Rift Changed U.S. Psychiatry

The confrontation between Western and Soviet psychiatric leaders over abusing psychiatry to detain political dissidents was dramatic in its own right, but its lessons reverberate today wherever psychiatry and legal authority meet.

In a 2002 article in the Journal of the American Academy of Psychiatry and the Law titled “Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies,” Richard Bonnie, J.D., argued that Soviet political abuse influenced mental health law in the United States at a formative stage of its development and that mental health law in this country has, in turn, had a profound impact on the shape of international human-rights norms pertaining to psychiatric care.

He noted, for instance, that the “the liberty-protecting norms of U.S. mental health law and the core principles of ethics regarding professional independence” were eventually codified within Russian mental health law and the laws of many former Soviet republics. In turn, the confrontation with the Soviets informed the development of ethics to all manner of contemporary American issues—such as managed care utilization review, coercive treatment of sexual offenders, and assessment of competency for execution—and more generally helped shape the professional identity of forensic psychiatry in this country.

Bonnie said the confrontation was especially formative regarding ethics related to involuntary treatment in the United States. “Even though libertarian and therapeutic approaches to involuntary treatment continue to vie for dominance, everyone recognizes that psychiatric discretion to hospitalize and treat a person over his or her objection should be constrained by socially prescribed criteria and disciplined by independent external review,” Bonnie wrote.

In an interview with Psychiatric News, Bonnie noted that APA's firm stance against the involvement of psychiatrists in interrogation for national security purposes can be seen as a legacy of the stand against Soviet abuses.

“The Soviet experience highlighted the importance of the ethical autonomy of medicine and psychiatry,” he said. “It was a cautionary tale about the dangers of allowing the skills of doctors to be used by the state without any genuine therapeutic aim.”

“Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies” is posted at <www.jaapl.org/cgi/reprint/30/1/136.pdf>.