponent of prevailing Greek political thought, in turn also the product of a troubled Greek past severely affected by the Cold War and its consequences.

As said before, the lives of these men enabled the author to describe the broader political-historical context of the twentieth century, which formed the breeding ground for the Cold War, and which in turn determined the events that form the object of this work. Without knowing this broader context, and without understanding the Cold War and the effects it had on people on both sides, the history of Soviet psychiatric abuse and the World Psychiatric Associa- tion in the period 1983-1989 remains a one-dimensional one, and merely a summing up of historical events that seem like facts, but have no depth and therefore no real meaning. At the same time, both men were key actors during the period on which the dissertation fo-

17 cuses, and therefore have not been chosen at random but were carefully selected.

Writing the dissertation in a form that made all this accessible and digestible was a challenge in itself. Equally challenging was the fact that the author himself had been an active participant in the events, and that in the course of writing the dissertation he continued a process started earlier (and which had led to the publication of his personal memoirs On Dissidents and Madness in 2009, a book which, in turn, triggered the writing of this work)18 to reflect on his own activities, his own views and convictions, and his own place within the context that forms the background to this work. Part of this process is reflected in some of the more personal parts of the manuscript, which have been marked by using an italics font. This might be an unusual approach in a scholarly work, yet at the same time the author is convinced it adds another important (human) dimension to the text, and also makes it more readable and accessible.

V. THEORETICAL APPROACH OF THE INVESTIGATION.

Introduction Separating methods from sources is a complex issue, because the borders between the two are usually rather fluid, in particular when sources have a multiple function. In the dissertation Cold War in Psychiatry this is an issue of importance, and need an introduc- tory explanation. When trying to encompass the full complexity of the issue of political abuse of psychiatry as a means of repression in a totalitarian state, an issue of contention between two rivaling superpowers and at the same time both an issue of ideological and ethical debate within the world psychiatric community, the author chose to

18 Van Voren, R., On Dissidents and Madness, Rodopi, 2009

18 use the lives of two key actors in the period that forms the core of the research (1983-1989) as a historical framework as well as a reference point to describe adequately the human dimension. However, while being objects of research, both men also formed a crucial source of information, in particular Jochen Neumann whose reports to the DDR leadership formed an extensive documentation of the proceedings within the Executive Committee of the World Psychiatric Asso- ciation. However, by allowing both men to come close to the actual writing of the dissertation and reviewing the text with them on more than one occasion, they also acquired the function of reviewer and sounding board. It depended on the skills of the author to draw the line when necessary and make sure that the outcome of the collabo- rative work remained his, and not a collective one. At the same time, the challenge of using both men in more than one form helped to deepen the book and give much more body to the human dimension.

In this avtoreferat, the political contexts of two other main actors – one Soviet and the other Greek – are added in order to complete the diverse picture.

19 METHODS AND SOURCES

Political science The issues discussed within the context of this dissertation lend themselves perfectly for an in-depth political scientific study. The East-West confrontation that followed the Second World War dominated political life on both sides of the divide for more than forty years, and led to a standoff that became a central reference point for many decisions and actions.

The totalitarian Soviet state, in trying to present itself as the su- perior form society in which all rights were guaranteed, tried to put up a humane face and increasingly hid part of its repression behind the mask of psychiatric illness. As I will explain later in this document, the totalitarian context and the homo sovieticus or New Soviet Man that was created during decades of Soviet power and terror, very much facilitated the development of psychiatry as a systematic tool of repression. As Richard Bonnie and Svetlana Polubinskaya, two lawyers from the United States and the Soviet Union respectively who were very much involved in the process of bringing about an end to the political abuse of psychiatry, point out “the repression of political and religious dissidents was only the most overt symptom of an authoritarian system of psychiatric care in which an expansive and elas- tic view of mental disorder encompassed all forms of unorthodox thinking, and in which psychiatric diagnosis was essentially an exer- cise of social power.”19

From the 1960s onwards, foreign opinion became an important factor in the decision making process within the Soviet elite, which is clearly illustrated in the many documents that former Soviet dissident Vladimir Bukovsky managed to scan in the early 1990s in the

19 Bonnie, Richard and Polubinskaya, Svetlana: Unraveling Soviet Psychiatry. In: The Journal of Contemporary Legal Issues, Volume 10: 279, 1999, pp. 284-5

20 archives of the Central Committee of the Communist Party.20 This also affected their policy of incarcerating political opponents in psychiatric hospitals, because Western public policy and protests from Western political figures (especially when also the French and Italian Communist parties joined in) forced them to backtrack and use this method of repression mainly for lesser known dissidents. Likewise, from the above-mentioned records is becomes quite clear that the Soviet leadership in some cases remained hesitant as to what means of suppression or repression to use (e.g. in the cases of Aleksandr Solzhenitsyn and Andrei Sakharov), afraid of a backlash in international relations. Also the non-violent legalistic approach of the dissident movement seems to have caused them much concern.21

Within the world psychiatric community, the issue resulted in a deep rift between those in favor of strong action (either because out of moral reasons, as it constituted a gross violation of medical ethics, or for more political reasons) and those against (either because they opposed excluding such a large group of largely innocent psychiatrists from their midst or – likewise – for more political reasons). Also within the Word Psychiatric Association this divide resulted in angry exchanges, Cold War politics and personal conflicts. More than hitherto believed, larger politics influenced the debate, on one hand because of infiltration by intelligence agencies and politicking behind the scenes, on the other because of the final agreement between the US State Department and the Soviet Foreign Ministry that psychiatry as a political issue should be solved and removed from the negotiat- ing table once and for all.

20 See www.bukovsky-archives.net. For an analysis of these documents see Red- daway, P., Patterns in Soviet public policy towards dissent: 1953-1986, to be published in a collection on samizdat in Eastern Europe and the USSR, edited by Wolf- gang Eichwede. 21 see Reddaway, P., Patterns in Soviet public policy towards dissent: 1953-1986

21 At the same time, and more on a human level, the standoff did not prevent people from either side of the divide to find common ground, and the human dimension described in this dissertation and based on extensive research (the developing friendship between a highly principled and ethical faithful Communist and an exponent of increasing American dominance over world psychiatry) brings the issues discussed also down to the human level.

This dissertation puts special focus on that human dimension and, in doing so, on the “human factor” behind the “dry” facts. A political scientific approach, in essence a study of human behavior where developments and actions are not the result of unconscious decisions of organisms or inanimate objects but of the human context in all its complexity, allows putting the historical facts in a broader analytical context.

Social history During the second half of the twentieth century, new approaches to historiography had a profound influence on the way history was written down and perceived. An increase of interest in the history of the common man led to the development of social history. Often described as history from below because it deals with the every-day people; crudely put: it focuses on ordinary people rather than on battles and kings.

Social history became increasingly popular after the Second World War and in particular in the 1960s and 1970s. The Journal of Social History, one of the main journals in the field, was founded in 1967. While proponents of history from below and the French An- nales School of historians22 have considered themselves part of social

22 The Annales School is a style of historiography named after its French-language scholarly journal Annales d'histoire économique et sociale. Prominent leaders include co-founders Marc Bloch (1886-1944) and Lucien Febvre (1878-1956). A second gen-

22 history, it is seen as a much broader movement among historians in the development of historiography. The Annales school has been particularly influential in setting the agenda for historiography in France and numerous other countries, especially regarding the use of social scientific methods by historians, which an emphasis on social rather than political or diplomatic themes. The school has dominated French social history and influenced historiography in Europe and Latin America. The third generation of Annales historians stressed history from the point of view of mentalities, or mentalités. The current and fourth generation of Annales historians, led by Roger Char- tier (1945- ), clearly distances itself from the mentalities approach, and emphasizes the analysis of the social history of cultural practices.

Unlike other approaches, social history tries to see itself as a synthetic form of history not limited to the statement of so-called historical fact but willing to analyze historical data in a more systematic manner and taking other factors into account as well.

Oral history The absence of sufficient documents and archival materials triggered the development of oral history as an important means of collecting historical data. Also oral history is a relatively new branch of historiography, which was used increasingly in the years before the Second World War but, like social history, obtained widespread popularity only in the 1960s and 1970s.23 eration of Annales historians was led by Fernand Braudel (1902-1985). After a third generation, led by Emmanuel Le Roy Ladurie (1929- ), a fourth generation is now in charge. 23 Some anthropologists started already collecting recordings (at first especially of Native American folklore) on phonograph cylinders in the late 19th century. In the 1930s the Works Progress Administration (WPA) sent out interviewers to collect ac- counts from various groups, including surviving witnesses of the American Civil War, slavery, and other major historical events. The Library of Congress in Washington D.C. began recording traditional American music and folklore onto acetate discs. However, the task of oral historians became easier after the Second World War when audiotap- ing was introduced.

23 Early interviewing projects at Columbia and elsewhere tended to focus on the lives of the elite - leaders in business, the professions, politics, and social life. However, in the 1960s and 1970s the scope of oral history widened in response to both the social movements of the period and historians' growing interest in the experiences of common people. Increasingly, interviews were conducted with workers, ethnic minorities, women, labor and political activists, etc. By doing so, they gave a voice to those who hitherto had been historiographically silent.

Also in the former Soviet Union oral history has been an essential component in the quest to retrace and document the terror under the Communist regime. The society “Memorial”, a cluster of dozens of organizations in different regions of Russia, Ukraine, Kazakhstan, Latvia, and Georgia that sees as its main task the awakening and preservation of the societal memory of the severe political persecution in the recent past of the Soviet Union, uses oral history as one of its main tools of preserving that past. In the late 1980s and early

In 1946 David Boder (1886 -1961), professor of psychology at the Illinois Institute of Technology in Chicago, traveled to Europe to record long interviews with "displaced persons", most of them being survivors of the Holocaust. Using a wire recorder, the first device capable of capturing hours of audio, Boder collected over a hundred interviews totaling 120 hours. His recorded interviews are probably the first recorded oral histories of significant length. Two years later, in 1948, the Columbia University historian Alan Nevins established the Columbia Oral History Research Office, with a mission of recording, transcribing, and preserving oral history interviews. It is now the largest archival collection of oral history interviews in the world. Nevins was the first to initiate a systematic and disciplined effort to record on tape, preserve, and make available for future research recollections deemed of historical significance. While working on a biography of President Grover Cleveland, he found that Cleveland's associates left few of the kinds of personal records (letters, diaries, memoirs) that biogra- phers generally rely upon. Moreover, the bureaucratization of public affairs was tend- ing to standardize the paper trail, and the telephone was replacing personal corre- spondence. Nevins came up then with the idea of conducting interviews with participants in recent history to supplement the written record. In 1967 American oral historians founded the Oral History Association, and two years later British oral historians founded the Oral History Society. There are now numerous national organizations and an International Oral History Association, which hold workshops and conferences and publish newsletters and journals devoted to oral history theory and practices.

24 1990s, the Historical Archive Institute in Moscow, directed by the Russian democratic political leader Yuri Afanasyev, was very much involved in the development of oral history as a tool of documentation and research, and the author – then Director of the Amsterdam- based Second World Center - actively collaborated with Prof. Afa- nasyev and his colleagues.

Also in other places in the former USSR oral history has been an important means in retracing the past, in particular with regard to the effects of the Stalinist terror.24 In Kiev, the Ukrainian Center for the Rehabilitation of Victims of Totalitarianism and Civil Wars, which the author helped establish in 1994, carried out interviews with many of its patients, thereby documenting their experiences and at the same time using the interviews as a therapeutic tool: former Gulag inmates were often chronically traumatized due to the long time span with which they lived with their experiences, and telling their stories to someone who was willing to listen – often the first time in many decades – had a therapeutic effect on them.

The author and oral history During his adolescent years, the author was inspired by several works in which oral history formed an important if not an essential element of the research done, such as the books Is Paris Burning? and Freedom at Midnight by Larry Collins and Dominique Lapierre25 and the books The Longest Day and A Bridge too Far by Cornelius Ryan.26 When entering university, the classic Hard Times: An Oral History of the Great Depression by Studs Terkel and his The Good

24 A recent example of such work is the book The Whisperers: Private Life in Stalin’s Russia by Orlando Figes, which was published in 2009 and gives a chilling account of life in the USSR under Stalin. 25 Collins, L., and Lapierre, D.: Is Paris Burning? 1965, and Collins, L., and Lapierre, D.: Freedom at Midnight, 1975. 26 Ryan, C.: The Longest Day, 1959, and Ryan, C.: A Bridge too Far, 1974

25 War: An Oral History of World War Two left a deep and lasting impression.27

During the years when the author studied Modern and Theo- retical History and Russian language at the University of Amsterdam (1979-1986), the prevailing debate among historians focusing on the Second World War and its consequences was the shift from a black- and-white picture to one of shades of grey. Renowned historians such as Lou de Jong, director of the State Institute of War Documentation (RIOD) and author of The Kingdom of the Netherlands during World War II, a book series of 26 volumes and a length of over 15,000 pages,28 and Prof. Sam Presser, author of the standard work Ondergang. De vervolging en verdelging van het Nederlandse Jodendom 1940-1945,29 were proponents of the black-and-white picture, in which all Germans were invariably bad and Dutch society resisted occupation collectively, apart from a small minority of despi- cable citizens who collaborated with the occupational regime and were for that reason justifiably ostracized from society after the liberation.

One of the author’s teachers, Professor Hans Blom, who succeeded Lou de Jong as Director of the RIOD (later renamed into NIOD), tackled that image and argued that it was a simplification of

27 Terkel, S.: Hard Times: An Oral History of the Great Depression, 1970, and Terkel, S.: The Good War: An Oral History of World War Two, 1985. Terkel, coincidentally like Melvin Sabshin the son of a Jewish Russian immigrant, published his first book, Giants of Jazz, in 1956. He followed it with a number of other books, most focusing on the history of the United States people, relying substantially on oral history. 28 Louis ("Lou") de Jong (1914 -2005 in Amsterdam) was a Dutch journalist and historian specializing in the history of the Netherlands in World War II and the Dutch resistance. 29 Jacob (Jacques) Presser (Amsterdam, 1899-1970) was a Dutch historian, writer and poet best known for his book Ondergang; De vervolging en verdelging van het Ned- erlandse Jodendom 1940-1945 (Collapse; The persecution and extermination of Dutch Jewry 1940-1945) on the history of the persecution of Dutch Jews during the Second World War.

26 reality, which was much more diverse and balanced.30 Several scan- dals in Dutch society, in which alleged heroes were unmasked as collaborators (e.g. the Weinreb case31) further stimulated the debate.32

The use of oral history as an integral and even essential component in historical research formed the basis of the author’s doctoral

30 Hans Blom (1943), a Dutch historian, was director of the RIOD and professor of Dutch history at the University of Amsterdam. He is well-known for his inaugural lecture Gripped by right and wrong? (In de ban van goed en kwaad?) in 1983, when he distanced himself from the right-wrong paradigm of his predecessor Lou de Jong. He is equally renowned because of the Srebrenica report that he and several colleagues wrote in 2002 and which led to the collapse of the Dutch government. In keeping with his lecture, in this report Blom spoke little or no value judgments. This earned him severe criticism from colleagues, publicists, lawyers and politicians. In 2007 Blom retired from the NIOD (former RIOD). In 2007 he published the book In de ban van goed en kwaad (gripped by right and wrong), in which he reflected on the discussion in The Netherlands and his own positioning in it. 31 Friedrich Weinreb (1910-1988), a Hasidic Jewish storyteller, writer and economist, came from a traditional Eastern European Hasidic Judaism. His family came in 1916 from Vienna to the Netherlands. During World War II Weinreb played a controversial role. He ran a fictional “emigration agency” and created a nonexistent German Gen- eral, with whom he - in its own words - corresponded. Jews who registered with him against payment were told that by doing so they could postpone their deportation. Curiously the German occupiers at least partially participated in Weinreb initiative: the Jewish Council temporarily exempted the people on his list from deportation. Even after the failure of this system, when it appeared that several persons on the list were arrested anyway, he continued, and he later justified this by saying that he offered victims of the Holocaust as at least some form of hope. Weinreb managed to save himself from the Germans in early 1944 by going into hiding. The Special Court of Cass- ation sentenced Weinreb in 1948 to six years imprisonment. In December of that year he was pardoned, thanks to the 50-year jubilee of Queen Wilhelmina. Jacques Presser wrote in his book De Ondergang some laudatory passages on him, and Weinreb, published, under editorial support by the writers Aad Nuis and Renate Rubinstein, an autobiography, in which he tried to create a positive picture of his activities during the war. The book resulted in a lot of controversy and led to the Weinreb affair. Weinreb’s editors sought his rehabilitation, but their efforts took the opposite direction. Several issues in his book proved to be false. In response to this uproar, the then Minister of Justice in 1970 asked the RIOD directed by Dr. Lou de Jong to write a report on this matter. After six years of research, the Institute published a report, which left very little intact of Weinreb’s alleged acts of resistance. Numerous witnesses concluded that during the Second World War, Weinreb had in fact been guilty of treason and collaboration. 32 The debate is still continuing, and not only among historians. In 2009 a public debate focused on the erection of a monument for a German soldier in the town of Riel, who during the last days of the war saved two Dutch children during a bombardment. The question whether a monument for a member of occupation forces was morally justified resulted in sometimes angry and emotional exchanges.

27 thesis, Op zoek naar Robert van Voren (In search of Robert van Voren), in which he tried to recover the lost history of his uncle ir. Simon Karel Luitse (1917-1945).33 Simon Luitse (who was the first to take the pseudonym Robert van Voren) became a member of the Dutch resistance shortly after the Germans occupied The Nether- lands in 1940. He was arrested in 1943 and after an odyssey through seven camps and prison managed to escape, only to die two weeks after his liberation from disease and exhaustion. By interviewing his surviving relatives, school and university friends, former fellow resistance fighters and even former Dutch forced laborers who found him in a meadow after his escape, combined with archival research, his life was retrieved and a fairly complete picture of his relatively short life was recovered.

Research for Op zoek naar Robert van Voren also showed the author that the image of all Germans being bad and all Dutch (except a minority of collaborators) being good citizens who actively resisted German occupation, was to a high degree a very incomplete if not incorrect one. Dutch society, and in particular the Reformed (Her- vormde) Protestant part of the population, generally accepted the German occupation as an authority given by God that they should not resist. Apart from that, many people wanted to continue their lives undisturbed, did not feel the Germans to be much alien to them and as long as they themselves were not affected they did not see a reason why resistance would be necessary. The Dutch resistance consisted mainly of members of the Dutch Reformed Church (Gerefor- meerde Kerk, not to be confused with the Hervormde Kerk), who considered the Germans to be a hostile occupational force, and Communists (in particular after June 21, 1941, when Nazi Germany invaded the Soviet Union and the Molotov-Ribbentrop Pact was no longer a factor keeping them from resisting the Nazi’s). Until 1943-

33 Van Voren, R.: Op zoek naar Robert van Voren. Kok, Kampen, 1986

28 1944, when the tide of the war turned and it became clear the Ger- mans were not going to win the war, the general population was often as much an enemy to the resistance as the Germans: every act of resistance resulted in retaliation, and that angered the population that wanted their lives to remain untouched. Many of the former resistance fighters interviewed by the author for the book Op zoek naar Robert van Voren confirmed this dilemma.

Also in this dissertation oral history is an important component. Having been an active participant in part of the events in 1983-1989 that form the core of the dissertation, the author ran the serious risk of providing a personal and one-sided image of the events. Even though twenty years have passed, recollections remain highly subjective and colored by the position one had when the events unfolded. Time allows a person to take distance and acquire a more balanced view, yet for a historian the threat of describing only one subjective version of history remains high. The author countered this threat by having information confirmed through archival research and seeking information from multiple sources , thereby neutralizing the threat of subjectivity as much as possible.

Oral history and the subject of research This potential problem was tackled through several means. First of all, by involving both (opposing) sides of the events in retracing the history of what happened, a certain degree of objectivity could be ascertained. Oral historiography focused on persons who had been on both side of the “barricades”. Long and intense interviews with key individuals, added the human dimension to the documents and helped fill in the blank spaces. Interviews (and subsequent corre- spondence) with other participants in the events, including top officials of the Soviet Foreign Ministry as well as former Foreign Minis-

29 ter Eduard Shevardnadze himself, helped to describe the events as detailed and as accurate as possible.

Unfortunately, due to the political situation in Russia in 2009, where fear for repercussions has again became a normal element in daily life, only few former Soviet psychiatrists dared to speak out openly; some provided information confidentially, which helped to complete the picture. With much effort, fairly detailed information on the lives of some of the Soviet key actors could be gathered (even though some of the sources had to remain anonymous for obvious reasons), yet the possibility of interviewing them extensively did not exist, partially because they passed away before this research was undertaken, partially because of their unwillingness to expose themselves (either for political or personal reasons). This unfortunately limited the possibility of fully exploring the human dimension with regard to their role in the events.

In particular in the case of sessions of the Executive Committee of the World Psychiatric Association interviews were an essential element in recovering the past. The retraced Executive Committee minutes (not one source had the complete set of minutes and it took considerable time and effort to put the whole set together) provided only a fairly limited and “one-dimensional” picture.34 However, extensive interviews with members of the Executive Committee as well as supportive documents from the archive of the World Psychiatric Association and the personal archives of Jochen Neumann and Melvin Sabshin helped to turn the one-dimensional picture into a three-dimensional one.

34 This was particularly clear in the case of the minutes of the meeting of the Executive Committee in Rome in October 1984, where Jochen Neumann was elected as Vice President of the World Psychiatric Association (WPA), but where the proceedings were dominated by a row between WPA President Costas Stefanis and WPA General Secre- tary Fini Schulsinger. The minutes were later carefully doctored in order to keep the real content of the argument as vague as possible for the outside world. Proof of this was found in the WPA archives in Geneva.

30 Participatory historiography In the course of the development of the manuscript the author embarked on what could be called participatory historiography, involving some of the key actors on either side in the development process. In a way, this participatory historiography can be compared with participant observation, a research method used in sociology in which the researcher strives to "get to know" the people they're studying by entering their world and participating - either openly or secretly - in that world. The researcher puts himself "in the shoes" of the people he is studying, in an attempt to experience events in the way they experience them. Some research methods stress the importance of the researcher not becoming "personally involved" with the respondent, making sure that the researcher maintains both a personal and a social distance between himself and the people he is re- searching. Participant observation, however, sometimes called a form of subjective sociology, aims to understand the social world from the subject's point-of-view. 35

A well-known example of participation observation is the book Asylums by Ervin Goffman (1961).36 Goffman used the device of a "field diary" to record information - at the end of every day. Of course, this method raised clear problems of accuracy, memory and interpretation. In the case of this dissertation, the use of combined sources (interviews with the aid of original documents, reports and archival materials, and subsequently feedback by multiple revisions of the text and long interactions between the two main characters) minimized these dangers.

35 For an extensive analysis of this method see Jogensen, Danny L., Participant observation: a methodology for human studies, Sage publications, USA, 1989 36 Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York, 1961. In this book, for which he gathered information at the National Insti- tute of Mental Health in Washington, D.C., Goffman describes "institutionalization" as a response by patients to the bureaucratic structures and mortification processes of total institutions such as mental hospitals, prisons, and concentration camps.

31 In particular the long and intensive sessions with Ellen Mercer, Jochen Neumann, Melvin Sabshin and Costas Stefanis were in many respects unique experiences. On one hand the interaction between the interviewees (in particular Jochen Neumann and Melvin Sabshin, later joined by Ellen Mercer) triggered the memories of those involved, gradually retracing parts of the memory that initially seemed lost. Also the provision of key documents for consideration and discussion during these sessions, helped trigger memories and retrace historical events that initially seemed lost. At the same time, the confrontation of persons who had been on either side of the barricades but now gradually found common ground, helped reconsider “holy houses” in the memories of the persons in question, while the discussions provided an excellent sounding board to consider and reconsider conclusions reached both earlier and in the course of writing the dissertation. The analytic mind of Melvin Sabshin, who never stopped questioning the author and continued to push to dig deeper and deeper, combined with the very detailed factual memory of Jochen Neumann, greatly contributed to this process.

The long interviews with former WPA President Costas Stefanis were also intense and often moving experiences that challenged the author maximally in finding an acceptable balance between closing a personal chapter (for both parties involved) and seeking an as objective picture as possible of what happened. The fact that Stefanis was not only of progressing age and seriously ill, yet at the same time concerned to make sure his voice was heard and his story was told, made the process even more challenging. Possibly the fact that the subject of the interviews as well as the author himself have been involved in mental health issues for many decades, made it possible to find an adequate balance and understand the underlying processes and deal with them. As Stefanis himself wrote in December 2009: “our last meeting (…) I see more as a friendly confession than a for- mal interview that occurred between two people who once consid-

32 ered themselves as opponents.”37 However, the author fully recog- nizes that this factor could be perceived as a liability – yet at the same time he feels it was adequately turned into an asset.

As indicated above, throughout the process the author was however aware of the risk of involving objects of research too deep into the historiographic process, and this was discussed with them on occasion. Finding an adequate balance was a stimulating challenge in itself, however there was never any doubt that the eventual text and the conclusions were the author’s and that in the end he alone could decide what the outcome of the process would be.

Feedback In addition, several persons who directly participated in the events, read specific chapters. For instance, the chapter on the US delegation to the USSR in March 1989 was read by the main actors on both sides: US delegation leader Prof. Loren Roth, Assistant Sec- retary of State Richard Shifter; Soviet Deputy Foreign Minister Ana- toly Adamishin and the main civil servant of the Soviet Foreign Min- ister involved in the negotiations and preparations, Andrei Kovalyov. By doing so, the author managed to obtain an as complete picture as possible.

In addition, the author had a number of people reading texts, sometimes in rudimentary form and sometimes as finished drafts, commenting both on content, style and whether the issues discussed were covered in an accessible and understandable manner. Their feedback was essential, because when being so much involved in detail in what happened and when dealing with such an overwhelming amount of information, one runs the risk of losing track and assum- ing issues clear and understood when for an outsider they need more

37 E-mail from Costas Stefanis to the author, December 25, 2009.

33 explanation or background information. And, finally, having acquired so much information, the challenge was not to make the text inaccessible by incorporating too much. The author tried to solve part of this problem by putting information of lesser importance in footnotes, but in some cases information was not included because doing so would be detrimental rather than helpful in putting the story across.

Archival research Archival research on all sides helped to provide to a considerable degree a balanced picture. Archival research in Berlin (Birthler Behörde, the archives of the former Ministry of State Security – Stasi), Geneva (archives of the World Psychiatric Association), Hilversum (archives of the International Association on the Political Use of Psychiatry) and in various places the private archives of key individuals (Ellen Mercer, Jochen Neumann, Peter Reddaway, Loren Roth, Melvin Sabshin and Robert van Voren) as well as the archives of a number of key organizations (British Royal College of Psychia- trists, British Working Group on the Internment of Dissenters in Psychiatric Hospitals as well as the U.S. Federal Bureau of Investiga- tion-FBI) provided a wealth of documentation.

The private archive of Jochen Neumann turned out to be a key element in the research. His reports to the political leadership of the DDR were not only very detailed and able to bring back the spirit of the time; they also gave a unique insight in the world and thinking of Jochen Neumann as a leading East German psychiatrist and member of the ruling elite. The documents he provided from his own archive proved to be more complete than those found in the Stasi archives, and in some cases he also had more complete records of Executive Committee sessions or other key WPA events than those found in the archives of the World Psychiatric Association. All of his personal ar-

34 chives were turned over to the author in the course of the project, including his personal diaries from the post-DDR period.

Literature Apart from making interviews and doing archival research, the author read a vast amount of literature on the issue of Soviet political abuse of psychiatry, but also on issues that are related to the subject of the dissertation: Jewish life in Russia and the United States at the turn of the century; university life in Louisiana in the 1940s and the McCarthy period in the United States; the socio-psychological effects of Nazism and the Second World War in Germany; the founding and development of the DDR and the Stasi; Soviet dissidence, Soviet psychiatric abuse and world psychiatry; Greek political thought in the post-war period and during the Cold War, etc. In addition, the author read several unpublished manuscripts. A listing of more than one hundred books, manuscripts and articles is added to the dissertation, as well as a listing of the more than twenty interviews conducted and nine archives consulted. The listing is, however, a selective one and does not contain many of the newspaper articles and other materials that have been used in the text and are quoted on occasion.

35 VI. THE SUBJECT OF RESEARCH As stated before, for more than forty years the issue of political abuse of psychiatry in the Soviet Union dominated the agenda of the world psychiatric community. The issue has on one hand resulted in angry exchanges, yet on the other hand it has stimulated an ongoing debate on human rights and professional ethics. During those years the World Psychiatric Association (WPA), around which most of the discussions evolved, adopted a series of ethical codes and declarations on human rights that condemn the use of psychiatry for non- medical purposes, and also installed mechanisms to investigate complains of violations of these regulations.

The Soviet All-Union Society of Neuropathologists and Psychia- trists (AUSNP) had left the WPA in January 1983 when it became clear they would otherwise be expelled during a General Assembly later that year. Several other socialist psychiatric societies followed suit; others only threatened to leave. In spite of strict instructions a leading Hungarian psychiatrist, Prof. Pal Juhasz (to whom the dissertation is dedicated), was voted onto the new Executive Committee in the summer of 1983. However he died several months later after having been submitted to strong pressure by the Hungarian authorities. His place was taken in October 1984 by the East German Jochen Neumann, whose election was the result of careful politicking and who, as would become clear only in the late 1990s, was working for the East-German Stasi as an unofficial agent. During the years 1983- 1989, (part of) the leadership of the WPA tried to bring the Soviets back into their fold, while several Western psychiatric associations as well as the International Association on the Political Use of Psychia- try strongly resisted. During the same period, political changes swept through Eastern Europe and the USSR, eventually resulting in a common strategy of the Soviet Foreign Ministry and the US State Department to end the issue of Soviet political abuse of psychiatry

36 once and for all. Eventually, during a tumultuous General Assembly in Athens in October 1989, the AUSNP was allowed back in under strict conditions. However, within two years the country that the AUSNP represented, the USSR, ceased to exist. At that moment, new psychiatric associations from (former) Soviet republics already joined the WPA, effectively ending the monopoly over Soviet psychiatry that the AUSNP had maintained for many decades.

The period 1983-1989 was an important turning point, in many respects. The WPA became a battleground in the Cold War, with the issue of Soviet political abuse being its focal point. While the USSR (with Jochen Neumann as their main peon on the Executive Commit- tee) tried to keep the issue off the table and time and again referred to an anti-Soviet political campaign, the West (with Mel Sabshin being a prime peon on the Executive Committee) continued to push for a condemnation of Soviet practices and an end to Soviet psychiatric abuse. At the same time, WPA President Costas Stefanis from Greece tried to follow a policy of non-alignment, very much in line with general Greek policy of that time, but by doing so was repeatedly dubbed as “pro-Soviet” and accused of conducting “clandestine negotiations”. In the end, however, it was an agreement between the Soviet Foreign Ministry and the US State Department, which had a decisive influence on the outcome of this battle, although the work of human rights organizations surely prepared the grounds and helped termi- nate Soviet political abuse.

So what is the need to retrace what happened and to view the course of events from all sides, as much is humanly possible? As Leonidas Donskis points out, “the politics of remembering is sound and good only in so far as we maintain the legitimacy of two or more opposed modes of memory and narratives. The legitimacy of two opposed interpretations of the same phenomenon, including political

37 experience, is what modernity with a human face is all about.”38 Yet at the same time the politics of remembering also carry a risk, especially when it is used merely as a means to impose one’s own view on history. Then it “can turn into a dangerous fixation on the selected series of events and historical personalities, resulting in the total de- nial of those individuals and groups that remember in a different fashion. (…) …if forced and practiced with no alternative to it, un- avoidably will be at the peril of becoming an oppressive instrument of arbitrary and selective memory.39

Indeed, the book Cold War in Psychiatry is an attempt to provide a multi-dimensional picture of what happened, viewed from all sides and by all parties involved. And one of the interesting results of this undertaking is the confrontation between the author and one of his original “arch opponents”, Professor Costas Stefanis from Greece, the former President of the World Psychiatric Association. In this case, remembering served another purpose, the purpose of being able to forget; because this is the other side of the medal, the possibility of letting go. As Donskis writes, [the policy of] forgetting can have a purpose: “it does not necessarily imply the destructiveness of modern life with totalitarian regimes, devaluation of life, insensitivity, and social constructivism. Sometimes, forgetting lends itself to forgive- ness, liberating us from the burden of worn-out concepts and arguments. (…) Remembering and forgetting have to encompass each other as two complimentary forms of grasping life as two intertwined ways of looking at the world around us.”40

38 Donskis, Leonidas: Troubled Identity and the Modern World, pp. 37-38 39 Donskis, Leonidas: Troubled Identity and the Modern World, p. 38 40 Donskis, Leonidas: Troubled Identity and the Modern World, p. 38

38 VI.A. THE CONTEXT: THE TOTALITARIAN ENVIRONMENT

“Totalitarianism promises happiness for all – but only when all who are not worthy of it (enemy classes, infe- rior races) have been wiped out.” Tzvetan Todorov41

One of the key factors that enabled the political abuse of psychiatry is the totalitarian socio-political context, in which everything was subjected to control by the state and the possibility of an independent view on psychiatry and mental “normality” ceased to exist. It was the result of a combination of factors that were only possible to mature under a totalitarian regime.

First of all, the decision in 1950 to give monopoly over psychiatry to the Pavlovian school of Professor Andrei Snezhnevsky was one crucial factor. This decision was very much in line with Stalinist political thought, that each branch of science should be dominated by one line of thought or concept that provided an easy explanation to complex issues. The Pavlovian school of thought was in that sense a very attractive one, as it saw the basis of mental illness as a purely biological one, and thereby excluded the need to take social factors into account. The leading role of Snezhnevsky’s school was imposed after a joint session of the Academy of Sciences and the Academy of Medical Sciences on June 28 – July 4, 1950 and, subsequently, during a session of the Presidium of the Academy of Medical Sciences and, a year later, the Board of the All-Union Society of Neuropa- thologists and Psychiatrists. This joint session of the USSR Academy of Sciences and the USSR Academy of Medical Sciences met in com- pliance with an order of I. V. Stalin to institutionalize the theory of higher nervous activity of I. P. Pavlov. The session decreed that an-

41 Todorov, Tzvetan, Hope and Memory, p. 312

39 nual scientific conferences should be held to consider problems related to Pavlovian physiology.

In response to this call, a year later on October 11-15, 1951, a session of the Presidium of the Academy of Medical Sciences and the Board of the All-Union Society of Neuropathologists and Psychia- trists was convened to discuss the 'Physiological Teachings of the Academician I. P. Pavlov on Psychiatry and Neuropathology'. A number of influential Soviet psychiatrists were condemned for ad- hering to anti-Marxist ideology and to psychiatric theories conceived by Western psychiatrists.42 The named psychiatrists acknowledged the correctness of the accusations, admitted their 'errors', and prom- ised in the future to follow Pavlov's teachings on psychiatry. The session's Presidium urged the development of a “New Soviet Psychiatry” based upon experimental and clinical findings and consistent with the Pavlovian conceptualization of higher nervous activity, which considered psychiatric and neurotic syndromes in terms of the dy- namic localization of the brain's functions. The New Soviet Man (homo sovieticus), to whom I will return later, needed a New Soviet Psychiatry as well.

The centerpiece of the attack on all other directions in Soviet psychiatry was a lecture during these sessions by four authors, A.V. Snezhnevsky, V.M. Banshchikov, O.V. Kerbikov43 and I.V. Strelchuk. Two former colleagues of Prof Snezhnevsky later wrote: “In principle there were four psychiatrists that could claim that position [of the leader] (…) It is clear that these four formed a sort of clan, amongst whom the pie had to be divided…. Maybe Banshchikov and Strelchuk left the ring because they were professionally clearly secondary to

42 For instance V. A. Giliarovskii, M. O. Gurevich and A. S. Shmaryan. 43 Oleg Vasilievich Kerbikov (1907-1965), Head of the Yaroslavl Medical Institute and Professor of psychiatry in Yaroslavl, in 1952 became Head of the Department of Psy- chiatry of the Second Moscow Medical Institute and a member of the Academy of Medical Sciences in 1962.

40 Snezhnevsky and Kerbikov.44 But the latter two were quite equal. What caused the decision who of the two would be on top, we don’t know.”45

Andrei Snezhnevsky, who came out as victor, was a scientist who had a vision, and the totalitarian climate made it possible for him to implement his plans unobstructed. During Stalin’s reign well- known psychiatrists who disagreed with him lost their jobs, some were even exiled to Siberia. It was unwise, to say the least, to oppose Snezhnevsky, and in that respect he cleverly made use of the sense of terror that reigned the Soviet Union during these years.

A second important factor, closely linked to the first, was that Soviet society had become a centrally ruled totalitarian State. Every- thing, even hobby clubs and sports clubs, had been politicized and nothing was possible without the will and support of the Communist Party. The purges of the 1930s, 1940s and early 1950s had made that perfectly clear. Doctors had been subordinated to the Party by having them swear the Oath of the Soviet Doctor instead of the Hippocratic Oath. And the Oath of the Soviet Doctor was very clear: the ultimate responsibility was before the Communist Party, and not before medical ethics.46 As a result of this political system of total control, the Soviet Union had become a closed society, a society that was cut off from the rest of the world. World psychiatric literature was unavail- able, except to the politically correct psychiatric elite. The power of the Party seemed endless, whether you believed in their ideals or not. And thus any person who decided to voice dissent openly ran a high risk of being considered mentally ill. As a result, the political abuse of psychiatry, that initially mostly effected intellectuals and artistic cir-

44 Both V.M. Banshchikov and I.V. Strelchuk were narcologists by profession. 45 Psychiatry, psychiatrists and society, p. 88 46 The Oath of the Soviet Doctor was adopted by the Presidium of the Supreme Soviet of the USSR on March 26, 1971. Vedemosti Verkhovnogo Soveta SSSR, 1971, no. 13, p. 145

41 cles, grew into a important form of the repression with approximately one-third of the dissidents in the 1970s and early 1980s being sent to a psychiatric hospital, rather than to a camp, prison or exile.47

The totalitarian state The totalitarian state is generally seen as a form of government in which the state attempts to control virtually all aspects of the social life including economy, education, art, science, private life and morals of citizens. Although the term “totalitarianism” is invariably linked to the German Jewish political theorist Hannah Arendt (1906- 1975), it finds its roots in a description of "total" political power by the state by Giovanni Amendola (1982-1926), an Italian journalist and opponent of fascism, who in 1923 described Italian fascism as a system fundamentally different from conventional dictatorships. And although the term is currently mostly regarded in a negative perception, a leading Italian philosopher and self-ascribed “philosopher of fascism”, Giovanni Gentile (1875-1944), gave the term instead a positive connotation. Gentile used the term "totalitario" to refer to the structure and goals of the new state, that provides the "total repre- sentation of the nation and total guidance of national goals." Accord- ing to him in a totalitarian society the ideology of the state had influence - if not power - over most of its citizens. A decade later, Austrian writer Franz Borkenau (1900-1957), universally seen as one of the pioneers of the theory of totalitarianism, commented in his The Communist International that there was more that united the Soviet and German dictatorships than that divided them.

In The Origins of Totalitarianism (1951), Hannah Arendt traced the roots of Stalinist Communism and Nazism in both anti-Semitism and imperialism. Arendt concluded that while Italian fascism was a

47 According to a report on a high-level meeting between the KGB and the Stasi in 1976, half of those arrested in the USSR for “political crimes” were considered to be mentally ill, see later in this document.

42 nationalist authoritarian movement, Nazism and Stalinism were totalitarian movements that aimed to destroy the state. The book was quite controversial at the time of its publication, because it suggested that an essential identity existed between the two phenomena. World War II had just ended and Hitler was dead; however, but Stalin was still alive and still by many revered as one of the main leaders who had brought an end to the war and the destruction that had swept across Europe.

Hannah Arendt argued that Nazi and communist regimes were new forms of government. As Leonidas Donskis writes in The End of Ideology and Utopia?, in her view totalitarianism was a “new, spe- cially modern form of government which should not be confounded with earlier and more traditional forms of oppression.”48 In The Ori- gins of Totalitarianism, Arendt discusses the transformation of classes into masses, the role of propaganda in dealing with the non- totalitarian world, and the use of terror, essential to this form of government. She believed that the source of the mass appeal of totalitarian regimes was their ideology, which provided a comforting, single answer to the mysteries of the past, present, and future. For Nazism, all history was the history of racial struggle; for Marxism, all history was the history of class struggle. Totalitarian movements were in Ar- endt’s view fundamentally different from autocratic regimes because autocratic regimes sought only to gain absolute political power and to outlaw opposition, while totalitarian regimes tried to dominate every aspect of everyone's life as a prelude to world domination.

Also many other scholars focused on the issue of totalitarianism. Sir Karl Popper, the main example of the Hungarian-American philanthropist and later founder of the Open Society Institute George Soros, contrasted the "open society" of liberal democracy with totali-

48 Donskis, Leonidas: The End of Ideology and Utopia?, p. 39

43 tarianism, and argued in his books The Open Society and Its Ene- mies (1945) and The Poverty of Historicism (1961) that the latter was grounded in the belief that history was moving toward an immutable future, in accordance with knowable laws. Many other political scientists and historians had the issue of totalitarianism as one of the main focal areas,49 and although they all had their own specific perception of what totalitarianism actually meant, they agreed that totalitarianism sought to mobilize entire populations in support of an official state ideology, and was intolerant of activities that are not directed towards the goals of the state, resulting in repression or state control of business, labor unions, churches or political parties. It were the political scientists Carl Friedrich and Zbigniew Brzezinski who were primarily responsible for expanding the usage of the term in university social science and professional research, reformulating it as a paradigm for the communist Soviet Union as well as fascist regimes. For both men, the defining elements were intended to be taken as a mutually supportive organic entity composed of the following: an elaborating guiding ideology; a single mass party, typically led by a dictator; a system of terror; a monopoly of the means of communication and physical force; and central direction, as well as control of the economy through state planning.

Also for the Franco-Bulgarian philosopher and writer Tzvetan Todorov 50 totalitarianism is a main issue of thought and discourse,

49 For instance well-known Sovietologists as Richard Pipes, Leopold Labedz, Walter Laqueur, Leonard Schapiro, Adam Ulam and Robert Conquest 50 Tzvetan Todorov (1939) has lived in France since 1963 writing books and essays about literary theory, thought history and culture theory. Initially a literary theorist and one of the founders of the discipline of poetics, in the 1980s he turned his attention to the fields of history and political thought. Todorov has published a total of 21 books, including The Poetics of Prose (1971), Introduction to Poetics (1981), The Con- quest of America (1982), Mikhail Bakhtin: The Dialogical Principle (1984), Facing the Extreme: Moral Life in the Concentration Camps (1991), On Human Diversity (1993), Hope and Memory (2000), and Imperfect Garden: The Legacy of Humanism (2002). Todorov's historical interests have focused on such crucial issues as the conquest of The Americas and the Nazi and Stalinist concentration camps.

44 an ever-returning subject in his books and writings. “For me the central event of the century was the emergence of the unprecedented political system called totalitarianism, which, at its peak, ruled a substantial part of the planet.”51 He agrees that Europe suffered two totalitarianisms, Communism and Fascisms, and that “totalitarianism was the great innovation of the twentieth century and also its greatest evil.52 “The recitation of the list of the massacres and miseries of the past century, with its monstrous numbers blotting out the individuals who ought to be recalled one by one, is enough to make you give up trying to make sense of it. But to renounce understanding would be to lose everything.”53

Both fascist and communist totalitarianisms had as extreme exponent of the system the concentration camps that permeated the landscape. As Todorov writes: “Kolyma and the Solovki gulags were the Russian equivalent of Buchenwald and Dachau,” yet he adds: “but there never was a Treblinka in the Soviet Union.54 In Facing the Extreme he wonders why the twentieth century has brought forth an unprecedented suffering, not only in terms of numbers of people killed but also in terms of “suffering inflicted on the victims and the depravity which their tormentors showed themselves capable”. He concludes that it was possible because of two “common, altogether ordinary attributes of our daily lives: the fragmentation of the world we live in and the depersonalization of our relations with others.”55 In his view, the transformation of our societies has led to a certain specialization or “compartmentalization” that led to this fragmenta-

51 Todorov, Tzvetan, Hope and Memory, p. 2 52 Todorov, Tzvetan, Hope and Memory, p. 3 53 Todorov, Tzvetan, Hope and Memory, pp. 5-6 54 Todorov, Tzvetan: Hope and Memory, p. 88. Treblinka was one of the five Nazi extermination camps on the territory of Poland, where probably some 1,2 million Jews were exterminated in the course of a year and a half. For a chilling account on Treb- linka see Sereny, Gitta: Into that Darkness, based on interviews with the former Treb- linka camp commander Franz Stangl. 55 Todorov, Tzvetan: Facing the Extreme, pp. 289-290

45 tion, while the depersonalization is the result of a transference of instrumental thought to the realm of human relations. He points out that Rousseau already envisioned this development during his time when commenting that “iron and wheat civilized man… and ruined the human race” and concludes: “Unfortunately, the amount of good in the world has not kept up with the growth in evil.” However, he adds: “I do not think it has diminished either. Our definition of what is good might change, however, and in this there is reason for opti- mism: there are many more acts of kindness than those recognized by the traditional moral perspective…”56

Interestingly, one of the first works of Todorov in the field of history and political thought focused on Jean-Jacques Rousseau, whose name is so closely connected to the French Revolution and who, in particular after World War II, was seen by intellectuals as Karl Popper and Bertrand Russell as an “intellectual forerunner” of the totalitarianism of the twentieth century. Todorov disagreed with that view, believing that Rousseau’s extremism was in fact “sheer intensity of thought” and the result of his pursuit of different lines of reasoning to their logical extremes. And the conclusions might be extreme, Todorov concluded, but that did not automatically mean that Rousseau “simple accepts everything he says.”57 Yet when one reads Todorov’s essay on Rousseau, Frail Happiness, there are elements that makes one wonder whether Todorov is not too infatuated by Rousseau. When discussing the need to have equal education for all, he words Rousseau’s belief that “the most effective means for at- taining this goal is to insure that the State is informed of the actions and thoughts of its citizens. It is therefore essential that they never escape the State’s relentless gaze.”58 And later he quotes Rousseau that the surest way to guarantee the well-being of the State “is to see

56 Todorov, Tzvetan: Facing the Extreme, p. 290 57 Todorov, Tzvetan, Frail Happiness, p. 3 58 Todorov, Tzvetan, Frail Happiness, p. 22

46 to it that all the citizens constantly that they are under the gaze of the public.”59 The question is to what extent the “public” is in this case different than the State, and how a person like Todorov, coming from Communist Bulgaria, does not seem to feel the danger of an all- pervasive State control – unless we believe that indeed he only follows the line of reasoning of Rousseau to the extreme without its im- plications; yet at the same time it is easy to understand why Rous- seau is seen as an early “godfather” of totalitarianism. Todorov himself words his position as follows: “he presents an “if… then” analysis: if one assumes the perspective of the citizen, then this is what follows. Let those who are committed to this way be aware of the consequences of their actions.”60

Todorov shortlists the distinctive features of totalitarianism as being “its need for an initial revolutionary phase; its transformation of collective autonomy into a mere façade; its rejection of personal autonomy; its preference for monism over pluralism, on every level; war as a rule of life; root-and-branch elimination of difference as a collective aim, with the ensuing systematic destruction of a part of the population; generalized terror;” and “collectivization at every level.”61 The result is what we have seen throughout the totalitarian world: individual autonomy was banned, because it would be considered to be a threat to the monist-totalitarian structure. Only the Party could be right.

According to Todorov the monist aspect of totalitarism is a crucial one, the I is in totalitarianism replaced by the we of the group, and as a consequence plurism is abandoned and replaced by its opposite, monism. And thus, Todorov concludes, a totalitarian state is in this respect the exact opposite of a democratic state. Todorov sees

59 Todorov, Tzvetan, Frail Happiness, p. 22 60 Todorov, Tzvetan, Frail Happiness, p. 25 61 Todorov, Tzvetan, Hope and Memory, p.77

47 monism in fact as a synonym for totalitarianism, having two complimentary aspects. On one hand, there is no longer a division between the individual sphere and the regulated public sphere: “the personal world vanishes inside an all-encompassing, impersonal order.”62 On the other hand the system imposes monism in all aspects of public life in order to assure that a unified and “bonded” community is formed: “Totalitarianism effectively restores the old unity of the theological and the political – it makes the pope the emperor or the emperor pope.”63 Elsewhere he points out that totalitarianism “gives human action transindividual ends, such as the party, the nation, or the regime; and it accepts the sacrifice of the individual in the service of revolution, ideal society, or cleansed humanity.”64

Todorov quite vehemently attacks those who believe that Com- munism, unlike Fascism, was based on a universalist ideology, an ideology that favors peace over war. His attacks focus in particular on Raymond Aron,65 who in his book Democracy and Totalitarianism separates communism from fascism, believing that communism had originally “noble aspirations” and a “belief in universal and humani- tarian values” while fascism was “nationalistic, racial and anything but humane”.66 According to Todorov, Aron contradicts himself when asserting that the Communist state demonstrated “a will to build a new regime and maybe a new kind of man, by any means”

62 Todorov, Tzvetan, Hope and Memory, p. 14 63 Todorov, Tzvetan, Hope and Memory, p. 14 64 Todorov, Tzvetan, Hope and Memory, p. 312 65 Raymond-Claude-Ferdinand Aron (1905-1983) was a French philosopher, sociologist and political scientist. The son of a Jewish lawyer, he studied at the École Normale Supérieure where he met Jean-Paul Sartre (who became his friend and lifelong intellectual opponent). In 1930, he received a doctorate in the philosophy of history from the École Normale Supérieure. In 1939, when World War II began, he had been teach- ing social philosophy at the University of Toulouse for a few weeks; he left the Univer- sity and joined the Armée de l'Air. When France was defeated, he left for London to join the Free French forces. After the war, he returned to Paris to teach sociology at the École Nationale d'Administration and at the Paris Institute of Political Studies. From 1955 to 1968, he taught at the Sorbonne, and after 1970 at the Collège de France. 66 Raymond Aron, Democracy and Totalitarianism, London, 1968, pp. 197-198

48 while at the same time he describes the Soviets as a “party which grants itself the right to use violence against all its enemies, in a land where, to begin with, it was in a minority.” Todorov believes that this contradiction stems from the fact that Aron on one hand judges the Nazis by their deeds, while at the same time his judgment of the So- viets is based on their self-proclaimed aims which, as Todorov points out, is distinctly different from what the regime actually did in practice.67 However, Todorov in the end of his argument admits that Aron at the end of his life agreed that his view had been wrong, and that “communism is no less hateful to me than Nazism was. The argument that I once used to distinguish class messianism from race messianism no longer impresses me very much. The apparent uni- versality of the former has become, in the last analysis, an illu- sion…”68

Finally, Todorov sees totalitarian ideology as a “knife with two edges”, seeking to reconcile demands that are on ultimately incom- patible.69 On one hand the contradictions will let it collapse as a house of cards, however on the other hand the contradictions give it a special strength, because a breach in one area can be closed easily by introducing a contradictory value. As a result, it has a special appeal to a wider public.70 However, Todorov also sees three “fault lines”, as he calls them. The first tension is the result of the elementary phi- losophical opposition between determinism and free will. According to the totalitarian ideology, everything is determined by irreversible

6767 Todorov, Tzvetan, Hope and Memory, pp. 36-37. Later in Hope and Memory To- dorov returns to his criticism of Raymond Aron, who in his book Democracy and To- talitarianism asserts that the Great Purge under Iosif Stalin and the extermination of the Jews served no real purpose to the regime. This is a wrong way of thinking, To- dorov asserts: “the actions he refers to were perhaps not really to the advantage of the Nazi or the Soviet states; but there is no a priori reason to suppose that the actions of the heads of those states were intended to serve such a purpose.” Hope and Memory, p. 79 68 Raymond Aron, Fifty Years of Political Reflection, New York, 1990, p. 471 69 Todorov, Tzvetan, Hope and Memory, pp. 40-47 70 Todorov, Tzvetan, Hope and Memory, p. 40

49 causes, yet on the other hand it believes we can shape the world by our idealism, we have the future in our own hands. The second tension, Todorov believes, lies in the fact that totalitarianism is at the same time anti-modern and arch-modern. In fascism this contradiction could be seen in the combination of a longing back to the cultures of the Gothic traditions and Nordic gods with the massive in- dustrialization and the construction of the Autobahns, while in the Soviet Union the slogan “Communism = electrification + all power to the Soviets” embodied this duality, because on one hand the indus- trialization and electrification of the country was a enormous drive to modernity, while at the same time the regime distrusted intellectuals who had to bring about the modernization schemes and who were not members of the Party (and who usually had had a bourgeois education). And, finally, the third tension Todorov sees in totalitarianism in the role of the ideology. Some, like Raymond Aron, saw the ideology as a legitimization of the state. In that view power was the instrument and the political ideal the aim. However, as Todorov points out, many Eastern European scholars believe that the ideology was just a Potemkin village, a façade, covering up a fundamentally stra- tocratic regime. He himself believes there was a shift in time, that with the regime becoming more established the difference between words and reality was dealt with in a different way. After Stalin’s death, Todorov assets, “the gap between language and world was no smaller, but efforts were made not to reduce it, but to mask it.”71 And in the end, when the regime collapsed, “it was plain to see: outside the tiny fraction of former dissidents, Soviet citizens knew no rule save that of selfishness.72

The issue of legitimization of the regime is also an important element in the works of political scientist T.H. Rigby, who expanded

71 Todorov, Tzvetan, Hope and Memory, p. 44 72 Todorov, Tzvetan, Hope and Memory, p.45

50 the concept of rational legitimization well beyond its legal confines and included the notion of an instrumental or goal-oriented legitimacy, whereby rulers and key sectors of society agree on their goals or aspirations with regard to political or social development. Accord- ing to political scientist Dmitri Glinski, this goal-oriented legitimacy became a vital issue for the Soviet regime, as it lacked either traditional or legal modes of legitimization for its rulers. Its legitimization had been “the establishment of a just and equitable society” and “it was the failure to approximate this objective and increasingly obvious deviations from this path that undermined the legitimacy of the Soviet system, leading to its degeneration and decay.”73

According to Leslie Holmes,74 who greatly expanded on the theories of legitimization of power and identified ten modes of legitimization, there was a clear shift in the positioning of the Soviet elite in the 1960s when it more and more put emphasis on a con- sumer-based legitimacy. However, this did not stave off the growing legitimization crisis, as promises to provide a standard of living iden- tical to that in the capitalism West failed and, instead, urban centers increasingly had to deal with the “vices of capitalism” such as sub- stance abuse, pornography and black-marketeering. As Holmes concludes: “As the process unfolded, it appeared to many citizens and even officials in the Communist world that they were being increasingly subjected to all the negative aspects of both capitalism and Communism ... at the same time as the positive aspects of both … seemed in many cases at least as distant as they had ever been. In

73 Glinski, Dmitry, and Reddaway, Peter: The Tragedy of Russia’s Reforms, United States Institute of Peace, Washinton D.C., 2001, pp. 43-44 74 Leslie Holmes was born in London, and educated at the Universities of Hull (where he studied modern languages), Essex, Berlin (Free) and Leningrad. He has been Professor of Political Science at the University of Melbourne since 1988.

51 short, Communism … appeared more and more to represent the worst of all worlds, rather than the best.”75

And after the Soviet regime collapsed, the new government held for a while an unprecedented legitimization, with enthusiastic involvement of many citizens and organizations in the political debate. However, gradually the democratic nature of the government came under pressure and the polish lost much of its shine. In Hope and Memory Tzvetan Todorov quotes the Polish dissident and political scientist Adam Michnik, who once joked that “the worst thing about Communism is what comes after.”76 As Glinksi points out, it was Yel- tsin’s armed attack on the Russian “anti-democratic” parliament in 1993 that brought a final end to the public support for his government and marked the transition to the leadership that the country has now.77

According to Glinski, the attempt by Soviet leaders such as Yuri Andropov and Mikhail Gorbachev to revamp the system and find a new legitimization were based on the fact that although the political elite had already abandoned their goal-oriented claim to legitimacy, a large part of Soviet society had not. “Indeed, the more obviously the behavior of the ruling establishment and its urban clients deviated from the fundamentals of the system… the more the general public grew anxious and disgruntled.”78 The attempt to find a new legitimization failed, however, as no replacement could be found. Also the dissidents could not provide an alternative, Glinski notes, as they “sought an alternative development strategy mostly in political or moral (not socioeconomic) terms. Yet even among them, there was

75 Quoted in Glinski, Dmitry, and Reddaway, Peter: The Tragedy of Russia’s Reforms, pp. 45 76 Todorov, Tzvetan, Hope and Memory, p.47 77 The Tragedy of Russia’s Reforms. p. 47 78 The Tragedy of Russia’s Reforms. p. 45

52 no consensus at all on the most desirable national strategy.”79 In- deed, the fact that the dissidents could not provide an alternative and were generally not very successful as politicians under the new con- stellation, disappointed many people. However, as Leonidas Donskis correctly points out in his book The End of Ideology and Utopia?, “disenchantment with intellectuals is probably the consequence of great expectations and unfulfilled hopes regarding radical transformation, and the resulting anomie, experienced by society. It is more than true with regard to societies under transition or even radical transformation, such as those in Central and Eastern Europe. Intel- lectuals are expected to provide instructions regarding society’s future development, continuity of social existence, and even existential meaning in general.”80 Donskis refers to Arnold Toynbee, who wrote that intellectuals are seen as genius-saviors, however one should not forget that they too are mortal and are bound to make mistakes and misjudgments. Also a widely respected thinker as Michel Foucault made a painful faux pas when he applauded the Islamic Revolution in Iran in 1978. In his view, "as an Islamic movement it can set the entire region afire, overturn the most unstable regimes, and disturb the most solid. (…) Islam — which is not simply a religion, but an entire way of life, an adherence to a history and a civilization — has a good chance to become a gigantic powder keg, at the level of hundreds of millions of men." How much Iran, and Islam in general, became a powder keg he could not foresee, but it was certainly not what he had in mind when he wrote his seven articles for the Corriere della Serra and Le Nouvel Observateur.81 Yet, as the Polish philosopher and historian of ideas Leszek Kolakowski wrote, "a modern phi-

79 The Tragedy of Russia’s Reforms. p. 45 80 Donskis, Leonidas: The End of Ideology and Utopia?, p. 27 81 For more on Foucault’s Iranian “adventure” see Anderson, Kevin and Afary's, Janet: Foucault and the Iranian Revolution, Chicago, 2005. As the authors point our, Fou- cault later became disillusioned and understood his own misjudgement of the Iranian Revolution, but never took public distance from his eulogy of Khomeini’s regime. See also Zizek, Slavoj, In Defence of Lost Causes, pp. 107-117.

53 losopher who has never once suspected himself of being a charlatan must be such a shallow mind that his work is probably not worth reading."82

Homo Sovieticus and the totalitarian state The imposition of a totalitarian state on the population of the Soviet Union, first through terror and eventually through a well- developed system of total control, led to the emergence of a new person, the New Soviet Man. Initially, Soviet ideologists and, conse- quently, philosophers, writers and other artists, praised the emergence of the New Soviet Man, the product of a new society who had shed all the shortcomings of the bourgeois man. The New Soviet Man or New Soviet Person was an archetype of a person with certain qualities that were said to be emerging as dominant among all citizens of the Soviet Union, irrespective of the country's long-standing cultural, ethnic, and linguistic diversity, creating a single Soviet nation. Leon Trotsky wrote in his book Literature and Revolution: “The human species, the sluggish homo sapiens, will once again enter the stage of radical reconstruction and become in his own hands the object of the most complex methods of artificial selection and psycho- physical training... Man will make it his goal...to create a higher so- ciobiological type, a superman, if you will." Elsewhere, Trotsky ex- plained that “to produce a new, ‘improved version’ of man – that is the future task of communism. And for that we have to find out everything about man, his anatomy, his physiology and the part of his physiology which is called his psychology. Man must look at himself and see himself as a raw material, or at best as a semi-manufactured product, and say: ‘at last, my dear homo sapiens. I will work on you.’”83

82 In Kolakowski, Leszek: Metaphysical Horror, London 2001, p. 1 83 Quoted in Zizek, Slavoj: In Defence of Lost Causes, p. 212

54 The New Soviet Man was to be selfless, learned, healthy and enthusiastic in spreading the socialist Revolution. The adherence to Marxism-Leninism, individual behavior consistent with that philosophy's prescriptions, as well as selfless collectivism were among the crucial traits expected of the New Soviet man.

However, with the revolutionary fervor gone, replaced by a policy of terror and, after Stalin’s death, by a thaw followed by a gradual ossification of society (usually referred to as the period of stagnation, zastoi), the concept of the Soviet man became less idolatry and was replaced by that of the Homo Sovieticus, a sarcastic and critical reference to a category of people with a specific mindset that were created by Soviet policies. The term became even more widespread when the well-known Soviet writer and sociologist Aleksandr Zino- viev84 used it as the title of a book in which he described the Homo Sovieticus in his own critical and sarcastic style.85 The Homo Sovieti- cus was indifferent to the results of his labor and showed a complete lack of initiative. He was indifferent to common property and had no problem with petty theft from the workplace, both for personal use and for profit. The Homo Sovieticus was isolated from world culture, created by the Soviet Union's restrictions on travel abroad and strict censorship of information in the media as well as the abundance of propaganda. He was an obedient citizen, passively accepting every-

84 Aleksandr Zinoviev (1922 - 2006), an internationally renowned Russian logician, sociologist and writer. Son of a poor Russian peasant, Zinoviev distinguished himself as a fighter pilot in the Second World War, and later as a scientist, having earned a professor's title and international recognition in the field of logic. After that, in the 1970s he voluntarily sacrificed his social standing by voicing a critical attitude to the political system of the Soviet Union, and eventually facing exile in 1978 for having published his novels The Yawning Heights and The Radiant Future. He continued to develop his ideas about society and projected them in his writings, at times employing his original genre of the sociological novel. In 1999 he returned to Russia, because he could no longer in the West that "destroyed his country and his people". Some of his political views were severely criticized, such as his public support for Yugoslav leader Slobodan Milosovic and his remark that Stalin was one of the greatest persons in the history of mankind. 85 Zinoviev, Alexander: Homo Sovieticus. Gollancz, London, 1985

55 thing that government imposed on him and avoided taking any individual responsibility on anything.

Later, in his later non-fictional works Zinoviev analyzed the post-Soviet and modern Western social formations. He believed in the decline of significance of the nation-state framework, and the recent (post-World War II) emergence of a new phenomenon of what he called a supersociety. The supersocial traits arise due to the exhaustion of the fundamental "evolutionary limit" of the usual societies (like nation-states, although with no implicit strict correspon- dence between the terms). According to Zinoviev, both Communist and Western countries exhibited similar tendencies of development, which he attributed to that new supersociety, such as a complex su- pereconomy, which is de facto planned to a great degree; a powerful supergovernment of networks and cliques that is non-democratic by nature; at the same time, the seemingly unreasonable growth of governmental structures and institutions; the corruption of some liberal- ist principles like that of separation of powers; and the emergence of superhumans with two variations: the Homo Sovieticus in the USSR and the Zapadoid ("Westoid") in the West that have some new, important behavioral qualities molded by the changed social conditions.

As many scholars have argued, by the time Gorbachev took power in 1985 and the policy of perestroika and glasnost was initiated, the devastation of the national mores in the USSR was near complete. Some Soviet analysts saw the degradation of the people not only as a painful effect of decades of Soviet rule, but argued that the policy had been a deliberate attempt to destroy everything that was reminiscent of pre-Revolution society. Russian cinematographer and politician Stanislav Govorukhin86 accused the seven decades of Bol-

86 Stanislav Govorukhin(1936), one of the most popular Soviet and Russian film directors since the 1960s, abandoned cinema for politics after perestroika. He became one of the leaders of Democratic Party of Russia. In 1990, he directed a much-publicized documentary highly critical of the Soviet society, entitled We Can't Live Like This,

56 shevism with "deliberate" and thorough destruction of the "best genetic stock" in the country.87 “But what kind of moral health of a nation could there be if for decades the best genetic stock of the country was being entirely and deliberately destroyed? How much of it per- ished in the basements of Lubyanka, beside the coal heaps, or in village outskirts? These were intelligent, noble, decent people. Lost with them to society was also the value of the concepts of honor, nobility, and decency." Instead, "a new type" of man appeared, whose creation Govorukhin called "the main crime" of Stalinism. "Raised in an atmosphere of lies, treachery, servile loyalty to the leader," surrounded by a society in which "white became black," Homo Sovieticus was infected at birth with the "virus of treachery" and "mistrust" and had "fear instilled" in his brain.

As this new species reproduced itself in several generations, it created its own "culture," whose leaden grip will be felt by the Soviet Union for decades to come. Leading Soviet essayist and prose writer Maya Ganina (1927-2005) listed Homo Sovieticus' main traits as "bribery, thievery, lies, denigration of the powerless, subservience to those in power." Homo Sovieticus does not demand, nor does he ever get indignant or stand up for his rights. Instead, he "lazily steals whatever is badly guarded, lets what he grows go to rot, turns good things into bad." For the New Soviet Man, "conscience," "duty," "charity," "decency," and "dignity" are unfamiliar notions. Moreover, while the older generation still had some recollection of "the other," pre-Soviet morality, the young, according to Ganina, accept the state of universal lies as "the only possible social condition."

It was this Homo Sovieticus that played an equally important factor in making the political abuse of psychiatry in the Soviet Union

which won him the Nika Award for Best Director. He remained active in politics and in 2000 he took part in Russian presidential elections, but failed to be elected. 87 Novoye Russkoye Slovo, 19-20 August, 1989

57 possible. As a result of his inability to stand up for his rights, his dis- interest in the lives of those around him and his ideologically im- planted dislike for everything that was different or non-conformist, he on one hand accepted the notion that people that were different or acted differently should be expelled and separated from society. And when being a psychiatrist, he had no problem practicing according to the teachings taught in medical school, accepting instructions from his direct superiors or security organs and, in fact, believed that persons who turned against the powerful Communist state should be mentally deranged.

58 VI.B. POLITICAL ABUSE OF PSYCHIATRY - A SOVIET PERSPECTIVE “A crime is a deviation from the generally recognized standards of behavior frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in Communist society? Evi- dently yes. If that is so, then there will also be offences that are charac- teristic for people with abnormal minds […]. To those who might start calling for opposition to Communism on this basis, we can say that.[…] clearly the mental state of such people is not normal.” Nikita Khrushchev 88

And thus the issue of misuse of psychiatry as a means of political coercion is clearly and inextricably linked to the political totalitarian context of Soviet society. It was at the end of Stalin’s reign that a system of political abuse of psychiatry was developed, whereby political and religious dissidents were diagnosed to be of unsound mind and sent to psychiatric hospitals, often for many years of torturous treatment. Soviet political abuse of psychiatry therefore developed on basis of very fertile grounds. As Richard Bonnie points out, “in retro- spect, repressive use of psychiatric power in the Soviet Union seems to have been nearly inevitable. The practice of involuntary psychiatric treatment presents an unavoidable risk of mistake and abuse, even in a liberal, pluralistic society. This intrinsic risk was greatly magnified in the Soviet Union by the communist regime’s intolerance for dissent, including any form of political or religious deviance, and

88 Pravda, May 24, 1959.

59 by the corrosive effects of corruption and intimidation in all spheres of social life.”89 An important aspect that very much triggered its development was the fact that it originated from the concept that persons who opposed the Soviet regime were mentally ill, as there seemed to be no other logical explanation why one would oppose the best socio-political system in the world. Slovenian philosopher Slavoj Zizek succinctly writes: “a person had to be insane to be opposed to Communism.”90

The diagnosis “sluggish schizophrenia,” developed by the Mos- cow School of Psychiatry and in particular by its scientific leader Academician Andrei Snezhnevsky,91 provided a very handy framework to explain this behavior. According to the theories of Snezhnevsky and his colleagues, schizophrenia was much more prevalent than previously thought because the illness could be present with relatively mild symptoms and only progress later. As a result, schizophrenia was diagnosed much more frequently in the So- viet Union than in other countries in the World Health Organization

89 Bonnie, Richard: Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies. In: The Journal of the American Academy of Psychia- try and the Law, Vol. 30, number 1, p. 138 90 Zizek, Slavoj: In Defense of Lost Causes, p. 36 91 Andrei Vladimirovich Snzehnevsky, born in 1904 in Kostroma, graduated from the Medical faculty in Kazan in 1925 and started working in the psychiatric hospital in his hometown. In1932-1838 he was chief doctor of this hospital and became active in the field of research. In 1938-1941 he was senior scientific associate and deputy director of the Moscow Gannushkin Psychiatric Research Institute and in 1947 he defended his dissertation on psychiatry for the elderly under the title Senile Psychoses. During the war he was first linked to a battalion and then became chief psychiatrist of the First Army. In 1945-1950 he worked as a lecturer at the psychiatric faculty of the Central Institute for Continued Training of Physicians and for almost two years (1950-1951) was Director of the Serbski Institute. Until 1961 he was head of the psychiatric faculty of the Central Institute for Continued Training of Physicians. In 1962 he became head of the Institute for Psychiatry of the Academy of Medical Sciences of the USSR a position he held until his death on July 17, 1987. In addition, from 1951 onwards he was chief editor of the Korsakov Journal of Neuropathology and Psychiatry. In 1957 he became a candidate Member of the Academy of Medical Sciences, in 1962 a full member.

60 Pilot Study on Schizophrenia reported in 1973.92 And in particular sluggish (slowly progressive)93 schizophrenia broadened the scope, because according to Snezhnevsky patients with this diagnosis were able to function almost normally in the social sense. Their symptoms could resemble those of a neurosis or could take on a paranoid quality. The patient with paranoid symptoms retained some insight in his condition, but overvalued his own importance and might exhibit grandiose ideas of reforming society. Thus symptoms of sluggish schizophrenia could be “reform delusions”, “struggle for the truth”, and “perseverance”.94

Several scholars analyzed the concepts of sluggish schizophrenia in the USSR, and the scientific writings that focused on this diagnosis. Canadian psychiatrist Harold Merskey, together with neurol- ogy resident Bronislava Shafran, in 1986 analyzed a number of scientific articles published in the Korsakov Journal of Neuropathology and Psychiatry. They took two sample years, 1978 and 1983, and found in total 37 and 27 articles respectively that focused on schizophrenia. In their article, they concluded that “the notion of slowly progressive schizophrenia is clearly widely extensible and is much more variable and inclusive than our own ideas of simple schizophrenia or residual defect states. Many conditions which would probably be diagnosed elsewhere as depressive disorders, anxiety disorders, hypochondriacal or personality disorders seem liable to come under the umbrella of slowly progressive schizophrenia in Snezhnevsky’s system.”95 In addition, they also questioned the quality of psychiatric research in the Soviet Union, at least as far as the articles they analyzed are concerned. “If the articles we are consider-

92 The International Pilot Study on Schizophrenia. World Health Organization, 1973. 93 in Russian: “vyalotekushchaya shizofreniya” 94 See Bloch, S., Soviet Psychiatry and Snezhnevskyism, in Van Voren, R.(ed.), Soviet Psychiatric Abuse in the Gorbachev Era, pp. 55-61. 95 Merskey, H, and Shafran, B.: Political hazards in diagnosis of ‘sluggish schizophrenia, p. 249. Published in the British Journal of Psychiatry, 1986, 148, pp.: 247-256

61 ing had been submitted in English to a Western journal, most of them would probably have been returned for radical revision. As noted above, the original writing is diffuse and cumbersome: we have attempted to make some of it more readable in translation. At times the writing is also disturbingly incomprehensible, even to readers who grew up speaking Russian and received a Russian medical education. Furthermore, the articles are often not arranged in a conventional pattern.”96

Two years later, Soviet dissident and former political prisoner Semyon Gluzman carried out an even more extensive research. In his analysis he quotes a large number of works by well-known associates of the Serbski Institute, and in some of these studies the political “illness” is far from being camouflaged. In some studies patients are ill with “excessive religiosity”,97 another study concludes that “compulsory treatment in an ordinary psychiatric hospital may be recommended for patients with schizophrenia with delusional ideas of reform, who show a diminished level of activity and in whom we can observe a difference between their statements and behavior.” How- ever, other showed an “extreme social dangerousness and [this formed] the foundation of the recommendation for compulsory treatment in a Special Psychiatric Hospital”98 A 1982 study by two Serbski psychiatrists, Yakov Landau and Anna Tabakova, was chill- ingly direct: “Previously conducted study of patients [by Landau and Tabakova] of patients with delusions of reform showed that the content of such delusional ideas extends beyond the realm of their inter- pretational relations, it always involved various aspects of the life of society as a whole… These patients wrote numerous appeals and complaints to various organizations… The clinical aspects of the pa-

96 Merskey, H, and Shafran, B.: Political hazards in diagnosis of ‘sluggish schizophrenia, p. 251 97 On Soviet Totalitarian Psychiatry, p.42 98 On Soviet Totalitarian Psychiatry, p. 43

62 tients’ pathological state as described above, coupled with their sense of psychological (‘offensive’) urgency, and, with their outwardly intact and orderly behavior, …determined the greatest degree of their social dangerousness and made it necessary to refer them to special psychiatric hospitals…”99

The available evidence shows that in the course of the 1960s the political abuse of psychiatry in the Soviet Union became one of the main methods of repression. By the end of that decade many well- known dissidents were diagnosed as being mentally ill. According to F.V. Kondratiev, an associate of the Serbski Institute, between 1961 and the date of his research (1996) 309 people were sent to the Fourth Department of the Serbski Institute for psychiatric examination after having been charged with anti-Soviet agitation and propaganda (art. 70 of the RSFSR Criminal Code), and 61 after a charge of “slandering the Soviet State” (art. 190-1 of the RSFSR Criminal Code). However, he admits that ‘politicals’ were also charged with other crimes, such as hooliganism, and that therefore the numbers might be higher.100

Interesting data are also provided in a report by Lieutenant- General S. Smorodinski of the KGB in Krasnodarski Krai of Decem- ber 15, 1969, and they show that the people who were sent to the Serbski Institute were only the tip of the iceberg. The mentioned document was sent by KGB Chairman Yuri Andropov to the Polit- buro in January 1970 in order to discuss measures to register and isolate mentally ill persons in the country more effectively. Among those who should be registered and isolated are those “who had ter- rorist and other intentions dangerous to society.”101 Smorodinski

99 On Soviet Totalitarian Psychiatry, p.44 100 Ocherki Istorii, published on the occasion of the 75th anniversary of the Serbski Institute, pp. 140-141. 101 Letter of Yuri Andropov to the members of the Politburo, No. 141-A, dated January 20, 1970, “Secret”. It is accompanied by the report by Smorodinski addressed to Yuri

63 listed a number of these dangerous criminal acts, including people who tried to escape from the Fatherland, people “fanatically trying to meet with foreigners”, as well as those who tried to found new parties or persons suggesting control mechanisms with regard to the Com- munist Party. According to Smorodinski one person suggested to establish a “council to control of the activities of the Politburo of the Central Committee of the CPSU and local party organs,” which was considered to be an especially dangerous act; others were accused of spreading anti-Soviet leaflets. Smorodinski concluded in his document that the Krasnodarski Krai had only 3785 beds available, while 11-12,000 persons should be hospitalized. Andropov added to Smorodinski’s document: “Similar situations occur in other parts of the country.” In other words: the number of beds in the USSR needs to be increased considerably in order to meet this urgent demand.

How extensive the abuse had become in the early 1970s is also well illustrated by a report on a high-level meeting between MfS and KGB in Berlin in April 1976, with data on the situation a few years earlier: “The increased stability of society in the USSR is also clear from the fact that in 1974 fewer people were convicted because of slandering the state or anti-Soviet propaganda than in previous years. For example, in 1973 a total of 124 persons were arrested for these crimes against 89 persons in 1974, in the context of which it is important to note that 50% of these people were mentally ill.”102

Andropov. The document is part of a much larger collection of documents from the Politburo, the Central Committee of the Communist Party of the Soviet Union (CPSU) and the KGB that were scanned by Vladimir Bukovsky during his research for the planned trial against the CPSU (which never took place) and which he subsequently put on the internet. See: www.bukovsky-archives.net 102 MfS-HAXX, 2941, p. 93. In a memorandum by KGB Chairman Yuri Andropov to the Central Committee of the Communist Party, dated December 29, 1975, more interesting figures are provided. According to Andropov, in the period 1967 until 1975 in total 1583 people were sentenced on basis of articles 70 and 190-1of the RSFSR Criminal Code, while in the preceding eight years (1958-1966) the total had been 3448 persons. However, later in the document he notes that during the period 1971-1974 63,108 persons had been “pro-

64 The use of psychiatry as a means of repression was not only used against individual persons, but sometimes also to separate larger groups of “undesired elements” from society for a certain period of time, for instance during Communist festivities or special events like the 1980 Olympic Games in Moscow. In some cases they were delivered en masse, such as in 1971 in Tomsk: “At a ceremonial meeting of the hospital staff in 1971 [in Tomsk], which I attended, [hospital director Dr. Anatoly] Potapov103 said literally the following: ‘We expect to register a great number of patients on November 4-7. There’ll be a special mark on their papers. They are suffering from ‘paranoid schizophrenia’. We are to accept them all no matter how many there are…”104 In 1980, KGB Chairman Yuri Andropov was quite explicit in a “top secret” memorandum to the Central Commit- tee of the Communist Party with regard to the preparations of the Olympic Games. In his 6-page report he quite explicitly wrote that ‘with the goal of preventing possible provocative and anti-social actions on the part of mentally ill individuals who display aggressive intentions, measures are being taken, together with police and health authorities, to put such people in preventive isolation during the period of the 1980 Olympics.”105 His deputy Viktor Chebrikov and Min- ister of Internal Affairs Nikolai Shchelokov referred to them as “mentally ill with delusional ideas.”106 This use of mental hospitals to sepa- filaktizirovano” (prevented), in other words, had been convinced by various means not to continue their anti-Soviet behaviour. Memorandum by Yuri Andropov, no. 3213-A, December 29, 1975, p. 3 103 Anatoly Potapov, a psychiatrist by profession, was from 1965 to 1983 director of the psychiatric hospital in Tomsk. He would later become Minister of Health of the Russian Soviet Republic. 104 Moscow News no. 37, 1990, reprinted in Documents 38, September 1990. 105 Regarding the main measures to guarantee security during the period of preparation and implementation of the XXII Olympic Games in Moscow, signed by KGB Chairman Yuri Andropov, document 902-A, dated May 12, 1980, p. 3. 106 On the measures of the MVD of the USSR and the KGB of the USSR to guarantee security during the period of preparation and implementation of the XXII Olympic Games in Moscow, “top secret” memorandum to the Central Committee, signed by Nikolai Shchelokov and V. Chebrikov, p. 2. Viktor Chebrikov was Deputy chairman of the KGB in 1962-1982 and Chairman in 1982-8. Nikolai Shcholokov, Minister of In-

65 rate undesirable elements during Communist holidays and special events was not limited to the USSR, however. Similar practices have been reported from Romania under Ceausescu and in the People’s Republic of China.107

Andrei Snezhnevsky – a short political biography Andrei Snezhnevsky, who for almost forty years dominated So- viet psychiatry, was, like so many others, formed by the political reality in which he lived. His role in the political abuse of psychiatry has been subject to much debate. Some consider him as one of the main architects of the political abuse, a cynical scientist who served the authorities and willingly developed a concept that could be used to declare political opponents of the regime to be mentally ill. Others have defended Snezhnevsky, and have pointed out that he was not the only person who believed in the concept of “sluggish schizophrenia” and that his ideas were abused by a regime without his active involvement. However, it is known that Snezhnevsky himself participated in some of the examinations of dissidents, and thus a complete whitewashing of his role is thereby impossible.

While one hand he was heavily implicated in the political abuse of psychiatry and very close to the Soviet leadership, at the same time he was often described as a modest man, a good clinician and certainly not a standard apparatchik. His office was decorated with a ternal Affairs and a personal friend of Soviet leader Leonid Brezhnev, was accused of corruption in 1988 and committed suicide. 107 For Romania see: Psychiatry under Tyranny, p. 9. In China, in preparation of the Olympic Games of 2008 the Beijing police defined a grading standard for mentally ill persons who could cause incidents and accidents and are moderately disruptive. Secu- rity brigade chiefs, civil police chiefs and the security directors of all police branches in all the incorporated districts and county councils of Beijing were trained according to the "Beijing City mental health ordinance". Also a thorough investigation of basic information regarding the mentally ill of Beijing was carried out. The Beijing Police used the above-mentioned professional training and basic investigation to determine a grading standard to rate the risks posed by mentally ill persons. See www.legaldaily.com.cn April 4, 2007

66 large portrait of Ernest Hemmingway, not a regular feature in a So- viet nomenklatura office. Yuri Novikov, a department head of the Serbski Institute who defected to the West in 1977 and knew Snezhnevsky personally, described him as cold, distant, yes also as- cetic, serious, and often shy. Yet he also recalls that Snezhnevsky sometimes stuck out his neck for others. In the late 1930s Snezhnevsky, being deputy director of the Moscow Gannushkin Psy- chiatric Research Institute, was unable to avoid the arrest and deportation of a well-known colleague, Erich Sternberg, a German communist of Jewish origin who had fled from the Nazis to the USSR in 1933. However, immediately following the death of Stalin, Snezhnevsky brought him back to Moscow and gave him a position at his Center. Considering the prevailing anti-Semitism in the Soviet Union, this was far from regular behaviour.108

In the mid-1990s two psychiatrists who worked in his research center wrote an analysis, which at their own request was never published and remained in the archives of the Geneva Initiative on Psy- chiatry.109 Fifteen years later the text is still of great interest, and provides a unique insight into Soviet psychiatry and the central role of Snezhnevsky. The authors, whose names are known to the author but who are kept anonymous for reasons of confidentiality, put the role and position of Snezhnevsky against the backdrop of a totalitarian Stalinist society, where each and every branch of society was dominated by one leader, one school, one leading force. “We assume that [Snezhnevsky’s school became the leading one] first of all be-

108 Novikov, Jurij, Andrei Sneznevskij – seine Wege und Irrwege in der sowjetschen Psychiatrie. Erich Sternberg (1903-1980), born in Prussia and educated in Berlin, worked at the Charité in Berlin and in Dresden before he lost his positions because of his Jewish background when Hitler assumed power in 1933 and fled to the USSR. 109 Initially the book, titled Psychiatry, psychiatrists and society, was to be published by Geneva Initiative on Psychiatry, but subsequently shelved because the authors had reason to believe that publication would be followed by repercussions that would affect their careers.

67 cause one or the other direction in Soviet psychiatry had to fulfill that role as a consequence of the general conditions [in society].”

The authors describe Snezhnevsky as a competent scientist, yet also as a person who met all the requirements imposed by the state and who avoided everything that could have a negative effect on his scientific work. “He chaired the session of the shameful ‘trade union meeting’ in 1973 that was organized to ‘discuss’ (as a form of harassment) Dr. V.G. Levit, who had decided to emigrate to the United States. It is hard to understand how this all could be part of the biography of one and the same person. He was a talented scientist, whose goal in life was clearly to find the scientific truth, and at the same time he was an amoral politician, who made this same truth secondary to the demands of the authorities. (…) Such a submission was the price he had to pay for the leadership position of both himself and his school.”110

“We witnessed how with a sense of dependence and willingness to submit he talked with any official of the party apparatus,” the authors continue. “Therefore we are convinced that he was not an ide- ologist, not an architect of psychiatric repression. He was a submis- sive implementer of that policy and agreed to look the other way, because he preferred to do so and not leave to do some regular job. (…) Exactly that – scientific work – was the goal in the life of Snezhnevsky and for that he paid his share all his life. That is not something new. Already doctor Faust sold his soul to the devil; there were people before him, and after him. Snezhnevsky was one of them.”111

Snezhnevsky was not only a leader who fulfilled all the requirements set by the authorities and, as indicated above, also personally

110 Psychiatry, psychiatrists and society p. 96 111 Psychiatry, psychiatrists and society p.97

68 participated in the examination of dissidents.112 He was also a totalitarian leader. “The atmosphere in the collective was far from ideal. In fact, in the institute the same totalitarianism prevailed as in the rest of the country. (…) His opinion was decisive in all questions, from setting priorities in scientific work to hiring new associates, their promotion or dismissal. The scientific council… had no real meaning. Decisions were prepared beforehand in “the corridors of power.”113 As a result of this, the prevailing attitude became one of pleasing the chef, not of finding scientific results. “This excluded the development of new and original ideas.”114

The two authors conclude: “Stalin was ‘Leader, Father and Teacher’ (all three with capital letters); beyond doubt, that is also how he really regarded himself. Is it then strange, that that image was transferred to all large and small leaders who were raised by him? And Snezhnevsky was one of them….”115

112 Among the persons he personally examined are Zinovyi Krasivsky and Leonid Plyushch. 113 Psychiatry, psychiatrists and society p. 113 114 Psychiatry, psychiatrists and society p. 114 115 Psychiatry, psychiatrists and society pp. 114-5

69 VI.C. POLITICAL ABUSE OF PSYCHIATRY - AN EAST GERMAN PERSPECTIVE “The Soviets did not know before [the 1977 WPA World Congress in] Ha- waii what was going on in the WPA, and came to inadequate conclusions and measures. Before [the 1983 WPA World Congress in] Vienna they were inadequately informed and lost a lot of time, and reacted not always with the right steps and decisions, and now again they do not know exactly what the atmosphere is, and will do again irreparable harm. It seems it eludes them completely that the world is counting on a renewed collaboration…” Jochen Neumann116

The political abuse of psychiatry in the Soviet Union was not a policy that was automatically followed by the Eastern European Communist regimes, and in most countries such abuses did not take place at all, or only in individual cases. Interestingly, the only other country where the presence of a system of political abuse of psychiatry was developed is Romania, which under leadership of the mega- lomaniac Nicolae Ceausescu and his wife Elena followed a rather independent political course, often to the chagrin of the Soviet leaders. One of the countries that were generally considered as a very faithful follower of Soviet policies was the German Democratic Re- public (Deutsche Demokratische Republik, DDR). The state had been founded on basis of the Eastern German or Soviet zone (Sowjetische Besatzungszone, SBZ), and the Marshall Plan that was pumped into

116 Reisebericht Basel by Jochen Neumann, June 1986, p. 10

70 the American, British and French zones in order to get Germany back on its feet, was inaccessible to them.117 The difference in poverty and economic growth increased considerably, with Eastern Germany lag- ging more and more behind especially because the Soviets, instead of rebuilding the economy, dismantled much of what was left of the German economic power and shipped the machinery to the Soviet Union as war reparations. During the early stages of the occupation (in particular 1945 and 1946), the Red Army seized around a third of the remaining industrial equipment from Eastern Germany to be shipped back to the Soviet Union, with a further 10 billion dollars in reparations extracted by the early 1950s in the form of agricultural and industrial products. 118

The DDR was founded in October 1949 in a fundamentally hostile environment, and was from the very start in need of a service that would guarantee its security. The Eastern part of Germany had been considerably pro-Nazi during the national-socialist regime of 1933- 1945, and many of its citizens saw the demise of the Third Reich as a failure, not as liberation from fascism. Thus, the relationship between the government, which mostly consisted of people who themselves had been traumatized by their incarceration in concentration camps under the Nazi regime or who had survived the Holocaust, and a population that did not share their sense of victory, was tense. This is probably one of the explanations of how it is possible that

117 The Marshall Plan was the primary plan of the United States for rebuilding and creating a stronger foundation for the countries of Western Europe, and repelling communism after World War II. The initiative was named for Secretary of State George Marshall. The reconstruction plan, developed at a meeting of the participating European states, was established on June 5, 1947. It offered the same aid to the USSR and its allies, but they did not accept it. The plan was in operation for four years beginning in April 1948. During that period some USD 13 billion in economic and tech- nical assistance were given to help the recovery of the European countries that had joined in the Organization for European Economic Co-operation. By the time the plan had come to completion, the economy of every participant state, with the exception of Germany, had grown well past pre-war levels. 118 The Russians in Germany, p. 167-9

71 former victims of a dictatorial Nazi regime eventually became rulers of a dictatorial state.119

In the perspective of the East German leadership, the Western allied zones became increasingly hostile. Travel between the Western and Soviet zones was unrestricted and large numbers of citizens living in the Soviet zone made their way to the Western zones, ridding the Eastern part of many of its skilled laborers and higher educated people. And, of course, Western infiltrations into the Eastern part became more and more frequent, thereby contributing to the sense of unsafety and thus the desire to arm itself against foreign influences. The result was a state that craved for a system that would keep the enemies at bay, and the Ministry of State Security (Ministerium für Staatssicherheit, MfS, or Stasi) had to provide that service.

With the above in mind, it is not strange that almost from the very start the DDR depended heavily on a wide network of informers and secret agents. Undoubtedly, the fact that the country had not known any democratic state structure since 1933 also played a role. In particular the uprising on June 17, 1953, caused by an increase of labor production quota with 10% but based on a widespread discontent among the population, resulted in a paranoid atmosphere, in which the DDR State declared itself as being good and progressive, and the other side as bad, reactionary an asocial. The State tried to establish a society in which there was no conflict, where all shared the same values. The result was a collective regression, with a State that centered its attention on the division between Good (“us”) and

119 The almost automatic reaction is to call the DDR a totalitarian state, like the other state in Eastern Europe and the USSR. Yet many of my interlocutors, former citizens of the DDR, do not fully agree that it just totalitarian; for them it was a state that was designed to be democratic but that because of both external and internal circumstances became dictatorial, “paranoid”. The system of involving citizens in all levels of society soon became a system of total control over its population, yet they assert that this was not the original goal of this system of government. The outcome, though, had all the elements of a totalitarian state.

72 Bad (“they”) and the fear that Bad would penetrate its society and cause this much-feared conflict. The only way to defend society against this outer threat was by building an ever-expanding spying system on its on citizens.

When the Ministerium für Staatssicherheit (MfS, or Stasi) was founded in February 1950, it was immediately instituted as the “Schild und Schwert der Partei” (the Shield and Sword of the Party) and was directly responsible to the SED, the ruling Socialist Unity Party. As it was not subordinate to any Ministry, it fell also outside Parliamentary control. At the beginning, approximately 1,000 agents staffed the organization, but that number grew very quickly, in particular after the June 1953 uprising, which came quite unexpectedly for the Stasi and the SED leadership, and which resulted in more than a million DDR citizens on strike and demonstrations in 700 communities. The Soviet Army quelled the uprising, and thousands of people were sentenced to imprisonment. Following this event, which clearly showed the lack of control over society, the MfS was temporarily subordinated to the Ministry of Internal Affairs and carefully reorganized, and two years later turned into a separate Min- istry again. Erick Mielke would lead the organization from 1957, when it became an independent agency again, until 1989, when the Berlin Wall came down.120

The number of persons involved with the Stasi grew enormously over the years, as a result of the ever-expanding spying system, and eventually reached more than a quarter of a million. In the middle of the 1950s already 20-30,000 persons were registered as “Inoffiziele Mitarbeiter”(unofficial agents, IM).121 In 1989, with a total popula-

120 Kerz-Rühling, I., and Plänkers, Th., Verräter oder Verführte, p.11. This book is authored by a group of psychoanalysts and probably the most interesting and insightful book on the issue that I read in preparation of this book. 121 Gieseke, Jens: Der Mielke Konzern, p. 112

73 tion of approximately 16 million citizens,122 91,000 persons were working full-time for the Stasi, while 174,000 persons were function- ing as unofficial agents (IM). In total, about 600,000 persons worked for the Stasi during the forty years of its existence.123 Many people who worked for the Stasi came from broken families, or were coerced to do so because of sometimes minor transgressions such as adultery, which was used against them as a means of blackmail. There were also many people who collaborated because they felt it was their duty to help defend their country, or didn’t fully realize that they were actually working as agents. Often they wrote no reports, but had meetings with their Führungsoffizier (case manager), who later made a written report on the issues discussed. However, also the Führung- soffizier had a plan to fulfill, so the content of his report was not always automatically what was actually said during the meeting(s). This resulted in much discontent after the collapse of the DDR regime, as until this very day former agents are not allowed to see their own files, yet the files are used as a basis for the provision of certifi- cates of “cleanliness” and these can be decisive for their future careers.

The DDR and the Soviet Union: not exactly brothers While the DDR was outwardly faithfully following Soviet policies, except during the last few years when it was no longer possible to hide the fact that the policy of perestroika and glasnost was viewed suspiciously by the DDR leadership and they tended to follow a much more orthodox policy than their Soviet colleagues, behind the scenes the relationship was certainly not always without criticism and even tension for a much longer period.

122 The East German population declined steadily throughout its existence, from 19 million in 1948 to 16 million in 1990. 123 ibid. Gieseke mentions 173,000 IM in 1988/1989. Der Mielke Konzern, p. 115

74 Such was also in the case of psychiatry. Already from the start Soviet policy in psychiatry was not automatically followed. For instance, while the Pavlovian School personified in Andrei Snezhnevsky from 1950 onwards dominated Soviet psychiatry, the influence on DDR psychiatry was minimal. In July 1950, SED Polit- buro member Kurt Hager expressed the view that the accomplish- ments of Soviet science should be leading in all disciplines, and this meant that in psychiatry the work of Pavlov should be followed. Two years later, in 1952, a State Pavlov Commission was established at the Ministry of Health and two conferences were organized in 1953 and 1954. However, the influence on psychiatry in East Berlin was minimal.124

The Stasi files, that were examined in connection with the research for the book Cold War in Psychiatry, show that also the relationship between DDR and Soviet psychiatry was not always a very smooth one, and in particular during Jochen Neumann’s tenure as Vice-President of the World Psychiatric Association tensions were frequent and at times quite strong. In general, the Soviet psychiatric leadership had – like the political leadership of their country – the tendency to behave in a rather colonialist or imperialist manner towards their “younger brothers” in Eastern Europe, and time and again attempts were made to smoothen the relationship. For instance, in August 1978 a meeting was held in Sofia between Georgi Morozov and Nikolai Zharikov on behalf of the Soviet All-Union So- ciety of Neuropathologists and Psychiatrists, Ivan Temkov from Bul- garia,125 and Dr. Rohland126 and Kurt Seidel127 on behalf of the DDR.

124 Rapp, Michael: Psychiatrischer Zeitgeist in der Berliner Gesellschaft für Psychia- try und Neurologie 1867-2007. in: Helmchen, Hanfried: Psychiater und Zeitgeist; zur Geschichte der Psychiatrie in Berlin, p. 394. 125 Temkov was known not to be very positive about his Soviet colleagues and described Morozov and Professor Zharikov as functionaries of Soviet psychiatry who had not made any scientific progress.

75 During this meeting the improvement of collaboration and the ex- change of information was discussed. The Soviets were told that it would have been better if they had kept their socialist colleagues better informed. One of the examples that were tabled was the fact that one of Morozov’s deputies, Dr. Yuri Novikov, had defected to West Germany. The DDR psychiatrists had found out only because a series of interviews that had been published in the German journal Stern. “Also in this case we would have liked to have received direct information, because there is theoretically the possibility that one would meet this Novikov on the occasion of a congress. The reactions from the Soviet guests to both questions was indifference, we had the impression that they were embarrassed.”128

A year later, in November 1979 a symposium was organized, in which delegations from the Bulgaria, Czechoslovakia, and the DDR. Hungary and Poland as well as some 400 Soviet psychiatrists took part.129 A special meeting was organized to discuss regional collaboration amongst psychiatrists from the socialist countries. Among others a decision was reached to organize a yearly psychiatric conference for socialist countries. Also an attempt was made to develop a mechanism by which the socialist countries would coordinate their response to Western allegations of political abuse of psychiatry.130 The East Germans were invited for a special meeting with the Soviet psychiatric leadership, where they were thanked for their ongoing

126 Dr. Rohland was at that time Director of the General Secretariat of medical- Scientific Societies of the DDR. 127 Head of the department for health policy within the Central Committee of the Party and a friend of Jochen Neumann, 128 Report by Dr. Rohland and Prof. K Seidel on a meeting in Sofia on May 26, 1978. HA XX 498 pp. 312-3 129 See the reports by Prof. H. Schulze and Prof. J. Neumann, HAXX 499 pp. 453-8 130 This was an issue to which the Polish delegate Prof. Dabrowski protested, as the Poles “had not prepared themselves” for this item of the agenda. An attempt by the Soviets to convince the Poles to give up their resistance failed; they insisted that their disagreement would be noted in the minutes of the meeting, something that resulted in irritation among the delegates from the DDR (and possibly of others too).

76 support. According to Jochen Neumann, who was a member of the DDR delegation, the DDR psychiatrists were “the most reliable part- ner of the USSR.”131 However, in February 1985 the same Jochen Neumann would write in a report on a visit to Moscow, where he and his colleague Bernd Nickel held meetings with among others Georgi Morozov, that according to Morozov “the collaboration with colleagues from our country is worse than with those from any other socialist country, and the chances to exert political and professional influence on Western colleagues through various resarch programs of the WHO is not enough used by us.”132

In October 1984, a week before his departure for Rome as a nominee for the position of Vice-President of the WPA, Jochen Neu- mann had two meetings with Prof. Karl Seidel, during which strategy was discussed. An important element during the discussions was, according to Neumann, the assertion by Seidel that in the DDR no political abuse of psychiatry took place or had taken place in the past, and that in that sense Neumann could function assertively without running the risk of having to deal with claims otherwise. “I remember that Prof. Seidel, already years before he became involved in high-level politics, both among colleagues and also in private strongly recommended absolute correctness when political factors played a role within the case of a patient. During one of the two meetings Prof. Seidel pointed out that the DDR in no way should subject itself always to the wishes of the ‘friends’ (that is: the Soviets; RvV) and that at least with regard to health policy the country had its own independent view.”133 In other words, high up in the DDR leadership

131 HAXX 499 p. 458. 132 See: Bericht by Jochen Neumann, February 1985, p. 2 133 Personal notes of Jochen Neumann, August 16, 2009. In the Stasi file of Karl Seidel there are a number of interesting documents that show that he was much less a staunch believer in the socialist regime than one would assume. A document from 1964, for instance, which reports on a meeting between a Stasi officer and Seidel, mentions the fact that Seidel “said… that even officers of the NVA [Nationale Volks Armee]

77 there was a clear wish not to be fully and unconditionally associated with the psychiatric politics of their “big brother”.

Jochen Neumann – a short political biography Jochen Neumann, born in 1936 in the small town Leisnig in Saxony, grew up as only child in a family that meandered between the various challenges brought upon them by the Nazi regime and the Second World War. His father was a member of the Nazi Party NSDAP and the SA, but was not an active Nazi and the racist convictions of the Hitler regime were not part of Neumann’s education. Still, the end of the war brought disaster on the young Jochen Neu- mann’s doorstep, as his father was arrested and mistakenly sent to prison and then a Soviet camp for Nazi prisoners. He returned only two years later, being a broken man. The uncertainties of the post- war period as well as the collapse of his parents’ marriage had a strong psychological influence on the Jochen Neumann, and he found an alternative “family” with the communist youth movement FDJ. Gradually, from being an anti-fascist he became a communist, and he joined the Communist Party (Socialist Unity Party SED) in 1954, a year after Melvin Sabshin left his.

Jochen Neumann had a successful career in the DDR, and after his professorship in Jena he eventually became Director General of the Deutsches Hygiene Museum in Dresden. This institution, with its manifold tasks of very different nature, whose only common de-

and the MfS (that he told the officer in passing, softly) are disappointed how socialism was being built in the DDR. They had something else in mind (freedom).” MfS 13788/83. p. 15. The same document indicates that through contacts with the Stasi Seidel had been able to obtain an apartment in Dresden. An extensive document that contains a transcript of a recording from 1968 expands on Seidel’s convictions and positioning, and concludes that he is not so much a believer in the system but that he understands that he will live and have to make a career in the DDR and that in order to do so certain things are expected. He appears to be rather opportunistic in his behaviour, adjusting himself to the opinions of the majority and avoiding anything that would rock the boat. See: MfS 13788/81, pp. 14-23

78 nominator was health in the broadest sense and whose main task was to promote nationwide health-improving motivations and behavior patterns, united under one roof rather different institutions and sectors in the field of health. During his career, several times he came into conflict with his superiors, mainly because of his directness and his inner drive to express his discontent when need be, in spite of the possible professional and/or political consequences. Several times his political protective network managed to save him from serious repercussions.

Recruited by the Stasi in 1978, Neumann initially decided to discontinue his contacts with the service because he refused to spy on other people and on top of that found the intellectual level of his Führungsoffizier not adequate. His refusal to continue collaboration led to himself being submitted to surveillance by the Stasi, as they didn’t trust his motives and were unsure about his (political) reliability.

Later Neumann was recruited again, this time only for service abroad, to report on what he had seen and encountered during his foreign trips. In October 1984 he was successfully deployed as Vice President of the World Psychiatric Association. During the five years of tenure as a member of the Executive Committee of the WPA, Jochen Neumann wrote dozens of reports for the DDR leadership, of which at least two copies found their way to the Stasi (and most probably also to the KGB). In these reports he describes in a factual manner what is happening within the Executive Committee, what the chances are for a Soviet return and an end to discussions about So- viet psychiatric abuse within the organization, and how the structure of the organization will be reformed in order to make it more democratic. Gradually, his reporting became more anti-Soviet, as a result of increasing irritation with the lack of coordination and strategy on the part of the soviet psychiatric leadership. Also, his affection for Mel

79 Sabshin and the American Psychiatric Association became increasingly visible, and he became increasingly vocal with regard to criticism of the political system in the DDR. In the end, he expresses his understanding for those citizens who decide to flee the country, which led to a high level meeting in East Berlin to discuss his political reliability.

The reports by Jochen Neumann are fascinating reading, without doubt. They are of high literary quality, clearly show his intelligence and his ability to analyze situations, are at certain moments humorous and unbelievably frank. The recipients must have taken a deep breath when reading Neumann’s open criticism of the Soviets, his growing admiration of the Americans and, finally, his criticism of what is happening in his own country. Yet at the same time they also show his loyalty to the DDR, his desire to help build a Communist society in spite of the fact that he became increasingly disenchanted, and his principality. He agreed to serve his country, and he did it, in spite of everything.

His criticism of the Soviets and admiration of the Americans is certainly not there from the very start. Clearly, during his five years on the Executive Committee Neumann goes through a process of a changing worldview, and a more balanced understanding of the political reality, which is also reflected in his use of wording. In his report on the Vienna Congress of 1983, he still very much uses all the obligatory political slogans and formulations. For instance, he writes “a circle of Zionist agitators dominate the Royal College and this is in its turn in England in agreement with official circles the leading view. Exactly these Zionist connections led to the systematically prepared anti-Soviet attitude and the abuse of the voting machinery and open manipulation.”134 It is, as far as I could establish, the only report in which the term “Zionist” is used. In his 1984 report on the Executive

134 Sofortbericht Jochen Neumann on the Vienna Congress, July 27, 1983, p. 3

80 Committee of the WPA he has changed his wording already to “the Royal College group”.135

Jochen Neumann is adamant that he never fulfilled any orders while being a member of the Executive Committee, and merely kept the DDR leadership and, both directly and indirectly, the Soviets informed of what was happening within the WPA. In the document sent to me prior to an interview in June 2009 he writes that “with regard to the influence [of the Stasi] on the Executive Committee and the WPA I would like to make the following specification. At no time did I receive any instructions with regard to the WPA from the MfS. They were only interested to know in detail what was happening within the WPA. In my reports I have tried to the best of my (subjective) ability to create an image as realistic as possible of what was happening in world psychiatry and the WPA, also with regard to individuals involved. In doing so I have not taken into consideration any possible wishful thinking on the side of the recipient of the reports and have in these reports never answered any expectations in- voluntarily in order to stabilize my own position. My reports were (subjectively) uncompromising, honest, and reflected my knowledge and views of that time.”136 And indeed, nowhere in his reports, nor in the documents that were found in his personal file in the Stasi archives, is there any evidence that he ever crossed that border. Every- thing points in the direction that Neumann, while working within the system and for an intelligence agency, did not violate his own moral standards and principles.

The end of 1989 also meant the end to Jochen Neumanns career. In October 1989 SED Party leader Erich Honecker was removed from power and a few weeks later the Berlin Wall came down. Neu-

135 “The influence of the Royal College groups is extraordinarily big, as before, but less important than in Vienna.” Report on the Rome EC meeting, October 19, 1984, p. 2 136 Situation MfS/ WPA, June 1, 2009

81 mann left his position as Director General of the Deutsche Hygiene Museum at the end of 1989 and became director of a regional psychiatric hospital, a position he lost in 1991. A period of disenchantment and depression followed. He had not only lost his belief in de system he helped build, but eventually also his professional career and country and, in the end, his family. In 1992 he left for Saudi Arabia, where he worked for five years as Director of a psychiatric clinic. His dairies from 1992 until 2005 show a man who has lost everything and repeatedly sees suicide as the only way out.

82 VI.D. POLITICAL ABUSE OF PSYCHIATRY – AN ANGLO-AMERICAN PERSPECTIVE AND THE INFLUENCE OF EAST-WEST POLITICS

“… There are probably no more out- rageous human rights violations in the long and ugly and dark history of the Soviet Union than the human rights abuses which relate to the use of highly trained, highly skilled physicians who are persuaded or cajoled or forced to pervert their scientific training, their training as physicians for the use of torturing people who see the Soviet Union in its true light.” Tom Lantos137

As noted before, in the course of the 1960s the political abuse of psychiatry in the Soviet Union had become one of the main methods of repression and by the end of that decade many well-known dissidents were diagnosed as being mentally ill.138 As a result of the grow-

137 Statement by Tom Lantos, member of the US House of representatives, at the Hear- ing before the Subcommittee on Human Rights and International Organizations of the Committee on Foreign Affairs and the Commission on Security and Cooperation in Europe of the House of Representatives, September 1983. 138 On basis of the available data, one can confidently conclude that thousands of dissenters were hospitalized for political reasons. The archives of the International Asso- ciation on the Political Use of Psychiatry (IAPUP) contained over a thousand names of victims of whom it had multiple data (name, date of birth, type of offense, place of hospitalization), all information that had reached the West via the dissident movement. However, this number excluded the vast “grey zone”, people who were hospitalized usually for shorter periods of time because of a complaint to lower officials, conflicts with local authorities or because of unorthodox behavior”. It is estimated that this group was actually much larger. Their names were, however, not known to the dissident movement and thus not recorded in the West. A biographical dictionary published by IAPUP in 1990 contained detailed information on 340 victims of political abuse of psychiatry as well as on more than 250 psychiatrists involved in these practices.138 Figures provided by the KGB to the Stasi in 1976 indicate that half of the dissidents arrested on basis of “political articles” of the Criminal Code (slandering the So- viet system and anti-Soviet agitation and propaganda) were considered mentally ill and sent to psychiatric hospital for compulsory treatment. See: MfS-HAXX, 2941, p. 97

83 ing numbers of dissidents winding up in psychiatric hospitals the protests in the West grew and eventually culminated into a campaign to end this abuse of the psychiatric profession. As political scientist Peter Reddaway points out in his analysis Patterns in Soviet Policies Towards Dissent: 1953 – 1986,139 foreign opinion became a factor constantly taken into account by Soviet leaders after 1966. However, sometimes the effect on policymaking was stronger than at others. In 1967 the KGB began an offensive against the emerging human rights movement, which lasted for six years and gathered pace especially after the invasion of Czechoslovakia in 1968. The offensive included, most notably, a focus in 1971-73 on shutting down the main samizdat publication of the human rights movement, Chronicle of Current Events. One of the reasons for this increased repression was the desire of the Soviet leadership to end the relative international isolation that the invasion of Czechoslovakia had provoked. This new strategy focused on the promotion of a policy of détente towards the West. However, this also required the regime to make sure dissidents understood that détente did not imply any political or ideological relaxation at home. Interestingly, the repressive measures did not focus also on the issue of emigration of Soviet Jews and Germans. Apparently the Soviet leadership decided that this issue had to be dealt with differently, as public opinion in the United States, Ger- many, and Israel was inevitably a powerful factor. As a result, the Soviets agreed with increased numbers of emigration and the number of emigrants quickly rose from a total of 1-2,000 a year in the 1960s to some 70,000 in 1979.

In early 1974 policy changed again and a five-year period of détente and significantly lower levels of dissident arrests began. This reduc- tion was geared to the diplomatic negotiations that led to the 1975 Conference on Security and Cooperation in Europe (CSCE) and the

139 Manuscript is to be published in a collection in the course of 2010.

84 follow-up conferences of 1977 and 1980. However, on the eve of the Moscow Olympics in 1980 the KGB began a new crackdown on all forms of dissent. Apart from the Olympic Games this crack down, which was aimed at annihilating the dissident movement once and for all, the main reasons were the worrying growth of the dissident movement, the waning of détente, the political weakening of Brezhnev, and the Soviet invasion of Afghanistan in December 1979, as well as the rise of the labor union Solidarnosc in Poland in 1980- 81. In his analysis, Peter Reddaway identifies four key variables that influenced Soviet policy towards dissidence. The first variable was the political strategy and style of each Soviet leader and his clos- est associates. When focusing on the issue of Soviet political abuse of psychiatry, subject to this dissertation, we mainly have to focus on the Brezhnev period, which had lost all its ideological dynamism and became increasingly corrupt. Thus, when he eventually died and An- dropov replaced him, the new leader, not surprisingly, further tight- ened the party’s controls all round, including, notably, in the politically sensitive sphere of dissent. A second and somewhat related variable was the political weakening of three top leaders toward the end of their rule. Interesting, in particular in the context of the subject of this research, is the third variable: the impact on the Kremlin of pressures from Western governments and NGOs regarding human rights. One of the examples mentioned by Reddaway is the whole CSCE process of the years 1973-79, which was used by Western leaders to make the Soviets accept a final document requiring the signa- tories to increase their respect for human rights and to have their performance reviewed by a CSCE conference every two or three years. Also the liberal human rights approach by the Euro- communist parties of notably Italy and France led the Soviets to re- lease a number of imprisoned dissidents. KGB documents, in particular memoranda written by KGB chairman Yuri Andropov, show

85 the intense irritation and then anger in the Politburo. And finally, as the fourth variable Reddaway mentions the Kremlin’s change of focus over time with regard to less prominent dissenting groups, har- assing and persecuting particular movements at particular times, depending on which ones were not attracting attention in the West.

As part of the effort to mobilize Western support and thereby pressure on the Soviet authorities, Vladimir Bukovsky sent in 1971 a file of 150 pages of documentation to the West. It was the first time that Western psychiatrists could study copies of the psychiatric diagnoses by Soviet psychiatrists involved in the abuse and learn the details of their diagnostic methods. The documents were accompanied by a letter by Bukovsky asking Western psychiatrists to study the six cases documented in the file and say whether these people should be hospitalized or not. A group of British psychiatrists examined the file and concluded: “It seems to us that the diagnoses on the six people were made purely in consequence of actions in which they were exercising fundamental freedoms…”140 They suggested to discuss the issue during the upcoming World Congress of the World Psychiatric Association (WPA) in November 1971 in Mexico. However, such discussion was not to take place. Although the President of the Congress referred to recently received documents about some places in the world where political opposition was treated as mental illness, WPA General Secretary, Dr. Denis Leigh, refused and stated that “the WPA is under no obligation to accept complaints from one member society directed against another member society.”141 The failure to discuss the issue opened the door for the Soviet authorities to sentence Vladimir Bukovsky to twelve years in camp and exile, and to increase the use of psychiatry as a means of repression.142

140 The Times, November 16, 1971 141 Minutes of the WPA Committee Meeting, November 28, 1971 142 Vladimir Bukovsky was eventually exchanged for the Chilean Communist party leader Luis Corvalan at Zürich airport on December 18, 1976.

86 In the period between the World Congresses in Mexico in 1971 and in Honolulu in 1977 a growing number of national psychiatric associations expressed their concern over the issue, but not more than that. The World Psychiatric Association did not study any of the evidence it received, nor did it interview former victims of Soviet psychiatric abuse. At the same time, however, part of the WPA leadership continued to maintain friendly relations with the Soviet psychiatrists that were closely involved in the political abuse of psychiatry.

In 1973 the British Royal College of Psychiatrists adopted a mo- tion in which it deplored the political abuse of psychiatry, and condemned the doctors who participated in it. For the first time the Col- lege discussed whether it should withdraw from the WPA if the Sovi- ets would remain among its membership and after a fierce debate it declared that it would do everything possible to have the next Gen- eral Assembly of the WPA condemn the systematic political abuse of psychiatry in the Soviet Union. This was quickly followed by a request from the American Psychiatric Association that a special session be held on concrete abuses of psychiatry at the World Con- gress.143

The move by the British and Americans had been supported by other societies as well, and thus there was no way the issue could be kept off the agenda. During the General Assembly of the WPA in Honolulu in 1977 a British resolution condemning Soviet political abuse of psychiatry passed with 90 votes against 88, but only after long debate about not only about the issue itself but also about the allotment of votes and other procedural issues. Six years later, at the 1983 World Congress in Vienna, the Soviets were no longer present, having left the organization after it became clear they would other-

143 News and Notes, Royal College of Psychiatrists, November 1976; Psychiatric News, October 1, 1976.

87 wise be expelled by a majority of the General Assembly. A resolution was adopted that put conditions on their return within the international psychiatric community.

The role of the US State Department The campaign against the political abuse of psychiatry in the USSR continued unabated and very much dominated the agenda of the World Psychiatric Association and its Executive Committee, as the dissertation Cold War in Psychiatry describes in minute detail. Eventually, in the course of 1987, also the US State Department became directly involved, probably because the ongoing reports on political abuse of psychiatry increasingly formed an obstacle to détente. Most political prisoners had been released, but somehow the prisoners in psychiatric hospitals were the last to go, and only one by one. Research shows that in fact this intervention was a joint initiative of the US State Department and the Soviet Foreign Ministry, who agreed to institute an official investigation in an attempt to establish whether the political abuse of psychiatry in the Soviet Union indeed took place, had ended or still continued. The outcome should provide enough evidence to end the issue of political abuse of psychiatry once and for all.

In March 1988, a Soviet official delegation visited the United States. Knowing that a psychiatrist would be among the delegation members who had specifically been asked to discuss involuntary psychiatric commitment, the State Department asked the APA to suggest American psychiatrists who might participate. Among the names provided was that of Dr. Loren Roth from Pittsburgh.144 The discus-

144 Dr. Loren Roth is the Associate Senior Vice Chancellor, Health Sciences at the Uni- versity of Pittsburgh. He was the former Chief Medical Officer of the University of Pittsburgh Medical Center. At the time described in this chapter (1988-9) he was Di- rector of the Law and Psychiatry Program at WPIC and Psychiatric Team Leader of the U.S. Delegation to assess changes in Soviet Psychiatry.

88 sion proved to be fruitful and led to Loren Roth being invited to participate in roundtable human rights discussions in Moscow in April 1988. Although he traveled to Moscow as a private psychiatrist, it was clear to all sides that he had been delegated by the APA to do so. One of the proposals was to involve the National Institute of Mental Health (NIMH) in the potential US visit, something to which the So- viets reacted enthusiastically because they were eager to resume the collaboration on mental health issues which had been discontinued after the Soviet invasion of Afghanistan. The compromise decision reached was that the undertaking would be a State Department mission with consultation from both NIMH and the APA.

In a memorandum to APA Medical Director Melvin Sabshin, Loren Roth noted how pressure on the Soviet psychiatric establishment was now coming from a very different side. “…It is clear that the winds of change… blow not from the West, but from the East. In effect, the Foreign Ministry is involved in a kind of internal political struggle with Soviet psychiatry. Soviet psychiatry is… being ‘scape- goated’, but in a ‘for internal consumption acceptable way’ as having made errors in the past … which is now being fixed. Thus the psychiatrists get the blame for what has been in most part a political, KGB problem, even if some prominent psychiatrists, probably a minority, have been active and enthusiastic participants in the political abuse maters. They must now eat crow – but only Russian crow which is more digestible than American crow.”145 Still, no acknowl- edgement of past mistakes had been forthcoming, neither on the part of Soviet psychiatrists nor on the part of the Foreign Ministry: “This, ‘officially’ while castigating the psychiatric establishment, the For-

145 Confidential memorandum of Loren Roth to Melvin Sabshin and Ellen Mercer, April 27, 1988, p. 2.

89 eign Ministry (and I assume ‘higher ups’) simultaneously still support it, de facto, in its old ways through its old leadership.”146

In his memorandum, Loren Roth outlined all the difficulties ahead, of which the political game between Soviet psychiatry and the Foreign Ministry was only one. “All this poses a most difficult question since we wish to be scientific and professional, yet the Soviets will attempt to stack the deck in every way.” The road ahead would be a very difficult one, as without concrete scientific proof the American visit could have a completely contrary effect and clear the way for a jubilant Soviet return to the WPA. “Because they have not been honest with us in admitting what they have done in the past, I believe they cannot be honest with us in the future vis-à-vis these examinations. (…) Clearly, the Soviet psychiatrists are unhappy.”147

An additional problem Loren Roth foresaw was the tension between the political and the scientific agenda. Once direct scientific exchanges between American and Soviet psychiatrists were established the ghost would be out of the bottle and it would be impossible to be put back, even if the visit as such would not provide the desired outcome: “Once an NIMH sponsored delegation goes to the USSR (whatever its findings), the point has been made that the Soviet Un- ion is open; international experts are welcome; we are reasonable people; etc. It will be very difficult for anyone, including the APA, to dismiss that fact in the forum of world psychiatry. (…) If the consequences are negative, we have done an immoral act. Therefore we

146 Confidential memorandum Loren Roth, p. 3. Eduard Shevardnadze confirmed in our interview that the issue had been discussed during a Politburo meeting and that it had been decided that the practice needed to end immediately. However, there was strong resistance, in particular from the KGB. He did not remember what the positioning of Chazov was with regard to this issue. Interview with Shevardnadze, October 15, 2009. According to Anatoly Adamishin, one of Shevardnadze’s Deputy Foreign Minis- ters who was very much involved in human rights issues, Chazov’s role was at first quite ambiguous but later a positive one. E-mail from Anatoly Adamishin, November 28, 2009. 147 Confidential memorandum Loren Roth, p. 4

90 must make certain that the outcome is positive. Otherwise what we are doing is not defensible.”148

The head of the American delegation, Assistant Secretary of State Richard Shifter, managed to move psychiatry to the top of the agenda and, in spite of Soviet attempts to block this, have the issue discussed during a plenary session. The three-day visit ended on a positive note. Clearly, disagreements with regard to the conditions under which a US visit would take place, remained, but in principle both sides agreed that the door to further negotiations was open and that a visit might be feasible later that year.

Later than initially planned, a small delegation traveled to Mos- cow on 9-12 November 1988, in order to negotiate the terms of the agreement that would form the basis of the visit.149 In spite of occa- sional irritations on both sides, gradually an agreement was reached on all the details of the visit.

Political scientist Peter Reddaway, who himself was selected to be a member of the US delegation, noted in his diary the continuous obstruction by Soviet psychiatrists. “When the Soviet psychiatrists (Ministry of Health – MoH) saw that the US group would be a much more serious and well-prepared one than any preceding group of visitors, it became wary and obstructive. However, the politically more powerful Ministry of Foreign Affairs (MFA) kept prodding the psychiatrists – sometimes even in front of the Americans – and in early November 1988 forced the MoH at last to agree to virtually all the US conditions.”150 The reason for this should be sought, according to Reddaway, in the fact that the Soviets very much wanted the United States to agree on holding a human rights conference in Mos-

148 Confidential memorandum Loren Roth, p. 5-6 149 The advance team consisted of Loren Roth, Darrel Regier, Sam Keith, Saleem Shah, and Ellen Mercer in addition to Bill Farrand of the US State Department. 150 Confidential diary of Peter Reddaway, April 12, 1989, p. 1

91 cow: “early November [1988] was the time was Soviet diplomacy was pulling out all the stops to get the West to hold a CSCE conference on human rights in Moscow in 1991 – hence the decision to agree to all or conditions. After the West responded positively to this and other concessions in late December, the Soviet psychiatrists, with the big diplomatic prize in the MFA’s pocket, began backtracking on most of the promises they had made to us in November. In January-February it often seemed that – since we basically refused to compromise on the November agreement – the whole thing might collapse. But extra trips to Moscow by our negotiators… brought the MoH more or less into line.”151

In his memoirs, Soviet Foreign Ministry diplomat Andrei Kovalev pointed at another reason for the constant obstruction on the Soviet side. ”The issue was that the patients who interested the American psychiatrists primarily had been diagnosed in the Serbski Institute. On their medical records was written ‘secret’. The diagnoses had been written by Academicians and well-known professors. In the medical files you encountered terrible things. For instance, they refused to discharge one of the patients from hospital until he would give up his religious convictions, for which he had been hospitalized. They wanted to hide all this and that’s why they put the whole thing in the reverse.”152 In order to hide the most unpleasant documents, such as proof that high-level psychiatrists were involved, papers were ripped out of the files.153 Subsequently, the Soviet psychiatric establishment used other tactics to try to obstruct the American visit. The files could not be photocopied, because the photocopiers at the Min- istry had broken down; coincidentally, the same counted for the cop- ier at the Serbski Institute and the one in Vartanyan’s office. Then a fire took place in [Serbski Institute associate Gennady] Milyokhin’s

151 Confidential diary of Peter Reddaway, p. 1-2 152 Page from the Book of Condolences, p. 16 153 Interview with Andrei Kovalev, October 12, 2009

92 office, where the files were kept. He barely managed to save them from the fire. After this, they were stored in Andrei Kovalev’s office, ready to be handed over to the Americans. By the time they were handed over most of them had not yet been photocopied and thus the Americans received mostly original files.154

At some point, the Ministry of Health even decided at a meeting of all those involved (undoubtedly included Morozov and Vartanyan) that no medical records would be handed over whatsoever. However, one of the officials at the Ministry of Health told Andrei Kovalev that the files could be handed over, and the latter called the American Embassy and an assistant came over to pick them up. “However, after the woman left with the files, I got a phone call from the same person at the Health Ministry, but this time the tone of the conversation was different. Instead of a conversation between acquaintances it was an official conversation, and he called my by my first name and patronymic. He informed me that the Ministry had decided not to hand over the files. I was shocked, it was clear I had been set up. I even checked the Criminal Code to see what punishment would be given for handing over official documents to a representative of a foreign country.”155 The situation was saved by Foreign Minister Eduard Shevardnadze, “who called Minister of Health Chazov and asked him to do everything possible to make the visit successful. Still, this chief Soviet ‘medik’, as I was told by witnesses later, shouted on the eve of the visit that ‘Kovalev is selling out the honor and dignity of the motherland’.”156

Long negotiations preceded the visit of the delegation, which were outlined in minute detail and included plans for sending the names of psychiatric prisoners or former psychiatric prisoners to be

154 Interview with Andrei Kovalev, October 12, 2009 155 Interview with Andrei Kovalev, October 12, 2009 156 Page from the Book of Condolences, p. 17.

93 examined, conditions as to the examinations, including taking urine samples from each person interviewed. In addition, there was to be a hospital visit team. On the Soviet side, the initiative was strongly opposed by some of the members of the Politburo, including former KGB Chief Viktor Chebrikov, and initially also by the above- mentioned Health Minister Evgeni Chazov. However after personal interventions by Soviet Foreign Minister Eduard Shevardnadze, the Soviet authorities agreed on virtually all points and in March 1989 the group of about 25 people traveled to the USSR. The delegation visited a number of psychiatric institutions and examined a number of alleged victims of Soviet psychiatric abuse together with Soviet colleagues. For this purpose, a long list of persons was handed over whom the Americans wanted to invite for such an examination. Apart from that several meetings with dissidents were planned. The Soviet negotiators had agreed to most issues, but Soviet psychiatrists continued to obstruct the process repeatedly. At the end of the visit, the US delegation and their Soviet hosts compared joint conclusions with those reached by Soviet psychiatrists in the past.

After a visit of more than two weeks the delegation returned home and wrote its report. The report, although published much later, was quite damaging to the Soviet psychiatrists. Not only had the delegation established that there had been systematic political abuse of psychiatry, but also that this abuse had not ended, that there were still victims of the political abuse in psychiatric hospitals and that the Soviet AUSNP continued to deny that psychiatry had been used as a method of repression.157 Considering the above-mentioned facts, it is safe to conclude that the issue of political abuse of psychiatry was ended at the initiative of the US State Department and the Soviet Foreign Ministry, in

157 The report was published in Schizophrenia Bulletin, Supplement to Vol. 15, No. 4, 1989

94 the course of which the “honor and dignity” of Soviet psychiatry was sacrificed to the larger political goal of good relations between the two superpowers. The fact that no serious reform took place within the Soviet psychiatric leadership, even following their return to the World Psychiatric Association in October 1989, shows that the change of policy was not a voluntary one.

The imposed policy change also resulted in a continued leadership role of the Soviet psychiatric nomenklatura. Although for several years the positions of the Soviet psychiatric leaders were in jeopardy, especially after the implosion of the Soviet Union and during the first years of the Yeltsin rule, one can now safely conclude that they managed to ride out the storm and retain their powerful positions. And not only that, they also managed to avoid an influx of modern concepts of mental health care delivery, and a fundamental change in the structure of mental health care services in the Russian Federation. All in all, Russia seems to be the country where the impact of mental health reformers has been the least, and those reform efforts that were undertaken in places like St. Petersburg, Kaliningrad and Tomsk have faltered, or were encapsulated when centrist policies under Vladimir Putin brought them back in line. By and large, we are still looking at Soviet psychiatry in Russia, and the fact that they recently published a fifth edition of a textbook on forensic psychiatry that was authored by two 88-year old Soviet psychiatric dinosaurs is one only of the painful reminders of this tragic situation.158

One of the conditions put to the All-Union Society in Athens in 1989 was a democratic change of leadership of the All-Union Society. The society ceased to exist in the early nineties following the disinte- gration of the USSR, and a new Russian Society of Psychiatrists took its place. However democratic the election of its officers might be, this new body proved to be in no way a challenge to the dominant

158 To the original text a section on compulsory treatment was added by Dr. V. Kotov.

95 position of the psychiatric Academicians and Institute directors, who all thank their positions to the psychiatric nomenklatura of the 1970s and 1980s. Age, however, plays a factor, with most leaders being just under, or well above the age of 80. It is not difficult to see a certain similarity with the Soviet leadership at the beginning of the 1980s, yet there is little hope that a “psychiatric Gorbachev” will emerge, and that when a younger generation takes the lead much will change: their power base is a continuation of the present status quo, and their refusal to make radical changes is often combined with mercantile and sometimes quite cynical attitudes.

The tragedy is, that also the new political wind in Russia provides little hope for a change for the better. To the contrary, since the turn of the century the number of places with an enlightened leadership is dwindling, and they are under severe pressure to accept the inevitable. And as far as the past is concerned, many of the current leaders of Russian psychiatry have revoked the earlier confession read at the 1989 WPA General Assembly that psychiatry in the Soviet Union had been abused systematically for political purposes. They now preferred to refer to “individual cases of “hyper-diagnosis” or “academic differences of opinion”.159 Russian psychiatry is, naturally and like in any other country, a mirror of Russian society, and also in that respect there is little hope much will change for the better in the years to come.

Melvin Sabshin – a short political biography Melvin Sabshin was profoundly influenced by the background of his parents who, both of Jewish origin, emigrated from Russia in 1910 and 1912 respectively, and were convinced socialists (his father was a Social Revolutionary activist, and following his arrest by the Tsarist police he escaped exile to Siberia only by fleeing to the United

159 Dmitrieva, D., Alyans Prava i Miloserdiya, Moscow, Nauka, 2001, pp. 116-130

96 States). Like many other Jewish immigrants from Russia, they were determined to build a new future in the United States and invested all their efforts in their children, and in particular in their son Melvin. The young Sabshin was extremely bright, finished school at an early age and went to college at the age of 14. Three years later he entered university. As a result of prevailing anti-Semitism in the United States it took his mother special effort to have him enrolled.

The rising tide of anti-Communism in the late 1940s and early 1950s further strengthened the anti-Semitic mood in the country. The connection was not such a strange one, because many members of the Jewish community often looked at issues from a different perspective. “As political liberals, Jews articulated positions that many Americans considered suspect. Not only advocacy of civil rights and civil liberties, but support of the United Nations, federal aid to education, and efforts to take religion out of public schools – a key issue for American Jews – set them apart from many, possibly most, Ameri- cans. Jews responded differently to the political events of the period than did most other Americans. According to a 1952 Gallup Poll, for example, 56 percent of all Catholics and 45 percent of all Protestants considered the anti-Communist tactics of Senator Joseph McCarthy acceptable. In contrast, 98 percent of all Jews polled disapproved.”160 The American Jewish Committee commissioned a sociological study on the interconnection between the two, which “pointed to a strong and chilling connection between the two, propelling this defense organization and others to strategize.”161 The study was carried out in connection with the fervor following the trial and following execution of Ethel and Julius Rosenberg in June 1953, a Jewish couple accused

160 The Jews of the United States, p. 277 161 The Jews of the United States, p. 278.

97 of spying for the Soviet Union.162 The fact that the two were of Jewish origin had a profound effect on the Jewish community.

Also Melvin Sabshin was during his university years politically very active and eventually became a member of the American Com- munist Party. His activity resulted in an avalanche of reports, either by “confidential informants” or by agents of the Federal Bureau of Investigation (FBI). The total file on Melvin Sabshin covers almost 400 pages covering the period from 1951, when the first investigation was initiated, to 1974, when Sabshin was already appointed as Medi- cal Director of the American Psychiatric Association in Washington D.C. The files painfully shows how extensively and detailed the FBI scrutinized Melvin Sabshin’s life. Former friends, colleagues, neighbors of Melvin Sabshin himself as well as of his parents were questioned. Apart from collecting “political information” a full “neighborhood watch” was carried out, whereby neighbors and land- lords were questioned whether they had noticed anything suspicious. The files bear a stunning resemblance to the Stasi files that I researched within the context of the research for this dissertation, the main difference being the absence of denunciations regarding alco- holism, adultery and possible homosexual tendencies. However, this is replaced by rather vague remarks regarding political views, or allegations of interracial contacts. For instance, one informant mentioned that it seemed strange to her that the Sabshin residence had “a succession of colored maids who had lived with the Sabshins perma- nently in the home and had shared a bedroom with the Sabshins’

162 Julius Rosenberg (1918 -1953) and Ethel Greenglass Rosenberg (1915 -1953) were American communists who were convicted on March 29, 1951, and on April 5 were sentenced to death. The conviction helped to fuel Senator Joseph McCarthy's investi- gations into anti-American activities by U.S. citizens. The Rosenbergs denied the espionage charges even as they faced the electric chair. They were executed on June 19, 1953 for conspiracy to commit espionage. Since the execution, decoded Soviet cables have supported courtroom testimony that Julius acted as a courier and recruiter for the Soviets, but doubts remain about the level of Ethel's involvement. The decision to execute the Rosenbergs was very controversial at that time and is still debated.

98 child.”163 Some informants clearly felt uneasy, not wanting to have their identities disclosed to the object of investigation (“I would pre- fer to appear only before a loyalty hearing board and not in the presence of Sabshin”)164 or refused to sign any statement (“Both of these informants declined to furnish a signed statement, and they will not appear before a Loyalty Hearing Board”).165 Yet some revealed themselves to be zealous contributors to the investigation, for instance one adding that “he cannot recommend him for a position within the United States Government, because he believes that the appointee was during this period a member of the Communist Party.”166

In spite of intense surveillance by the FBI and their active efforts to prevent him from finding employment, he managed to get a good position at the University of Illinois in Chicago. Here he would get additional education in psychoanalysis and meet his future wife Edith. He successfully continued his career at the Institute for Psy- chosomatic Research and Training at Michael Reese Hospital in Chi- cago (IL). The time in Chicago proved to be an excellent breeding ground for Sabshin’s later career. His responsibilities at PPI increased over time and eventually he was promoted to the position of Associate Director. In the fall of 1961 Melvin Sabshin became Head of the Department of Psychiatry at the University of Illinois. As far as numbers of students concerned, the medical school at Illinois was the largest in the United States and it continued to grow even larger during the 1970s and 1980s. Gradually Sabshin also became involved in State and national activities in psychiatry. He became President of the Illinois Psychiatric Society, sat on several committees of the APA, was elected as Trustee on the APA’s Board and in 1972 he became the chair of the APA Program Committee, which had the responsibility of

163 A 29-page FBI Investigation Report on Melvin Sabshin, October 17, 1952, p. 4 164 Statement by a witness, October 25, 1952 165 FBI report from New York, November 5, 1952 166 FBI Investigation report, NY 121-15707, no date provided.

99 organizing APA’s national annual conventions. In 1974 he was hired to become the new Medical Director of the American Psychiatric As- sociation (APA). Under his leadership, the APA grew into a 40,000- member organization with an annual turnover of 26 million US dollars, and the system of diagnostic criteria DSM, which was much developed under auspices of Melvin Sabshin, would become one of the main diagnostic manuals in the world.

Although his appointment as Medical Director of the American Psychiatric Association was a major step career-wise, for Melvin Sab- shin it was particularly important intellectually. Here he had the chance of influencing American psychiatry as a whole and put his ideas to practice. From very early on it was clear to him that psychiatry needed a clear concept of diagnostics, one that would end the prevailing lack of clarity and in his view also led to abuses. Under his leadership the organization grew immensely, and from a small professional organization mainly active in organizing annual meetings and publishing two journals, it became an organization with 40,000 members and an annual budget of 28 million US dollars.167 More im- portantly, the APA developed the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American classification scheme used in psychiatry worldwide, which was the first attempt to compare diagnoses in different environments. Considering the enormous amount of time and energy he put in its development, it is not strange that the fourth edition of DSM was dedicated to him.168

The election to the Executive Committee of the WPA in 1983 was in that sense the next logical step in his career, as it made it possible for him to implement his ideas and concepts on an international level, and to continue to promote clear diagnostic criteria as a means

167 See the interview of Claus Einar Langen with Melvin Sabshin on the eve of his retirement, published in Mental Health Reforms, 4-1997, p. 15 168 Changing American Psychiatry – A personal perspective, p. 128. The dedication reads: To Melvin Sabshin, a man for all seasons.

100 to curb improper use of his profession. In Sabshin’s view, the political abuse in the Soviet Union had been made possible primarily because of the absence of clear diagnostic criteria and thus the main barrier against such abuse in future would be the development of an internationally accepted psychiatric nosology.169

169 For a much more extensive description of Melvin Sabshin’s views and work regarding these issues see chapter 10 of Sabshin’s memoirs Changing American Psychiatry – A personal perspective

101 VI.E. POLITICAL ABUSE OF PSYCHIATRY – A GREEK PERSPECTIVE

Greece belongs to the West Konstantinos Karamanlis

Greece belongs to the Greeks Andreas Papandreou170

One of the key actors in the period 1983-1989 with regard to the World Psychiatric Associations’ dealing with the Soviet issue was the Greek psychiatrist Professor Costas Stefanis. Stefanis’ role was strongly influenced by the political positioning of his country, and also of the political party he was associated with, the socialist PASOK led by his friend Andreas Papandreou.

The polarization and instability of Greek politics in the mid- 1960s and Greek political thought in the 1970s and 1980s were very much a product of the Cold War, determined and dominated by the post-war period, when Greece was engulfed in a civil war between the government in Athens, supported by Britain and the United States, and the communist insurgents that were supported by the socialist/communist countries on the northern border of the country. The result was a deep divide between the leftist and rightist sections of Greek society.

Originally, both East and West regarded Greece as a nation well within the sphere of influence of Britain and Stalin kept his agreement with Winston Churchill not to intervene. However, Yugoslavia and Albania, being more independent minded (to the chagrin of Sta- lin), defied the USSR's advice and sent supplies during the Greek Civil War to the partisan forces of the Communist Party of Greece, the ELAS (National Popular Liberation Army). The UK in turn gave aid to the royalist Greek forces, but by 1947 the near-bankrupt Brit-

170 Clogg, Richard: A Concise History of Greece, p. 176

102 ish government could no longer maintain its massive overseas commitments and the British government decided to withdraw from both Greece and nearby Turkey. This would have left the two nations, in particular Greece, on the brink of a communist-led revolution.

Notified that British aid to Greece and Turkey would end in less than six weeks, the U.S. government, already hostile towards and suspicious of Soviet intentions, decided that action was necessary. With Congress solidly in Republican hands, and with isolationist sentiment strong among the U.S. public, US President Harry Truman adopted an ideological approach. In a meeting with congressional leaders, the argument of "apples in a barrel infected by one rotten one" was used to convince them of the significance in supporting Greece and Turkey. On March 12, 1947, President Harry S. Truman appeared before Congress to ask for $400 million of aid to Greece and Turkey. Calling on congressional approval for the United States to “support free peoples who are resisting attempted subjugation by armed minorities or by outside pressures,” or in short a policy of “containment,” Truman articulated a presentation of the ideological struggle that became known as the Truman Doctrine. Although based on a simplistic analysis of internal strife in Greece and Turkey, it became the single dominating influence over U.S. policy until at least the Vietnam War. Truman's speech had a tremendous effect and a silenced Congress voted overwhelmingly in approval of aid. The United States would not withdraw back to the Western Hemisphere as it had after World War I. From then on, the United States actively engaged any communist threats anywhere in the globe as the self- proclaimed leader of the “free world.” Meanwhile, the Soviet Union brandished its position as the leader of the “progressive” and “anti- imperialist” camp. 171

171 How strong the US influence over Greek politics in the 1950s and 1960s is illustrated by the fact that in 1951 the US Ambassador openly demanded a change in the electoral system from proportional to a majority system in order to make sure that the

103 The final victory of the Western-supported government forces led to Greece's membership in NATO, and helped to define the ideological balance of power in the Aegean for the entire Cold War.172 The civil war also left Greece with a vehemently anti-communist security establishment, which would lead to the establishment of the Greek military junta of 1967-1974, and a legacy of political polarization that lasted until the 1980s. Additionally, it divided the Greek people for ensuing decades, with both sides vilifying their opponents. Thou- sands languished in prison for many years, or were sent into exile on the islands of Gyaros or Makronisos. Many others sought refuge in communist countries or emigrated to Australia, Germany, the USA, UK, Canada and elsewhere.173 After the collapse of the military junta, a conservative government under Konstantinos Karamanlis led to the abolition of monar- chy, the legalization of the KKE and a new constitution that guaranteed political freedoms, individual rights, and free elections. In 1981 leftist United Democratic Left would not win the election. See Clogg: A Concise His- tory of Greece, p. 144. In 1964 US President Lyndon Johnson worded the US position in a rather direct manner when he told the Greek Ambassador: “**** your Parliament and your Constitution. America is an elephant. Cyprus is a flea. Greece is a flea. If those two fleas continue itching the elephant, they may just get whacked by the elephant’s trunk, whacked good.” See: Clogg: A Concise History of Greece, p. 155. 172 See Clogg, Richard: A Concise History of Greece, p. 147 173 An important factor that led to the Americans supporting a radical change of government in Greece (and the establishment of a military regime) was the role of the Papandreous and in particular of George Papandreou’s son, Andreas. The Americans saw the latter as the main troublemaker, and Andreas Papandreou’s statements about the Cyprus issue made things only worse. “Moreover, both Papandreous rejected American proposals for the solution of the Cy- prus problem and firmly supported the Non-Aligned Greek Cypriot President, Archbishop Makarios. This annoyed American policymakers. Furthermore, Papandreous’ and Makarios’ flirtations with the Soviet Union, and Andreas’ call for an anti-American, anti-NATO, and neutralist foreign policy, aggravated American mistrust…” (Semipheral Development and Foreign Policy – The Cases of Greece and Spain, pp. 60-61). The fact that George Papandreou blocked all American attempts to come to an agreement, sent 20,000 troops to the island of Cyprus, remained silent when Makarios contacted the Soviets for the delivery of substantial war material and refused to participate in NATO exercises and, in addition, declared that he would welcome Soviet support in his preparations for war against Turkey led to the American conclusion that US interests would be seriously damaged if Papandreou would win the 1967 elections. A month before the elections the military junta took control of the country. See: Semipheral Development and Foreign Policy – The Cases of Greece and Spain, pp. 62-3

104 the center-left-wing government of PASOK allowed veterans who had taken refuge in Communist countries to return to Greece and rees- tablish their former estates; PASOK contended that this helped di- minish the consequences of the civil war in Greek society. The PA- SOK administration also offered state pensions to former partisans of the Anti-Nazi resistance. Yet only in 1989, the coalition government between Nea Demokratia and the Coalition of Left and Progress proposed a law that was passed unanimously by the Greek Parlia- ment. The results were the final recognition by the Greek state of the 1946-1949 war as a Civil War and not merely a Communist insur- gency. Under the terms of this law for the first time in Greek postwar history the war of 1946-1949 was recognized as a Greek Civil War between the National Army and the Democratic Army of Greece.

As said earlier, Professor Costas Stefanis – although politically non-aligned and “independent” – was clearly influenced by his direct environment, among them his friends from PASOK including PA- SOK’s undisputed leader, Andreas Papandreou (and, after his death, his son George). PASOK’s world view was based on the idea that the bipolar system of the Cold War was a matter of the past and that Greece should play the role of bridge between Western Europe and the Balkans, de Arab world, Africa and the Communist East. As Pa- pandreou himself stated: “We are wrestling with the hawks in every part of the world. (…) We are for peace, and only support only Greece’s interests.” He added that Athens would become the ‘cross- roads’ and ‘meeting place’ of world leaders. “Our policy has become the starting point of rapprochement among the nations.”174 PASOK’s multi-dimensional policy of “national independence” was the result of the wish to free the country from the old Cold War commitments and to decrease the influence of both superpowers. An important factor in this positioning was the strong anti-American sentiment that

174 The Greek Socialist Experiment, p. 128

105 had resulted from the US support for the political right and the be- nign tolerance towards the Colonel’s regime, as well as the fact that the United States had now been able or willing to contain Turkey during the Cyprus crisis.175 During violent demonstrations the US Ambassador had even been shot dead.176

Papandreou’s positioning mainly resulted in systematic criticism of the United States, which he called “the Mecca of imperialism”, and in avoiding criticism of the Soviet Union.177 He refused to condemn the imposition of martial law in Poland in 1981 and later suggested himself as a mediator between the EU and the Jaruzelsky

175 The Cyprus crisis relates to the conflict between Greece and Turkey over the island of Cyprus, which until independence in 1961 was a British protectorate where Greek- Cypriots who made up 82% of the island's population. The Greek Cypriots desired unity (enosis) with Greece, and in the 1950s the issue flared up again when the Greek Cypriots, under Archbishop Makarios, claimed union with Greece. Turkish nationalist sentiment became inflamed at the idea that Cyprus would be ceded to Greece, and the Greek communities of Istanbul were targeted in the Istanbul Pogrom of 1955. In 1960 a compromise solution to the Cyprus issue was agreed on. Cyprus became independent, and a constitution was hammered out. Greek and Turkish troops were stationed on the island to protect the respective communities. Greek Prime Minister Konstantinos Karamanlis was the main architect of this plan, which led to an immedi- ate improvement of relations with Turkey. Both Greek and Turkish Cypriots were displaced during the period of inter-communal strife in 1963 and 1964. Thousands were displaced and massacres from both sides took place. The Cyprus dispute weakened the liberal Greek government of George Papan- dreou, and in April 1967 a military coup resulted in the establishment of the Colonel's regime. On July 15, 1974, a band of Greek Cypriot nationalists, advocating Enosis (Union) with Greece and backed by the Greek military junta in Athens, staged a coup against the Cypriot President and Archbishop Makarios. Nikos Sampson was appointed President. On July 20, Turkey, invaded without any resistance from the British forces in the island, occupying the northern 37% and expelling the Greek population. Once again war between Greece and Turkey seemed imminent. War was averted when Sampson's coup collapsed a few days later and Makarios returned to power; and the Greek military junta in Athens, which failed to confront the Turkish invasion, also fell from power on 24 July. However, but the damage to Turkish-Greek relations was done, and the occupation of Northern Cyprus by Turkish troops continues to this very day. The United Nations buffer zone, which cuts across the country, has created a physical and social barrier between the Greek and Turkish Cypriot communities and also separates the government controlled south from the Turkish military occupied north. The Turkish Cypriot community declared its independence as the Turkish Republic of Northern Cyprus in 1983. Currently it is recognized only by Turkey. 176 Clogg, Richard: A Concise History of Greece, p. 167 177 Clogg, Richard: A Concise History of Greece, p. 187

106 military regime.178 Even when the Soviets shot down the Korean flight KAL 007 on August 31, 1983, killing all 269 passengers and crew on board, Papandreou avoided direct criticism and asserted that it had been on a spy mission and that “if such a plane came into Greece, we would have downed it.”179 A few months later, in February 1984, Papandreou participated in the funeral of Soviet leader Yuri Andropov, whom he called a “most capable” and “reasonable” man who had been “truly for peace”.180

As Christopher Hitchens writes, “Papandreou oscillated between a bit of Arab diplomacy here, a touch of Balkan adjustment there; at different times flirting with a rapprochement with the United States or a new alignment with the Soviet bloc; now threaten- ing Turkey and then going to Davos to speak of ‘differences of emphasis’ with Turgut Ozal; at one minute fanatical about Cyprus and the next indifferent to it. In the same rather flippant fashion, he talked of expelling the American bases, leaving the EC, abandoning NATO, renegotiating the Greek membership of this or that, announc- ing a speech before the United nations only to cancel at the last moment.” 181

And thus Greece remained an integral part of NATO and the European Union and the Soviets’ consideration of PASOK as the fa- vorite socialist party that supported their policies and actively participated in their anti-nuclear campaigns changed into one of disillu- sionment. In the end, they just saw him as a “bourgeois nationalist” whose main goal was to have the Americans pay as much as possible

178 The Greek Socialist Experiment, p. 148 179 The Greek Socialist Experiment, p. 148. At that time Greece held the Presidency of the European Union and managed to prevent a strong condemnation of the Soviet Union. Instead, the statement didn’t name any country specifically and only expressed the Community’s “deep emotion”, calling for a ”thorough investigation.” 180 The Greek Socialist Experiment, p. 151 181 The Greek Socialist Experiment, pp. 4-5

107 for their military bases in the country.182 Theodore Kariotis sums up the eight years of Papandreou’s leadership as a sort of “derailed socialist train”: “Slowly the PASOK story became a tale of sacrificed talent, misplaced loyalty, and betrayed idealism.”183 He concludes: “History, in order to be fair to him, should write two chapters about Andreas (as he is known to most Greeks). One chapter for the man who brought to millions of Greeks a sense of pride, identity, and hope for a better future, and another chapter for the man who betrayed the socialist dream.”184

Costas Stefanis – a short political biography Born in 1928 a lower class family, his father a civil servant, Co- stas Stefanis had an impressive career. He studied medicine, special- ized in psychiatry and conducted post-graduate studies at Montreal's McGill University in Quebec, Canada. Back in Athens he became professor of psychiatry during the Colonel’s Regime of 1967-1974,185 built up the Mental Health Research Center at the University of Ath- ens and was propelled into the position of WPA President in 1983.

The election of Stefanis to this position was unexpected, both for Stefanis himself and for his surroundings. According to Stefanis himself he did not want this election and when the candidate of his own preference declined he agreed to be nominated, thereby ending the sense of desperation among the delegates.186 His election was met with approval by the DDR delegation: “[his election] can be seen as a

182 The Greek Socialist Experiment, p. 151. A Concise History of Greece, p. 178 and 185-6 183 The Greek Socialist Experiment, p. viii 184 The Greek Socialist Experiment, p. viii 185 According to Antonis Vgontzas Stefanis’ liberal views were not liked by the authorities. After the end of the junta regime he found documents of the Ministry of Health in which the complaint is voiced that Stefanis was made professor but that with his liberal or ‘progressive’ views he shows ingratitude to the military regime. Unfortunately, Vgontzas added, the documents were discarded during his moving from one house to another. Interview with Antonis Vgontzas, September 3, 2009. 186 Interview Costas Stefanis, July 14, 2009.

108 positive step. (…) In his capacity as chairman of the Ethics Commit- tee he decided that this committee should not deal with complaints or individual cases, but with general principles of ethics in psychiatry. In his report he praised he valuable work of the late American professor Weinberger [sic!] and of professor Vartanyan (Mos- cow).”187 However, the Stasi was less positive: “It is not possible to classify Stefanis exactly professionally and politically, but clearly he is not unwelcome to the Anglo-American lobby.”188

Five years after the end of his WPA term of office he was elected into the Athens Academy, and retired as professor of psychiatry in 1996. In the mean time he became Minister of Health of Greece for the socialist PASOK Party. “The same post was proposed to me in the past (…) and I declined, being more than hesitant to get involved in the political arena. I conceded in 2002 to Simitis government’s pro- posal under special circumstances. My contribution to get out of im- passes was mainly a citizen’s obligation. I do not regret it. Several things were accomplished in less than two years.”189

For many years rumors surrounded Stefanis that he had been long-time friends with the main apologist of Soviet psychiatry, Marat Vartanyan, and allegedly even friends with Evgeni Chazov, the Minis-

187 HAXX 1386/2, pp. 79-80. The American professor referred to was Jack Weinberg (not Weinberger), a former President of the American Psychiatric Association. Inter- estingly, according to Prof. Karl Seidel it was Soviet psychiatrist and Ethics Committee member Marat Vartanyan who in 1978 tried to prevent the WPA from electing Weinberg as Honorary Member. According to Vartanyan Weinberg was a “most reactionary, Zionist representative of the American Psychiatric Association”. See: MfS 13788/83, p. 169 188 HA XX 498, p. 122 189 Letter to the author, July 28, 2009. During an interview Antonis Vgontzas confirms the story: “There were three professors: Andreas Papandreou and Konstantinos (Co- stas) Simitis were professors of economics, and Costas Stefanis was professor psychiatry. The relations between Stefanis and Simitis were much less strong than with Pa- pandreou, and that is why people were very surprised that Stefanis, who always refused to become Minister of Health under Papandreou, agreed when Simitis asked him. Papandreou many times asked him before: ‘please, become Minister of Public Health’, but he always refused. He agreed when Simitis asked, because he saw it as something interesting, a sort of provocation.”

109 ter of Health of the Soviet Union, as well as personal physician of the socialist leader Andreas Papandreou. Antonis Vongtzas, a long time friend of Stefanis, insisted during a meeting with the author that Ste- fanis must be seen as an “independent mind”. “Stefanis was never a member of PASOK, but he is what in the United States you would call a liberal. Here in Greece you call it ‘progressive’. He is a completely independent mind, not belonging to any party, but of course his political allegiance is clear. He was a close friend of Andreas Papan- dreou, for many years. He is also on friendly terms with the son, George Papandreou, and he is still an important figure in the Papan- dreou family, but it is different than the close personal relationship he had with the old Papandreou. And yes, he was sometimes also his personal physician, but that was part of the friendship.”190 That Ste- fanis and Andreas Papandreou were good friends is also apparent from one of Neumann’s travel reports from 1985, in which he mentions a private party at Stefanis’ home. “At this party was also the Prime Minister Papandreou, a friend of Stefanis, who was introduced to [me]. During our meeting Prime Minister Papandreou referred to his talks with Erich Honecker.”191

From all information available it is clear that Costas Stefanis saw it as his main task to turn the WPA again into a truly global organization. As he himself put it during a meeting of the Executive Committee in Rome in October 1984: “the association must be willing to deal with these problems if it were to stay alive and keep the W before the PA.”192 And also in his first address as President of the WPA Costas Stefanis made his position every clear: “It was out of my deep concern for the Association’s future and out of my desire to con- tribute toward a disentanglement from its internal disputes, that I accepted the challenge [of becoming President]. (…) A number of

190 Interview with Antonis Vgontzas, September 3, 2009 191 Sofortbericht, 11-18 October 1985, on the WPA EC meeting in Athens, p. 2 192 Minutes of the WPA EC, October 1984, p. 9

110 societies encompassing thousands of psychiatrists, are no longer part of our association, others are apprehensive about its future and for- tunately only few member societies fail to demonstrate concern. One may well ask how this situation came about. The opinion we are most frequently provided with asserts that it resulted from the intrusion of Cold war political antagonism into the Association’s affairs and this might very well be true. (…) It is both surprising and regrettable that such attempts … succeeded in bringing about a rift in an organization of health professionals, a group least expected to succumb to outside pressures.”193

For Stefanis it was clear that his primary task was to heal the rift in the organization and reunite the societies that left the association in 1983. For him this was a goal that made all other issues were of secondary importance. “In order to accomplish its goals however, it has to be a truly global organization, representing psychiatrists from all countries, from all cultures and from all schools of thought. It has to develop within the framework of its founding principles and to become a meeting place where scientific knowledge is shared. (…) Common sense only is required to apprehend that unless we all join forces in an effort to disentangle the association from the grip of political prejudice and restore its image as a truly scientific and professional organization, all our attempts are doomed to failure.”194 How- ever, with this claim that the organization had become an arena for political conflict and Cold War politics, he inadvertently expressed a view very similar to that of the Soviet All-Union Society and their supporters. This very much angered the opponents of political abuse of psychiatry in the USSR, and was one of the factors that led to their suspicion of “clandestine negotiations” with the Soviets being carried out by Stefanis. However, in light of the political positioning of

193 WPA Newsletter 21, May 1984, p. 3 194 WPA Newsletter 21, May 1984, p. 4

111 Greece during the same period, Stefanis’ position is not strange at all, and very much in line with the policy of his “political friend”, An- dreas Papandreou.

Antonis Vgontzas confirms that Stefanis’ prime objective was to get the Soviets back: “Indeed … he saw that as his primary task. He was totally against the abuse, against any abuse of psychiatry, but it was his conviction that the only way to change them was by bringing them in, to have them under some sort of control. He did this out of his own conviction; it was not an order of Papandreou, or of PASOK, or of any party. You have to understand that Greeks were anti- communist, but at the same time we had good relations with them. There were good relations with Tito, with Zhivkov in Bulgaria, with the Romanians. All disputes could be solved with them, no problem. And also with the Soviet Union we maintained good relations. We tried to be a bridge between East and West. Also the old Karamanlis of Nea Demokratia maintained excellent relations with the communist neighbors.195 So you must also see his relations with the Soviets in that light. He had friendly relations with them, also with the Min- ister of Health as far as I remember, but that was quite normal and fitted into his political thinking, which in turn was very much in line with general Greek political thought.”196

195 See, for instance, The Greek Socialist Experiment, p. 131. Karamanlis was the first Greek prime minister who went on a state visit to Moscow and expanded Greek-Soviet trade relations. He also allowed Soviet vessels to be repaired at the Syros drydock. 196 Interview with Antonis Vgontzas, September 3, 2009

112 VI.F. POLITICAL ABUSE OF PSYCHIATRY – THE TIP OF THE ICEBERG In understanding the complexity of the struggle against the political abuse of psychiatry in the USSR and the positioning of the various sides, it is important to realize that much of the image of So- viet psychiatry that was known in the West was haphazard, incomplete, and in many respects rather crude. In spite of the fact that the dissident movement had been able to provide an overwhelming amount of evidence that political abuse of psychiatry indeed took place and was of a systematic nature, the psychiatric system as such remained to a large degree closed and information that did come out was interpreted within the context of the realities of the Cold War. The ever-increasing ferocity of the debate did not help in creating a balanced picture, as arguments were consciously or unconsciously selected by either side in favor of a Soviet return to the WPA or against. This very much strengthened the image of a black-and-white picture.

During the first years after the collapse of the Soviet system, it became increasingly clear that the political abuse of psychiatry was only the tip of the iceberg. Actually, that information started to come out already earlier, during the years 1987-1988 in articles in the So- viet press, and then also by reports by visitors from outside who had seen more than the usual “Potemkin villages”. However it took a while before the plight of ordinary mental patients in the Soviet Un- ion attracted the interest of the outside world. The report of the US Delegation to the USSR of March 1989 described in hitherto un- known detail the living circumstances in Soviet psychiatric hospitals. Part of the delegation visited as number of psychiatric hospitals in the country, including some of the most notorious ones, the Special psychiatric hospitals of Chernyakhovsk and Kazan. The hospital visit team was allowed almost total access to the hospitals and grounds

113 and was allowed to meet with many patients without the presence of the Soviets. Although these meetings were not psychiatric interviews, they provided relevant information on the type of cases in- terned in those hospitals and the conditions of treatment at each fa- cility. The (confidential) reports on these visits are often heartbreak- ing, because of the fact that the Americans for the first time faced Soviet psychiatry in its true form, not only with regard to political dissidents but also to mental patients in general.

Especially the visits to the Special Psychiatric Hospitals in Ka- zan and Chernyakhovsk left a lasting impression, although also the open attitude of the new director of Chernyakhovsk Special Psychiat- ric Hospital was noted.197 At the same time, the Soviets still tried to conceal the real situation (e.g. just before the delegation’s visit walls had been freshly painted, and quite a few members of the hospital visiting team noted fresh paint marks on their clothes) or influence the interaction between the Americans and their patients. One letter from the Chernyakhovsk hospital was especially noteworthy: “Re- spected delegation, we patients are very pleased and grateful for your visit to us. We ask you come to us more often – your visit makes it easier to live in these prisons. We very much want to tell you the true facts, which our administration in concealing from you. But all the patients are keeping quiet because they fear the consequences from their doctors. Simply for telling the truth they will give us injections after your departure. (…) Thank you again for your visit to us. It was very nice to meet the professor who radiates such compassion. I would like to be treated in America – why not try such an experi-

197 Viktor Fukalov, who had been appointed Director of Chernyakhovsk just a few months prior to the American visit. Almost twenty years later he is repeatedly host to teams of experts of Global Initiative on Psychiatry, who work together with him and his staff on creating a more modern approach to treatment and rehabilitation in his hospital. Fukalov’s openness and humanity is remarkable even for today’s Russian standards.

114 ment? Or at least your professors could come here and get us discharged.”198.

In early 1988, Chief Psychiatrist Aleksandr Churkin claimed in an interview with Corriere della Sera that 5,5 million Soviet citizens were on the register and that 30 percent would be removed from that list within two years.199 However, a year later the journal Ogonek gave a figure of 10,2 million, that it had received from the state statis- tics committee.200 People on the psychiatric register were registered with a dispensary and had some of their civil rights taken away. On top of them, it was hard for them to find a job, housing etc., as a result of which they were outcasts in society. Severe criticism was also voiced in 1979 by Dr. Etely Kazanets in his article in Archives of Gen- eral Psychiatry: “It was exceptional for a diagnosis to be revised in favour of an exogenous diagnosis or vice versa. This resulted in long and unfounded retention of patients on the dispensary list… Keeping these people on dispensary lists for long periods constitutes a real threat to their individual rights. (…) [It] infringes on rights and influences a great many things, such as fitness for military service.”201

The treatment of political prisoners in psychiatric institutions was, in most cases, not different than the treatment that regular persons with mental illness had to endure. They too were injected with massive loads of psychotropic drugs, whereby polypharmy (prescrip- tion of several drugs simultaneously) was not an exception. They too

198 Additional observations on Chernyakhovsk SPH, by Peter Reddaway, p. 141. This fear was not unfounded. The WPA delegation visiting the USSR in 1991 met one of the people who had been examined by the US delegation in 1989, and after the US visit his treatment had been increased: “…case 3, who complained to the US delegation in Ka- zan strict supervision hospital in 1989. The notes reported ‘a change in the patient’s condition’ and the drugs were considerably increased.” Report on the WPA visit in 1991, p. 21. 199 Corriere della Serra, April 5, 1988 200 Ogonek, no. 16, 15-22 April, 1989, p.24 201 Kazanets, E., Differentiating exogenous psychiatric illness from schizophrenia, p. 740-746

115 were subjected to the so-called sulphozine-therapy, during which a mixture of sulphur and peach extract was injected intravenously in order to induce high fever and coma in order to “burn out the poison of mental illness.” Insulin was also used for this purpose. During the crisis years at the beginning of the 1990s in Ukraine, dozens of people died as a result of diabetes because of the lack of insulin, while, at the same time, it was still being used in psychiatry. Only in 1995, sulphozine was banned as a psychiatric medication.202

In general, Soviet psychiatry proved to be a perfect example of a highly institutional, biologically oriented psychiatry, in which persons with chronic mental illness, persons with intellectual disability as well as social outcasts were locked away in institutions usually placed outside urban areas. In a way, they became the new lepers of the twentieth century, a repetition of the leper houses of the Middle Ages that later were used for other purposes. As Michel Foucault wrote in Madness & Civilization, “what doubtless remained longer than leprosy, and would persist when the lazar houses had been empty for years, were the values and images attached to the figure of the leper as well as the meaning of his exclusion, the social importance of that insistent and fearful figure which was not driven off without first being inscribed within a sacred circle. (…) Leprosy dis- appeared, the leper vanished, or almost, from memory; these structures remained. Often, in the same places, the formulas of exclusion would be repeated, strangely similar two or three centuries later.”203 Soviet psychiatry very much repeated that model, ridding society from all the unproductive elements and isolating them for life from the rest of society.

202 For quite a few years, psychiatrists in Ukraine still tried to convince me that it was a very effective treatment. 203 Foucault, Michel: Madness and Civilization, pp. 6-7

116 When reading Foucault, one cannot avoid seeing certain simi- larities. While in the Soviet Union approximately 3,5 percent of the population was maintained on the psychiatric register and hundreds of thousands of persons were (and continue to be) held in so-called internaty, usually euphemistically called social-care homes (although “care” is often exactly what was and is missing), in the seventeenth century in Paris one percent of the population was locked up in places of confinement, such as the Hôpital Général, which was set up in 1656 by royal edict.204 In some respects, the practical purpose of these institutions was quite similar. The Hôpital Général was a “sort of semi-judicial structure, an administrative entity which, along with the already constituted powers, and outside of the courts, decides, judges, and executes.”205 In the case of the (post-) Soviet social care homes, of course all activities were undertaken on basis of Ministe- rial instructions and national legislation, yet in practice the situation was reminiscent of the situation in 1656: “the directors having for these purposes stakes, irons, prisons, and dungeons … appertaining so much as they deem necessary, no appeal will be accepted from the regulations they establish within the said hospital; and as for regulations as intervene from without, they will be executed according to their form and tenor, notwithstanding opposition or whatsoever appeal made or to be made, and without prejudice to these…”206 And although many people were locked up because the State wanted them off the streets, others were also locked away because “the honor of families and that of religion sufficed to recommend a subject for a house of confinement.”207 Foucault quotes in his book the French statesman Guillaume-Chrétien de Lamoignon de Malesherbes, who

204 Foucault, Michel: Madness & Civilization, p. 40. According to Foucault, “one tenth of all the arrests made in Paris for the Hôpital Général concern ‘the insane,’ ‘de- mented’ men, individuals of ‘wandering mind’ and ‘persons who have become completely mad’.” See: Foucault, Michel: Madness a& Civilization, p. 65 205 Foucault, Michel: Madness and Civilization, p. 40 206 Edict of 1656, as quoted in Foucault, Michel: Madness and Civilization, p. 40 207 Foucault, Michel: Madness & Civilization, p. 67

117 in the eighteenth century wrote that “it seems that the honor of family requires the disappearance from society of the individual who by vile and abject habits shames his relatives.”208 Equally, in the Soviet Union the stigma of mental illness or mental disability became such that often patients were kept indoors all the time, out of sight, and that having a person with mental illness or intellectual disability in the family was seen as a shame that should be kept hidden at all cost.

In France at the turn of the nineteenth century it was Philippe Pinel who brought about a fundamental change in the perception of mental illness when he concluded in his Traité de la Manie that insanity was curable. Although initially it was claimed at two-thirds and even nine out of ten could be cured, reports by Pinel from the period 1805 to 1813 show a success rate of fifty percent, “nothing like the nine-tenths projected by the Conseil des Hospices, but … also a far cry from demonstrating the uselessness of therapy.”209 The fundamental element in this change was Pinel’s belief that an acute illness manifests a spontaneous dynamism inclining it towards a cure, and that it tends to pass through “successive periods of graduated development, stationary state, decline and convalescence.”210 The consequence of this was, according to Pinel, that a patient had to be kept in a therapeutic environment, because it was impossible to pre- dict when the illness would end, and recovery could never be completely ruled out.211

This position was maybe on paper shared by the Soviet authorities, however in practice it differed quite fundamentally from the daily reality for hundreds of thousands of people in social care homes

208 Foucault, Michel: Madness & Civilization, p. 67 209 Gauchet, Marcel and Swain, Gladys: Madness and Democracy, p. 35 210 Pinel quoted in Gauchet, Marcel and Swain, Gladys: Madness and Democracy, p. 41 211 However, Pinel himself maintained a period of two years before “pronouncing his verdict (…) After that period, there is no more room for hope…” See: Gauchet, Marcel and Swain, Gladys: Madness and Democracy, p. 42

118 who had no hope of ever coming out and who lived under conditions that also Soviet authorities themselves considered to be unacceptable. As early as 1971 Soviet Minister of Health Boris Petrovsky212 reported to the Central Committee that the living conditions in the Special Psychiatric Hospitals did not meet the standards necessary for adequate treatment of the mentally ill.213 Petrovsky’s criticism stood not alone. Three years earlier, decree 517 of the Central Com- mittee and the Council of Ministers of July 5, 1968, “On measures to further improve health care and the development of medical science in the country”, outlined that 125 psychiatric hospitals with at least 500 beds should be built before 1975, and indeed the Five Year Plan of 1971-1975 included the construction of 114 psychiatric hospitals with a total capacity of 43,800 beds.214 However, the situation continued to be unsatisfactory. In 1971 the Ministry of Health together with the Ministry of Internal Affairs (MVD) and the KGB, sent a plan to the Council of Ministers for the further improvement of medical assistance to persons with mental illness.215 A few weeks later, the commission received a highly critical four-page report by the De- partment of Science and Education of the Central Committee, addressed to the Central Committee, which provided much detail about the prevailing situation. The report mentioned that already for several years special attention had been paid to the mental health care services in the country, but that the Central Committee was still re-

212 Boris Vasilievich Petrovsky was a general surgeon who made several major contributions to cardiovascular surgery, transplant surgery, and oesophageal surgery. He organized and headed the All-Union Research Institute for Clinical and Experimental Surgery. After his retirement in 1989 he remained the director emeritus of the institute and died in its intensive care unit. For more than 15 years (1965-80) Petrovsky was minister of health in the former Soviet Union. 213 Report by B. Petrovsky to the Head of the Department of Science and Education of the Central Committee of the CPSU, March 25, 1971. 214 On the situation of psychiatric help in the country, p. 3 215 Excerpt from the minutes No. 31, paragraph 19c of the session of the Central Com- mittee of the CPSU of February 22, 1972. Among the members of the commission is a comrade Tsvigun, probably referring to Semyon Kuzmich Tsvigun, Deputy Chairman of the KGB 1967-1982 and husband of Leonid Brezhnev’s sister in law.

119 ceiving “complaints from the population with regard to serious shortcomings in the mental health care services in the country” and that “the state of psychiatric help continues to be unsatisfactory. Ac- cording to the report, the number of people in need of psychiatric help had grown enormously: while in 1966 just over two million citizens were on the psychiatric register, the number had grown by 1971 to 3,7 million.216 In many of the hospitals, the report continued, patients had only 2-2,5 square meters at their disposal, although the norm was 7 square meters. “Cases in which patients are sleeping in pairs in one bed and even on the floor are not rare. In several hospitals double bunk beds have been made.”217 The report continued: “As a result of overcrowding of hospitals sanitary-hygienic norms are being violated, unacceptable conditions are created for living, diag- nosing and treatment of mentally ill persons as well as for the work of the personnel. Not seldom patients are discharged prema- turely.”218 In the Russian Soviet Republic the number of available beds in social care homes were less than half of what was needed.219

216 In 1988 the number of persons on the psychiatric register had grown to 10,2 million. See: Ogonek (no. 16, 15-22 April, 1989, p.24) According to the authors of the book Psychiatry, psychiatrists and society during the 1960s-1980s the total number of registered mental patients in the USSR increased by tenfold. The growth concerned in particular the lighter form of mental illness, because it was not because more and more people fell ill but because more and more people turned for psychiatric help. New mediation appeared, treatment by doctors became more and more effective, and people for whom before it didn’t make any sense to go to the dispensary now went as well.(…) However, the instructions did not take these changes into account. The number of social sanctions (and they increased in number) concerned, like before, every- body who was on the psychiatric register…and could exclude the possibility of being involved in various forms of professional life, driving a car, go to a sanatorium, buy a hunting rifle, go abroad on a business trip or as a tourist, etc.” Psychiatry, psychiatrists and society, pp. 39-40 217 On the situation of psychiatric help in the country, Report to the Central Commit- tee, February 18, 1972, signed by the Head of the Department for Science and education S. Trapeznikov, p. 1 218 On the situation of psychiatric help in the country, p. 1. 219 At the end of the 1980s – beginning of the 1990s the USSR had 284 psycho- neurological out-patient clinics, in 1983 of which there were beds, and 491 psychiatric hospitals. The total number of bed in the USSR was 380,604. On top of that the Minis- try of Social Affairs had 261,000 beds at its disposal. See: Psychiatry, psychiatrists and society, p. 29

120 In spite of all the efforts, the living conditions in mental institutions remained unsatisfactory. Several years later, in October 1976, Deputy Minister of Health of the USSR S. Burenkov sent an outline to the Central Committee of the package of plans to “expose the mendacity and incompetence of bourgeois propagandists, who try to use the misfortune of mentally ill people for purposes of political specula- tion.” 220

Of course, Pinel, who is often seen as the man who freed the mentally ill from their chains, himself adapted his position to time and circumstances, and later versions of his Traité much more focus on the management of the institution and in later editions of his work “is subordinating the therapeutic perspective to the perspective of institutional management.”221 It is the birth of the asylum model, one could say, the moment when the belief is firmly established that the institution as such is able to perform all necessary therapeutic interventions, the moment when “treating insanity consisted first and foremost of governing a population of insane individuals.”222 It is the model that until this very day dominates the institutions for the chronically mentally ill on the territory of the former Soviet Union, and virtually all of psychiatric services in Russia. This highly, or almost exclusively institutionalized care, leads almost invariably to human rights violations, and human right monitoring reports of the early years of the twenty-first century show that many of such violations continue to take place in the former USSR. For instance, a monitoring report by the Latvian Center for Human Rights, Mental Disability Advocacy Center and Global Initiative on Psychia- try of 2003 showed many shortcomings and human rights viola-

220 On measures to counter the anti-Soviet campaign in the West concerning “the use of psychiatry in the USSR for political purposes”, report to the Central Committee by the Ministry of Health, October 22, 1976, p. 4 221 Gauchet, Marcel and Swain, Gladys: Madness and Democracy, pp. 44-45 222 Gauchet, Marcel and Swain, Gladys: Madness and Democracy, p. 45

121 tions.223 With regard to Lithuania, the report established that the right to information was regularly violated and that the quantity of information received by residents of social care homes often depended on the goodwill of individual staff members and their knowledge about human rights of the residents. Also, the residents’ right to the respect of private life was being violated: their entire lives were constantly watched by the personnel and other residents and they rarely had an opportunity to be alone. It goes without saying that also their right to make and maintain intimate relations was being violated. In psychiatric hospitals the right of patients to have privacy was equally maximally limited and virtually absent in acute wards. Also, patients were subjected to discrimination. Obedient residents of social care homes, actively co-operating with staff members, were encouraged and given privileges inaccessible to other residents. Ex- tremely severe residents were most often exposed to discrimination and placed in the poorest wards. Finally, torture and inhumane behavior was established in various instances. Most frequent forms of improper treatment were neglect, too infrequent freedom of movement, psychological, physical, sexual violence against the patients, and staff decision making on behalf of the patients on the issues of their personal life. One of the most brutal violations of human rights in asylums was considered to be forced abortion, which was used repeatedly.

In psychiatric hospitals the situation was sometimes not much better. Most psychiatric hospitals did not have a standardized proce- dure for imposition of physical exclusion, physical or chemical restrictions as well as a mechanism for revocation of the mentioned measures. On the other hand, in hospitals where the mentioned pro-

223 Human Rights in Mental Health Care in Baltic Countries, Latvian Cen- ter for Human Rights, 2003. Monitoring reports of later date also list considerable numbers of human rights violations, see http://www.old.gip- vilnius.lt/leidiniai/human_rights_monitoring_report.pdf, http://www.old.gip-vilnius.lt/leidiniai/human_rights_en.pdf

122 cedures were officially regulated, a number of shortages in implementation were detected: requirements for filling in the protocols of restraints were violated; patients were fixated for periods exceeding two hours, personnel didn’t take care of the patients during fixation, patients were left unattended for several hours and no contact was kept with the patients during the fixation, and measures with chemical effect were always applied in parallel to fixation. In addition, fixation was found to be used as a penalty.

Of particular concern was the fact that in most cases the director of the institution remained legal guardian over his patients, thereby exercising virtually total control over their lives and posses- sions.224

224 Guardianship is a legal framework within which decisions are made on behalf of an adult with “mental disability” who lacks “competency” in an area of their life. Proce- durally, if an adult is thought to lack competence to manage his/her own affairs, a court may declare that the adult is incapable in law. The adult’s legal rights can be transferred to another person (the guardian). The guardian has the power in most countries to make decisions regarding the adult’s finances, residence and medical treatment. The right to vote, to marry and to enter into contracts may all be restricted by the placement under guardianship.

123 VII. CONCLUSIONS 1. The issue of Soviet political abuse of psychiatry had a lasting impact on world psychiatry. From 1971 until 1989, the issue of Soviet psychiatric abuse dominated the agenda of the World Psychiatric Association (WPA), and led to a deep rift between Western and East- ern Bloc psychiatrists and many angry exchanges. The Soviet All- Union Society of Neuropathologists and Psychiatrists was forced to withdraw from the WPA in 1983 and only returned in 1989 when most of the abusive practices had been halted after an intervention by reform-minded Soviet leaders, among them notably Soviet For- eign Minister Eduard Shevardnadze.225 The most positive outcome of the conflict is, that the issue triggered the discussions on medical ethics and the professional responsibilities of physicians (including psychiatrists), resulting in the Declaration of Hawaii and subsequent updated versions. Also many national psychiatric associations adopted such codes, even though adherence was often merely a for- mality and sanctions for violating the code remained absent.

2. The deep conflict within the WPA during the years 1983-1989 made absolutely clear that psychiatry could easily be turned into an arena for political strife. In their attempts to keep politics out of psychiatry, the WPA leadership actually obtained the opposite: it opened the door to carefully orchestrated interventions by the political leadership in Moscow, supported by active involvement of the secret agencies Stasi and KGB. At the same time, the goal of the opponents of political abuse of psychiatry to take politics out of psychiatry was equally unsuccessful. Their work was, whether they wanted or not, an

225 For detailed information on the struggle against the political abuse of psychiatry and the WPA, as well as on how the abuse eventually came to an end, see Van Voren, Robert: Human Factors, Secret Actors – Cold War Psychiatry in the 1980s, to be published in 2010 by Rodopi, Amsterdam/New York.

124 element in the Cold War between East and West, and also in their case “higher forces” undoubtedly had their influence.226

3. The Cold War had a strong adverse effect on inter-personal relations and trust in the good intentions of persons on the other side of the “barricade”. This issue counts for both sides, those who supported a return of the AUSNP to the WPA and those who strongly opposed it. What seemed to be an issue of black and white turned out to be an issue with many shades of grey, whereby (Communist) “red” turned out to be less red and (anti-Communist) “white” turned out to be less white. Belief in moral values and principles was not an exclusive domain for either side, and on both sides one could find persons with strong convictions, as well as persons who used the situation for their own personal gain. In that respect, the result of this dissertation is in a way a repetition of the outcome of Why did we shoot at each other? by the German writer Heinrich Böll and the Soviet Germanist Lev Kopelev, in which both men discussed their role during the Sec- ond World War when they were fighting on either side of the front, but in the 1970s became friends, engaged in the struggle for human rights in the Soviet Union.227

4. The WPA leadership said they tried to keep politics out of psychiatry, yet the result of their actions and their quite intense communications with the Moscow psychiatric leadership was exactly the opposite: it opened the door to carefully orchestrated interventions by the political leadership in Moscow, supported by active involvement of the secret agencies Stasi and KGB. It is not unthinkable that other secret agencies were also having their share in this game. At the same time, the goal of the opponents of political abuse of psy-

226 Research shows that both the WPA and the International Association on the Politi- cal Use of Psychiatry were infiltrated by the Stasi. A detailed account is provided in Van Voren, Robert: Human Factors, Secret Actors – Cold War Psychiatry in the 1980s 227 Böll, H., and Kopelew, L.: Warum haben wir aufeinander geschossen? Lamuv Ver- lag, 1981

125 chiatry to take politics out of psychiatry was equally unsuccessful. Their work was, whether they wanted or not, an element in the Cold War between East and West, and also in their case “higher forces” undoubtedly had their influence.228

5. Although Jochen Neumann diligently fulfilled his role as In- offizieller Mitarbeiter of the Stasi and constantly informed both the political leadership of the DDR and the psychiatric leadership in Moscow of everything that was happening within the WPA Executive Committee, one can wonder in the end to what extent he was really an asset to them and to what extent a liability. All the available information indicates that Jochen Neumann was an unusually principled and moral person, who indeed worked for the Stasi out of conviction yet never crossed the line he set himself and until the end refused to spy on other people. For this positioning he paid a very high price.

6. The way Germany incorporated East Germany in its socio- political and economic system is generally praised, undoubtedly for good reasons, but also has evident flaws. One of them is the way in which former Inoffizieller Mitarbeiter are excluded from viewing their own files, although at the same time these files to a large degree determine their future professional careers and thus also their personal lives. Undoubtedly, among the Inoffizieller Mitarbeiter are those who willingly spied on their fellow citizens, yet there are also many who either never fully realized what they were involved in, or were coerced to work for the Stasi, or saw their collaboration as a fully legitimate way to defend the system they believed in, without becoming a participant in the all-encompassing culture of spying.

228 For instance, from the book by Sonja Süss it becomes clear that the main actor against the political abuse of psychiatry in the USSR, the International Association on the Political Use of Psychiatry, was unknowingly infiltrated by the Stasi. The available reports run until 1983; the files of a later date seem to have been destroyed when East- ern German totalitarian rule disintegrated.

126 Also in this case sophistication is needed, and for instance in the case of one of the main actors of this dissertation this treatment seems to be highly unjust and inconsiderate.

7. With the fall of communism in Eastern Europe in the late 1980s, most of the regular practice of using psychiatry to suppress political opponents ceased to exist. Some cases surfaced in Central Asia, notably in Turkmenistan and Uzbekistan. Also in Russia individual cases of political abuse of psychiatry continue to take place. The ranks of the victims over the last years have included women divorcing powerful husbands, people locked in business disputes and citizens who have become a nuisance by filing numerous legal challenges against local politicians and judges or lodging appeals against government agencies to uphold their rights. However, there appears to be no systematic governmental repression of dissidents through the mental health system. Instead, citizens today fall victim to regional authorities in localized disputes, or to private antagonists who have the means, as so many in Russia do, to bribe their way through the courts.

8. Most of the attempts to reform mental health care in Eastern Europe and the former Soviet Union during the years 1991-2009 seem to have failed or have not provided the results many of the mental health reformers hoped for. In particular in Russia the pros- pects for amelioration seem to be pretty bleak. In addition, many of the current leaders of Russian psychiatry, many of whom already be- longed to the establishment in Soviet times, have revoked the earlier confession read at the 1989 WPA General Assembly that psychiatry in the Soviet Union had been abused systematically for political purposes. They now preferred to refer to “individual cases of “hyper- diagnosis” or “academic differences of opinion”.229 This history, which to a large degree falls outside the scope of this dissertation,

229 Dmitrieva, D., Alyans Prava i Miloserdiya, Moscow, Nauka, 2001, pp. 116-130

127 calls for additional extensive research, as many of the related documents are still available (although mostly unorganized in personal files or archives of organizations) and many of the actors are still alive – and thus accessible for interviewing.

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Donskis, Leonidas: Troubled Identity and the Modern World, New York, 2009

Figes, Orlando: The Whisperers: Private Life in Stalin’s Russia, London, 2008

Fireside, Harvey, Soviet Psychoprisons, New York, 1982

Foucault, Michel: Madness and Civilization. New York, 1965

Gauchet, Marcel, and Swain, Gladys: Madness and Democracy. Princeton, 1999

Gieseke, Jens: Der Mielke Konzern, München, 2001

Glinski, Dmitri, and Reddaway, Peter: The Tragedy of Russia’s Reforms. Washington D.C., 2001

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Kerz-Rühling, Ingrid, and Plänkers, Thomas, Verräter oder Verführte, Berlin, 2004

130 Koppers, André, A Biographical Dictionary on the Political Abuse of Psychiatry in the USSR, Amsterdam, 1990

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Zizek, Slavoj: In Defense of Lost Causes, London, 2008

132 IX. MAJOR WORKS PUBLISHED BY THE AUTHOR ON THE SUBJECT books

Van Voren, R.: (1983) Political Psychiatry, IAPUP (Dutch, Eng- lish), samizdat (Polish)

Van Voren, R. (ed.) (1987) Koryagin: A Man Struggling for Human Dignity, IAPUP, Amsterdam

Van Voren, R.(ed.) (1989) Soviet Psychiatric Abuse in the Gor- bachev Era, IAPUP, Amsterdam

Van Voren, R. (2009) On Dissidents and Madness, Rodopi, Am- sterdam/New York

Selected contributions to books:

 Snezjinevskiisme, sovjetpsychiatrie en glasnost (Snezhnevskiism, Soviet psychiatry and glasnost); in: Van Goedoever, P. and Naarden, B.: Gorbatsjov en Stalin’s erfenis, H&S Publishers, 1989

 Mental health policy in former Eastern Bloc countries; with Toma Tomov, Danius Puras and Rob Keukens; in: Knapp, M., et.al.: Mental health policy and practice across Europe, Mc Graw/Hill, New York, 2007

 De ontwikkeling van de geestelijke gezondheidszorg in Oosteuropa en de voormalige Sovjetunie (Mental health in Eastern Europe and the former USSR), with Rob Keukens; in: Oosterbaan, D. et.al: Psychiatrie over de Grens, Free Musketeers, Zoetermeer (NL), 2008

 Most probably the best professor of forensic psychiatry; in: Liber Amoricum Prof. Dr. Dick Raes, Wolf Legal Publishers, 2009

133  Abuse of psychiatry for political purposes in the USSR: a case-study and personal account of the efforts to bring them to an end, in Helmchen, H. and Sartorius, N. (eds): Ethics in Psychiatry – European contributions, Springer, 2010

 Political abuse of psychiatry, in Dudley, M.(ed), Oxford Textbook on Mental Health and Human Rights, Oxford University Press, to be published in 2010

Articles

 Sovjetpsychiatrie: einde aan politiek misbruik? (Soviet psychiatry: an end to political abuse?); in Internationale Spectator, April 1988

 Nieuwe psychiatrische verenigingen in de voormalige USSR (New psychiatric associations in the former USSR); in: Maandblad Geestelijke Volksgezondheid, September 1992

 Ukrainian psychiatry: back to basics; in: RFE/RL Research Report, volume 2, number 3, 15 January 1993

 Hervormingen in de Oekraïnse psychiatrie: een zeldzaam lichtpuntje (Reforms in Ukrainian psychiatry: a rare fearure); in: Maandblad Geestelijke volksgezondheid, February 1995

 Comparing Soviet and Chinese Political Psychiatry; in: The Journal of the American Academy of Psychiatry and the Law, volume 30, number 1, 2002

 Vilnius en St Petersburg: een wereld van verschil (Vilnius and St. Petersburg, a world of difference); in Maandblad Geestelijke Volksgezondheid, July-August 2002 Van Voren, R. (2002)

134  The WPA World Congress in Yokohama and the issue of political abuse of psychiatry in China; in Psychiatric Bulletin, Royal College of Psychiatrists, December 2002

 Westerse psychiatrische literatuur in Oost-Europa (Western psychiatric literature in Eastern Europe); in: Nederlands Tijdschtrift voor Geneeskunde (Dutch Medical Journal), volume 15, issue 3, 21 January 2006

 Reforming forensic psychiatry and prison mental health in the former Soviet Union; in: Psychiatric Bulletin, Vol. 30, No. 4, April 2006

 Istorija kartojasi; taip pat ir politineje psichiatrijoje; in: Istorijos, Spalis 2007

 Opnieuw politiek misbruik van de psychiatrie in Rusland? (Again political abuse of psychiatry in Russia?); in: Maandblad Geestelijke Volksgezondheid, February 2008

 Politiek misbruik van de psychiatrie in de Volksrepubliek China (Political Abuse of psychiatry in the People’s Republic of China); in: Maandblad Geestelijke Volksgezondheid, April 2008

 Geestelijke gezondheidszorg in Oosteuropa en de voormalige Sovjetunie (Mental health in Eastern Europe and the former USSR), with Rob Keukens; in: Elsa, volume 9, issue 1, February 2009

 Political abuse of psychiatry – a historical overview; in: Schizophrenia Bulletin, November 2009

135