A Profession Under Stress

By John Langone

Soviet doctors called it psychiatry, but sometimes it seemed decidedly unscientific. For decades, sane Soviet citizens were branded as lunatics because they defied the government. They were hospitalized for years under prison-like conditions and put on powerful drugs that turned them into zombies. Particularly unruly patients were sometimes wrapped in wet canvas and nearly suffocated. As word of such abuses spread outside the Soviet Union, the country's psychiatrists became outcasts in the international medical community.

Now the Soviets have mounted a concerted campaign to regain respectability. While never admitting that Soviet doctors had ever been instruments of political oppression, the Kremlin has released scores of dissidents from mental wards and reformed laws that govern the rights of psychiatric patients. The Soviets have also permitted Western psychiatrists to come to the U.S.S.R. and see for themselves whether mental patients are being mistreated. Those efforts seem to be bearing fruit: last week, the executive committee of the World Psychiatric Association voted to readmit the Soviets, who had withdrawn $ from the organization in 1983 under threat of expulsion. If that decision is approved at a meeting of the W.P.A.'s full membership in Athens next October, Soviet psychiatry will have scored a substantial victory.

Last month a team of 26 U.S. mental-health experts made an unprecedented two-week tour of Soviet psychiatric facilities. Armed with a list compiled by human rights activists of present or former mental patients believed to have been hospitalized unjustly, the delegation interviewed 27 people. The American group, which included psychiatrists, attorneys and a psychologist, has agreed not to discuss its findings publicly until the official report on the trip is issued later this year. At a press conference, the only revealing comment from Dr. Loren Roth, the University of Pittsburgh psychiatrist who led the group, was that the two weeks had been "stressful and difficult for both sides." Nevertheless, there were indications that at least a few Soviet mental patients could still be considered victims of psychiatric abuse.

Soviet psychiatry began to take shape in the 1920s and drew especially on the work of physiologist Ivan Pavlov (whose experiments on conditioning, particularly with dogs, gave the term Pavlovian response to the English language). His followers largely rejected the work of Sigmund Freud and other Western theorists and looked for physical rather than psychological causes of mental problems. That emphasis led Soviet psychiatrists to rely on drug treatment, work therapy and re-education rather than psychotherapy.

The practice of classifying dissidents as disturbed was facilitated by the work of Dr. Andrei Snezhnevsky, who was director of the Institute of Psychiatry of the U.S.S.R. Academy of Medical Sciences and who dominated Soviet psychiatry from the early 1950s until his death two years ago. Snezhnevsky considerably broadened the definition of schizophrenia by adding the category "sluggish schizophrenia." He defined the disorder as a slow- developing illness without the hallucinations that are a classic element in the Western definition of many schizophrenias. Instead, the "symptoms" could be nearly all forms of behavior -- unsociability, mild pessimism, stubbornness -- that deviated from the social or political ideal.

Hard evidence of Soviet psychiatric abuses first reached the West in the 1970s, and international outrage began to build. At the W.P.A. meeting in 1977, the delegates voted to condemn Soviet practices, and pressure mounted to expel the country's psychiatrists from the organization. Just before the 1983 W.P.A. meeting, the Soviets withdrew from the association.

Eager to rejoin the international psychiatric establishment, the Soviets have spared little effort to show their good faith. In the past two years, the government has released more than 100 dissidents from hospitals and carried out several legal and procedural reforms. The new regulations provide that mental patients or their relatives can appeal an involuntary hospitalization in court. Moreover, control of special psychiatric hospitals for the criminally insane has been shifted from the Ministry of Internal Affairs, which oversees the police, to the Ministry of Health. And in a break with the Soviets' monolithic tradition, a few articles discussing psychoanalysis have started to appear in periodicals.

Despite all the ferment, there is some reason to question whether fundamental change has taken place. The psychiatric leadership is still old line. The All-Union Scientific Center for Mental Health is headed by Dr. Marat Vartanyan, a longtime protege of Snezhnevsky's. And Moscow's Serbsky Institute of Forensic Psychiatry, which has been responsible for many of the forced hospitalizations, remains under the command of Dr. Georgi Morozov, as it has for decades. Critics doubt there can be any real reform until those two leaders and others trained by Snezhnevsky are replaced.

Alexander Podrabinek, an underground-newspaper editor who was once exiled to Siberia for nearly six years for examining Soviet psychiatry in a book titled Punitive Medicine, contends that the changes are strictly cosmetic. Even though the special psychiatric hospitals are nominally controlled by the civilian Ministry of Health, he notes, the guards are still military personnel and the doctors commissioned officers. Says Podrabinek: "The only thing that has changed is the label." He claims that new language in the regulations has actually given the government even greater latitude to misuse psychiatry. Under the old rules, "mentally ill" people could be forcibly hospitalized if they were judged to pose a physical threat to themselves or society. That remains unchanged, according to Podrabinek, but now people can also be put away if they threaten "the rules of the socialist community."

No one knows how many patients are being held in Soviet mental hospitals solely because of their political beliefs. In the past few weeks alone, a visitor encountered several possible cases. One man, for example, claimed that his son had been hospitalized for resisting the draft. Another young man said he had just been released after spending two months in a mental ward for refusing on religious grounds to enter the military. While hospitalized, he said, he was given sulfazine, a powerful drug that has no apparent effect other than inducing a high fever.

Despite their reluctance to comment, the U.S. psychiatrists who traveled to Moscow last month seemed far from reassured by their tour. Some of the visitors said Soviet psychiatrists still appeared to use drugs of dubious medical value. Many Western experts will no doubt oppose readmitting the Soviet Union to the W.P.A. until Moscow shakes up the psychiatric leadership and unequivocally renounces past practices. Though grounds for skepticism remain, there are signs that the current Soviet reform wave will lead to more humane and enlightened forms of psychiatric care.

With reporting by Glenn Garelik/Moscow