ANALYSIS AND COMMENTARY Comparing Soviet and Chinese Political Psychiatry Drs. Robert van Voren J Am Acad Psychiatry Law 30:131–5, 2002 The international campaign against the political However, Pandora’s box had been opened. Dur- abuse of psychiatry in the Soviet Union spanned a ing the six years between the congress in Mexico and period of 20 years. It started roughly in the beginning the next one in Honolulu, increasing numbers of of the 1970s when the Moscow-based dissident documented cases reached the West, and protests Vladimir Bukovsky sent the first documentation to began to mount. The first committee against the po- the World Psychiatric Association (WPA) and ended litical abuse of psychiatry was founded in 1974 in in 1991 when the same WPA sent a mission to the Geneva, lending the Geneva Initiative on Psychiatry Soviet Union to investigate whether the political its current name. Psychiatric associations became ac- abuse of psychiatry had indeed come to an end and tive, in particular the British Royal College of Psy- democratization had also reached Soviet psychiatry. chiatrists (RCP) and the American Psychiatric Asso- In the meantime, the attitude of world psychiatry ciation (APA), and when the next World Congress toward the problem changed almost 180 degrees, convened in Honolulu in 1977, it was inevitable that and bodies such as the WPA were triggered into the issue would be on the agenda. This congress led adopting codes of ethics and setting up investigative to the first official international condemnation of the bodies that would assure that the newly adopted abuses and approved the Declaration of Hawaii,1 a codes of conduct would be adhered to and that vio- document that outlined the standards of ethics for lators would be sanctioned. psychiatrists worldwide. Soviet psychiatric abuse be- gan to have an impact beyond the issue itself. Soviet Psychiatric Abuse and the World After Honolulu, pressure on the Soviets continued Psychiatric Community to mount. More groups were formed, resulting in December 1980 in the founding of what would later When in 1971 Vladimir Bukovsky sent the first become the Geneva Initiative on Psychiatry. The set of documentation of prominent Soviet cases to campaign was directed at two main goals: to embar- the WPA with the request to review them and discuss rass the Soviet authorities to such an extent that they the matter at the forthcoming World Congress of the would decide that it would be more profitable to end WPA in Mexico, his request fell on deaf ears. The Soviets threatened to walk out of the WPA, and the the abuses and send political prisoners only to labor notion that this would hurt the WPA instead of the camps, and to mobilize world psychiatry to take a Soviets themselves was so strong that the delegates in stand against these abuses in general and to take mea- Mexico succumbed to Soviet pressure. The situation sures to prevent such abuses from occurring else- was not discussed, and Bukovsky was subsequently where. The latter goal was quite difficult to attain, sentenced to 7 years in labor camp and 5 years in because many psychiatrists believed that the issue was exile. political rather than one of ethics. Slowly but surely, however, the notion was accepted that the campaign Drs. van Voren is General Secretary of the Geneva Initiative on Psy- against the abuse was targeted at taking politics out of chiatry, Hilversum, The Netherlands. Address correspondence to: psychiatry rather than allowing it to enter. This cam- Drs. Robert van Voren, General Secretary, Geneva Initiative on Psy- chiatry, P.O. Box 1282, 1200 BG Hilversum, The Netherlands. paign of embarrassment worked quite well on the E-mail: [email protected] Soviet authorities. Hospitalized persons were in- Volume 30, Number 1, 2002 131 Comparison of Soviet and Chinese Political Psychiatry creasingly less-prominent political prisoners, and as nated these abuses. Today, with the question of po- soon as international campaigns developed, they litical abuse of psychiatry in China on the agenda, were either released or moved to “normal” places of there is no discussion of whether it is a matter for the detention. In 1982, when it became clear that expul- WPA to address. To the contrary, the WPA has taken sion by the General Assembly was certain, the Soviets a very active role in this campaign and discussions angrily left the WPA, and a year later, a resolution with organizations such as the Geneva Initiative con- was adopted at the World Congress in Vienna that centrate on questions of tactics, not of content. put conditions on their return. For six years, the Soviet authorities tried to find a Soviet Political Abuse: A Personal View compromise between campaigning for a return to the from the Inside WP—showing that they indeed considered their Several years ago, at a seminar our foundation or- forced departure to be a loss of face—and continuing ganized for mental health professionals from the the abuses in a less conspicuous manner. Document- former Soviet Union, I had a long discussion with a ing the abuses became increasingly difficult because former Soviet and now Ukrainian psychiatrist about of the crackdown on the dissident movement, but the question of political abuse of psychiatry. Coinci- after Mikhail Gorbachev assumed power and started dentally, this woman had studied psychiatry in the his campaign of glasnost, Soviet newspapers increas- same class as Semyon Gluzman, a young Kiev doctor ingly started to discuss the matter openly. Cornered who later became well known for his opposition to by their own Soviet press, by evidence from victims the political abuse of psychiatry in the Soviet Union. of political abuse released as part of the policy of Shortly after graduating, he wrote a report in absentia perestroika, and by a damaging report by the U.S. on a dissident Soviet general, Pyotr Grigorenko, con- State Department mission to the Soviet Union that cluding that the latter had been interned for purely investigated the political abuse of psychiatry, the So- political reasons. It cost Gluzman 10 years of his life, viets sent a delegation to the World Congress in Ath- spent in a labor camp and in exile. ens in 1989 and agreed to acknowledge that, indeed, My interlocutor chose another path in life. She systematic abuse of psychiatry for political purposes joined the Communist Party and eventually became had taken place. As a condition for their return to the head of the regional party committee in the district, WPA, they promised to discontinue these abuses, where she headed a division of a psychiatric hospital. rehabilitate the victims, and democratize the Soviet She was a faithful party member and a good Soviet psychiatric society. The latter proved to be an unnec- psychiatrist. In 1985, she became very upset when essary promise. The Soviet regime soon fell, and new she received the first documents from the most recent national psychiatric associations sprang up across the Party Plenum. Mikhail Gorbachev had been elected country. When a WPA delegation visited the Soviet General Secretary of the Communist Party, and his Union in 1991, they met newly founded associations ideas about perestroika and glasnost were already fil- in Lithuania and Ukraine, set up by psychiatrists who tering through in these first documents. She could became key reformers in the years that followed. not sleep that night, and became increasingly worried The campaign against the political abuses had put during subsequent months as more instructions from the matters of human rights and medical ethics high Moscow appeared on her desk. They were unusual, on the agenda, and these formed the cornerstones of and what was worse, they confirmed her fears of that the work of mental health reformers in the former very first night: The author, Mikhail Sergeyevich Soviet republics during the years that followed. Gorbachev, was not normal. Actually, he was ill, These issues also continued to have an international clearly suffering from what was widely known in So- impact. In 1996, the WPA adopted the Madrid Dec- viet psychiatry as “sluggish schizophrenia.” And in- laration2 at its World Congress in the Spanish capi- deed, Gorbachev had all the symptoms: struggle for tal, further deepening and fine-tuning the Declara- the truth, perseverance, reformist ideas, and willing- tion of Hawaii adopted 19 years earlier. When ness to go against the grain. My interlocutor contin- reports of new abuses in Turkmenistan reached the ued to believe in her diagnosis until the Soviet Union West during the Madrid congress, one letter of pro- collapsed and the windows to the world were opened test from an international group including delegates wide. Only then did she realize that her concept of from the former Soviet Union immediately termi- mental illness, shared by virtually all the approxi- 132 The Journal of the American Academy of Psychiatry and the Law van Voren mately 45,000 Soviet psychiatrists, was what was ab- ance, was “not normal” and thereby almost inher- normal and that Gorbachev had been normal all ently was “antisocial” and “antisocialist.” When along. combined with the theories of “sluggish schizophre- During the past decade, I have had many such nia,” this training made it very easy to convince rank- discussions in many former Soviet republics. To me, and-file psychiatrists, who had only a Soviet educa- these discussions—frank, deep, and without impos- tion and no access to world psychiatry, that any ing any blame or guilt—were a unique opportunity person who went against the Communist Party and to analyze what I had learned to see as something was willing to risk the happiness of both his family purposely evil.