On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir Putin

The book On Dissidents and Madness is the personal story of a unique man and a true friend of ethical psychiatry. It is a story of courage, terror, opportunism, ingenuity, honesty, and humanity. It is a story of countries, politics, psychiatric organizations, ruthlessness, apologists, and shame. And although it is also a story of growth and change both personal and societal, it reminds us that resistance to true reform still runs deep in society.

A related review is available as an online supplement to this review at ps.psychiatryonline.org.

As a teenager in 1977, Canadian-born Dutch author Robert van Voren had been troubled by stories of the mistreatment of Soviet dissidents and began collecting signatures on a petition to send to Moscow. He made frequent, daring undercover trips to the Soviet Union, obtaining firsthand information about the psychiatric mistreatment of political dissidents. When, early in the 1980s a group of British, French, German, and Swiss psychiatrists and activists met in Paris and formed the International Association on Political Use of Psychiatry (IAPUP), van Voren was the only member of the group who had the damning evidence of political misuse of psychiatry.

The aim of the group was to have the Soviet All-Union Society of Psychiatrists and Neuropathologists barred from membership in the World Psychiatric Association (WPA). The IAPUP was successful insofar as the All-Union Society resigned rather than face the ignominy of expulsion. Subsequently, the WPA assembly voted for conditions that Soviet psychiatry would have to meet before being readmitted. The assembly, rather than its executive branch, eventually distinguished itself as WPA's decision-making body. As a former chairman of the APA Committee on the International Abuse of Psychiatry, and subsequently as a colleague of van Voren with the Geneva Initiative in Psychiatry (GIP), this reviewer can corroborate the engrossing and often troubling events reported, which included the all-too-leaden responses of the leadership of the WPA.

Van Voren was also concerned about the treatment of genuine psychiatric patients in the Soviet Union as well as the devaluation of psychiatrists and the inadequate training they received. After the breakup of the Soviet Union, the GIP (the transformed IAPUP) was able to organize a series of meetings in some of the newly independent states where psychiatrists from various parts of the former Soviet Union met and were exposed to the best of Western psychiatry. After some initial mistrust, it did not take long before a Network of Reformers emerged under the aegis of the GIP.

The second part of the book is an account of the successes of the GIP and the Network of Reformers in creating nongovernmental organizations of psychiatrists, nurses, and even public mental health support groups in the countries that achieved independence after the fall of the Soviet Union. In this section of the book we also see how the author transformed from a zealous, sometimes vengeful teenager to an inspired but realistic and worldly-wise reformer. He was very much aided in this transformation by a philosophical Ukrainian Jewish psychiatrist, Semyon Gluzman, who, despite having been a victim of the abuses and having spent several years in the Gulag, did not paint all the abusers alike.

Despite the presence of some annoying grammatical errors and spelling mistakes that were missed during the editing of the book, this is a very readable account of a dishonorable episode in the history of psychiatry and the contributions of those who endeavored to restore some honor and humanity to our specialty. It will have wide appeal to those interested in the history of psychiatry and should be required reading for psychiatric residents.