Historic Visit Documented Abuses, Led to Psychiatric System Reform

Twenty-five years after Soviet war hero General Pytor Grigorenko was incarcerated in a psychiatric hospital following his protest of human-rights abuses, and 18 years after Vladimir Bukovsky released to the Western press copies of forensic reports on Grigorenko and five other Soviet human-rights activists who had been similarly detained, the Soviet Union was in turmoil.

Grigorenko's incarceration and the release of the “Bukovsky papers” were sentinel events in the growing awareness among Western psychiatrists of the Soviet practice of using psychiatric hospitalization—sometimes augmented by use of drugs—to punish and contain political dissent.

The subject had dominated the 1977 meeting of the World Psychiatric Association (WPA) in Honolulu, resulting in a resolution censuring the Soviet All-Union Society of Psychiatrists and Neuropathologists. Prior to the follow-up meeting in 1983 in Athens, Greece, the All-Union Society withdrew from the world body, under threat of expulsion. Throughout the 1980s, APA's Committee on International Abuse of Psychiatry sought contact with incarcerated individuals believed to be held for nonmedical reasons (Psychiatric News, November 5 and November 19).

But change was brewing in the U.S.S.R., and by 1989 Mikhail Gorbachev was in power promising perestroika—a comprehensive restructuring of Soviet politics and economy—and glasnost, a policy of openness and transparency.

Hoping to revitalize a stagnant economy, Gorbachev and his ministry of foreign affairs, under the leadership of Eduard Shevardnadze, sought better ties with Europe and the United States, including a readmission of the All-Union Society to the WPA. But for that they needed to demonstrate adherence to the human-rights stipulations of the 1975 Helsinki Accords, which they had long ignored, including an end to the use of psychiatric hospitalization to detain political dissidents.

What would evolve from negotiations between the U.S. State Department and the Soviet Ministry of Foreign Affairs—with the crucial participation of the National Institute of Mental Health (NIMH) and APA—was a remarkable diplomatic endeavor to systematically investigate claims by humanrights activists who said dissidents were still being detained in psychiatric facilities and to assess more generally the state of Soviet psychiatric practice.

In late February 1989, a delegation of 26 psychiatrists, forensic experts, Sovietologists, and APA staff (including Ellen Mercer, director of APA's Office of International Affairs) traveled to the U.S.S.R. to conduct systematic videotaped interviews with hospitalized and released psychiatric patients and their relatives, and to investigate conditions at Soviet psychiatric hospitals.

“It was an extraordinary visit and a very well-coordinated work of diplomacy involving three major organizations—the State Department, APA, and the National Institute of Mental Health,” recalled forensic psychiatrist Loren Roth, M.D., who was the psychiatric leader of the American delegation. “It took an enormous amount of planning and preparation to accomplish two fundamental purposes—a truly valid scientific assessment of Soviet psychiatry, including its diagnostic procedures, and assessment of the extent of abuse of psychiatry.”

Most extraordinary was the unusual degree of access accorded the delegation: the Americans interviewed and videotaped patients—and where possible their relatives—without interference from authorities and in a neutral setting. Released patients were interviewed in a hotel room, while hospitalized patients were transferred and interviewed in a single Moscow hospital. The delegation was able to access records, collect urine samples, and assess the validity of Soviet diagnoses against American standards.

Moreover, they were allowed to enter Soviet psychiatric hospitals—including some of those most notorious for housing political dissidents—and interview patients at will.

“We were later told by the State Department and [then] Ambassador for Human Rights Richard Shifter that this was likely the most invasive human interchange one nation had ever conducted in another nation in the area of medical investigation,” Roth told Psychiatric News.

It was a measure of the change under way in the U.S.S.R. and of the desperation on the part of the Soviet government to rejoin its economy with the Western world. As delegation member William Carpenter, M.D., remarked, “Sovereign nations just don't normally allow this kind of invasiveness.”