In this essay, I analyze political abuses of psychiatry in the Soviet Union by exploring Andrei Snezhnevsky’s diagnosis of sluggish schizophrenia—a fictional branch of schizophrenia. Snezhnevsky used his false diagnoses to claim that those who opposed the Soviet state were suffering from delusions and an “incoherent relationship to their objective social world.” The purpose of this was to discredit dissidents.
I first trace the history of the politicization of psychiatry from tsarist times through the Soviet Union with an emphasis the Marxist-Leninist conception of mental health. Next, I discuss practices used by Snezhnevsky and his colleagues at the Serbsky Institute to diagnose and thereby commit thousands of sane political dissidents to psychiatric prisons. I then discuss the historical consequences of Soviet psychiatry in the continued operations of the Serbsky Institute and in the continued politicization of psychiatry in Russia today to categorize homosexuality as mental illness or to protect criminals from serving sentences.
I. Historical Perspective: A Marxist-Leninist Conception of Mental Health
In the early 1900s, Russian psychiatrists theorized that their “epidemic of mental illness and ‘nervousness’  was caused by alleged problems of modernity. Psychiatrists agreed that the cure for this epidemic was to be found in the advancement of modernity instead of its repudiation, and thus medical science served as the protector of the public good. As part of this effort, psychiatrists were seen as representatives who were to act in the public interest to fashion “modern, rational, health-conscious citizens.” Thus, psychiatry became a method of “holding citizens to scientifically imposed norms of behavior, medicalizing deviance, and shaping the modern sense of self.” The system that emerged from these values merged professional understandings of mental illness with the legal norms of the modern state, creating a paternalistic tradition in which the Soviet government had authoritative control over an individual’s mental state.
After the 1917 Revolution, the scientifically imposed norms of behavior came to reflect a Marxist-Leninist understanding of psychology, in which an individual’s psyche reflected his objective social world and simultaneously created its own reality. Eminent Soviet psychotherapist M. S. Lebedinsky claimed that the “problem of psychotherapeutic theory should be decided in accordance with the ideology of society” and thus, in the USSR, psychotherapy would develop on the basis of Marxist-Leninist philosophy.
Marx understood human nature to be the “product of sociohistorical development on the basis of biologically given characteristics.” Marx asserted that man is the sum of his social relationships and that his personal expressions are the “manifestation and affirmation of [objective] social life.” Lenin echoed Marx’s understanding of individuality in his theory of reflection, where he claims that human consciousness not only reflects and affirms the objective (i.e. social) world, but creates it as well. Lenin asserted that individual psychology and behavior was the product of social experience, and that “true cognition is an adequate reflection of reality, and social practice is the criterion of truth.” Thus, a mentally healthy citizen was one whose behavior reflected the truth of the Soviet reality. Early Soviet psychiatrists appropriated this Marxist-Leninist understanding of consciousness as the foundation for psychotherapeutic and psychiatric treatment.
Soviet psychiatry developed separately from Western psychiatry as a result of conflicting political ideologies and understandings of consciousness and personality. Soviet psychiatrists rejected Freud’s theory of the unconscious mind as “bourgeois pseudo-science [and] a reactionary mythology calculated to deceive the workers.” Soviet psychiatrists distrusted Western psychology’s emphasis on individuality, adhering instead to the Marxist-Leninist model of matter over mind, brain over consciousness, and scientific analysis over psychotherapy. The Marxist-Leninist understanding of consciousness directly opposed the Freudian-influenced Western conception of consciousness, in that it promoted a materialistic approach to the individual and a rational view of personality and consciousness, and it viewed psychiatry as a way to reconstruct an individual’s attitudes toward the state and social environment.
II. Medicalizing Social Deviance
The Marxist-Leninist understanding of consciousness allowed Soviet psychiatry to adopt the view that a healthy citizen was one who lived according to Soviet society’s expectations and norms. Thus, if human consciousness is the affirmation and manifestation of social life (as Marx proposed) and simultaneously the reflection and creation of the objective world (as Lenin argued), then a political dissident is someone who rejects his objective social world and displays an incoherent understanding of his environment. Anti-Soviet behavior such as protesting Soviet laws and customs, attempting to travel abroad, or participating in human rights protests was taken to be symptomatic of mental illness.
Indeed, many psychiatrists could not understand why dissidents would sacrifice their families, careers, and happiness for ideals that went against the Soviet status quo. In 1992, Dr. Fyodor Kondrat’ev, a psychiatrist at the Serbsky Institute that diagnosed thousands of political dissidents as mentally ill, explained:
the possibility that a person might not behave ‘like everyone else’ not because of mental-illness, but merely on the basis of his own moral positions, according to his conscience, was simply not admitted [by Soviet psychiatrists]. If someone acted against the political system, clearly, it was necessary to look for the psychopathological mechanisms of dissidence.
Instead of entertaining the possibility that the conditions of Soviet society were causing psychological distress among its population, or that certain individuals might want to press the state or society to improve some element of itself, Soviet psychiatrists viewed mental illness as a condition that could be cured through ideological reeducation, behavioral correction, and a reconstructed relationship with the state.
Soviet psychiatrists sought to medicalize social life and took an active role in treating patients by encouraging them to participate in Soviet society. Lebedinsky claimed,
We oppose passivity in the therapist…We favor a situation in which the doctor’s influence and basic attention will be directed to the patient’s present and future. The psychotherapist should help the patient correctly evaluate his responsibilities to his family and society, his service duty, [and] his interrelationships with his surroundings. In his interactions with the patient, the doctor should exert an influence which is defined by the medical task, the principles of our medicine, the ideology of our society, its morals and science.
Thus, therapists considered themselves to be mentor-like authority figures that helped patients “realize” their incorrect behavior and ideology and take responsibility for their mistakes. Patients were made to understand how their “incorrect life position[s]” influenced their mental illnesses. Vladimir Bukovsky, one of the most vocal dissidents against political abuse of psychiatry, claimed that “to get a discharge the doctors bluntly demanded that you acknowledge your sickness and condemn your previous behavior. This was called ‘criticism,’ a critical attitude to the symptoms of your illness which served as proof of your recovery.” However, admitting to one’s incorrect behavior was often not enough to overturn their diagnoses. In order to ensure that ideological reeducation had been successful, sane political dissidents would be isolated in psychiatric hospitals (psikushki) for years after recanting their previous objections against the government.
III. Totalitarian Control of Psychiatry
As part of its welfare state, the Soviet Union kept close control of health care, focusing on psychiatry in particular as a tool for monitoring citizens and carrying out political repression by giving psychiatrists power to act as penitentiary guards against vocal political dissidents. As dissident and noted physicist Andrei Sakharov claimed, “the diagnosis of mental illness is fuzzy and this increases the likelihood of mistaken, arbitrary or criminal actions. The menace is especially grave in a totalitarian society, where a victim’s religious or philosophical beliefs can lead to prosecution.” Like other institutions in the Soviet Union, psychiatry sought to protect the social and political interests of the state in addition to its more obvious, everyday tasks. Unlike their Western counterparts who took the Hippocratic Oath, Soviet psychiatrists swore to the Oath of the Soviet Doctor which, as historian Robert van Voren argues, “made clear that the Soviet Doctor’s ultimate responsibility was to the Communist Party, not to medical ethics.” The Oath of the Soviet Doctor required the physician to swear to be guided by “the principles of Communist morality, and to always bear in mind the high calling of a Soviet physician and responsibility to the people and to the Soviet state.” This allowed for abuses of psychiatry that served the best interests of the state instead of the patient.
Andrei Snezhnevsky, the creator of the false sluggish schizophrenia diagnosis, enjoyed 50 years’ worth of prestigious positions at the Soviet Union’s most influential research institutions. He, like other successful psychiatrists, worked closely with high-ranking Soviet officials such as KGB Chairman Yuri Andropov and was awarded influential positions at large academic and research institutions where, in the Soviet hierarchical system of institutions, psychiatrists had more influence on developing officially accepted psychological theories and making final diagnoses. As historian Robert van Voren explained,
if a doctor who worked in a dispenser would change a diagnosis, it was usually considered as an “attack” on the institution that was higher up on the hierarchical ladder. Because for many years, a diagnosis established by a “higher institution” was obligatory to follow by a “lower institution.”
Lower-ranking psychiatric institutions such as regional outpatient clinics never dared to overturn a diagnosis made by a large psychiatric hospital and thus, healthy dissidents locked up in psychiatric prisons had their false diagnosis reinforced for years.
IV. Psychiatry as a Tool for Political Repression
To contextualize Soviet psychiatric abuses of psychiatry, and later politicization of mental illness, we can refer to Foucault’s Madness and Civilization. Here, Foucault argues that the nature of mental illness is contextual, influenced by religion, culture and environment. Foucault claims that the conception of madness arose from Enlightenment-era rationalism responding to the unknown and a political attempt to marginalize those who are different. He claims that this need to isolate others created the need for an asylum, where unreason “could vegetate…without ever spreading…where unreason would be entirely contained.”
This notion of getting rid of undesirables by categorizing them as insane is a familiar theme in Russian history. In 1836, Russian philosopher Pyotr Chaadaev was proclaimed clinically insane on orders from Czar Nicholas I, sentenced to house arrest, and subjected to daily medical examinations, after arguing in his Philosophical Letters that Russia had contributed nothing beneficial to world history. In 1943, former Estonian president Konstantin Päts was sent to the Kazan Special Psychiatric Hospital for refusing to recant his official title as president of Estonia, taken from him after the Soviets invaded. Although these are only two such events in history, the notion of political repression on the basis of mental health was evidently practiced by Russian and Soviet leaders to isolate undesirables.
Joseph Stalin’s use of mass imprisonment through the GULAG prison camps diluted the importance of punitive psychiatry in controlling dissent. Political prisoners made up 25% of each camp, charged officially under Article 58 — anti-Soviet sentiment. The case of Estonia’s former president shows that the practice of punitive psychiatry did not entirely fade, but the GULAGs were obviously a more direct and efficient means of criminalizing dissent. Stalin’s death in 1954 and the subsequent political thaw under Nikita Khrushchev resulted in a relaxation of censorship and the dissolution of the GULAG system. Four million prisoners were released to political rehabilitation between 1956 and 1960. However, as political unrest in the late 1960s began to cause rifts in the Communist world, as evident in the Prague Spring, the loosened censorship of the Khrushchevian era was tightened again. Under Leonid Brezhnev’s administration after 1964, psychiatry was harnessed as a tool for censorship to suppress dissent. Official records show that 20,000 citizens were hospitalized for political reasons, mainly on charges of anti-Soviet agitation and propaganda, and dissemination of fabrications with an aim to defame the Soviet political and social system. Most historians and scholars agree that this number is an underestimate on account of unreleased documentation.
Many of these hospitalizations happened quietly and quickly without attracting media attention and were justified by psychiatrists and high-level political officials in the Ministry of Health and the Ministry of Internal Affairs (MVD). In these cases, officials from the Ministry of Health were given direct orders from regional officials from the City Soviet to target certain individuals who had been marked by the KGB for certain anti-Soviet behavior. Noted Soviet biologist Zhores Medvedev was one such targeted individual who was forcibly removed from his home by policemen after multiple unsuccessful attempts to lure him into the hospital for a psychiatric consultation. Medvedev’s involuntary hospitalization was justified by Soviet authorities with the fact that he published a scientific paper in New York that called for international scientific cooperation. In his autobiography, co-authored with his brother Roy Medvedev, A Question of Madness, Zhores Medvedev refers to his treatment as “medicine standing on top of its head” and “psychiatric blackmail.”
The justification for the involuntary treatment of political dissidents was rooted in Soviet values. In 1959, the state newspaper Pravda published a speech by Khruschev regarding mental health in which he claimed:
A crime is a deviation from generally recognized standards of behavior frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offenses, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal.
This ideological foundation served as the basis for the forensic psychiatry conducted by Andrei V. Snezhnevsky and his colleagues at the Serbsky Institute from the 1950s until the late 1970s. Individuals who did not comply with the prescribed behavior of a normal Soviet citizen were targeted as political dissidents and were officially diagnosed as exhibiting signs of sluggish schizophrenia, nervousness, eccentricity, and neuroticism.
In many analyses of psychiatry in the Soviet Union, historians point to Snezhnevsky as the primary orchestrator in the prominent waves of political abuse of psychiatry that plagued the Soviet Union for most of its existence. Through a very successful career in which he pledged transparent loyalty to the Communist Party, Snezhnevsky served as director at influential Soviet hospitals and research centers, where he exerted significant power and influence over the development and practice of psychiatry. Snezhnevsky’s views were adopted as official scientific positions and incorporated into major research publications and academic textbooks, thus serving as the foundation upon which Soviet psychiatrists trained and practiced.
In direct communication with Soviet intelligence agency KGB and its predecessor NKVD, psychiatrists were authorized to send political dissidents to psychiatric asylums known colloquially as psikushki, state-owned psychiatric hospitals operated by the Ministry of Interior Affairs, the same ministry that ran the police force and security services. Psikushki differed from other psychiatric hospitals, which were managed by the Ministry of Health and had their own sets of policies. In psychiatric hospitals, family members were allowed to visit for only one hour a month and patients, especially those who were outspoken and resistant to treatment, were given painful antipsychotic drugs, such as sulfur injections that sometimes resulted in death, and were often physically and emotionally assaulted by the hospital staff.
The main grounds for compulsory hospitalization were whether or not the patient posed a public danger and exhibited symptoms of abnormal behavior, such as:
- psychomotor excitation with a tendency towards aggressive action;
- irregular behavior accompanied by psychological disorder (hallucinations, delusions, a syndrome of psychological automatism, a syndrome of disorder consciousness, pathological impulsiveness, if accompanied by acute affective tension and a striving towards its active expression);
- a systematic syndrome of delusions with chronic deterioration, if it results in behavior dangerous to the public;
- a hypochondriac delusional condition, causing an irregular, aggressive attitude in the patient towards individuals, organizations or institutions.
Any sane person, faced with sudden apprehension by KGB officers and possible involuntary psychiatric confinement, would understandably be animated and upset and thus show behaviors that could easily be classed as “psychomotor excitation” and likely even “aggressive” behavior, as the natural fight-or-flight instinct compels the individual to defend their personal safety and freedom, as well as the fates of family members who may be dependent upon them. As noted before, Soviet doctors tended to see dissident views about the Soviet system as an indication that a patient was, in fact, sick. Thus, this could easily be classed as “irregular” behavior and even a “psychological disorder.” From this we can see that finding reason to isolate dissidents brought to a state clinic was not difficult under the prevailing policies and theories of Soviet psychiatry. By politicizing mental illness, the Soviet system was able to use psychiatry as an effective tool to isolate and discredit political dissidents that the Soviet system deemed a threat to the security of the Soviet state and its ideology.
V. Andrei Snezhnevsky and Sluggish Schizophrenia
Most experts on the topic of Soviet psychiatric abuse, such as Robert van Voren, Peter Reddaway and Sydney Bloch agree that Snezhnevsky and his core group of psychiatrists developed the concept of sluggish schizophrenia at the request of the Communist Party and the KGB. In developing his theories, Snezhnevsky presented research conducted from 1950–1967 on 5,000 subjects at various high-profile psychiatric institutes. It was compelling research to most Soviet psychiatrists at the time, for the diagnosis of sluggish schizophrenia seemed to logically explain how a person could commit a crime such as protesting against the State with full knowledge of the fact that such actions could result in the actor’s loss of family, employment, and freedom. In this sense, the Soviet psychiatrists had a point – the sluggish schizophrenic diagnosis does accurately describe the behavior of a political dissenter. However, deeming that behavior a mental disease removes the possibility that a dissenting individual can play a role in the evolution and development of the State and society. While this can obviously promote stability in a social system, it is just as likely to lead to stagnation, which can be just as detrimental to the survival of the State.
In his explanation of the symptoms of sluggish schizophrenia, Snezhnevksy noted its differences from other schizophrenic diagnoses, pointing to the diagnosed patient’s experience of time and space. While schizophrenia is recognized by the patient’s inability to physically locate or identify himself during psychotic episodes, Snezhnevsky claims that in sluggish schizophrenia, the patient cannot recognize himself temporally. In other words, the patient cannot see where he will be in the future based on present actions. The rest of the symptoms such as delusions, manic positive episodes, and depressive negative episodes, aligned with standard schizophrenic diagnoses.
Snezhnevksy also believed that sluggish schizophrenia worsened over time in a slow progression. The active period of illness was marked by delusions, hallucinations, disorganized speech, and “delusions of reform.” These psychopathic symptoms, Snezhnevsky said, eventually progressed into social withdrawal and apathy, especially during the patient’s stabilization and treatment. Snezhnevsky also stated that this withdrawn and apathetic state was usually the terminus of the treatment. Thus, this progression was the key to permanently isolating the dissenter. Since the condition has no chance of recovery, the dissenter was considered mentally incompetent and incurable, a status which required him to sign his rights away and spend the remainder of his days in a secured psychiatric prison.
Sluggish schizophrenia was also distinguished from other forms of schizophrenia as only affecting the social behavior of the individual. Psychiatrists from Serbsky Institute claimed that this stemmed from the fact that “most frequently, ideas about a struggle for truth and justice are formed by personalities with a paranoid structure.” Psychiatrists described patients with sluggish schizophrenia as appearing “‘quite normal most of the time but who would break out with a severe case of ‘inflexibility of convictions,’ or ‘nervous exhaustion brought on by his or her search for justice,’ or ‘a tendency to litigation’ or ‘reformist delusions.'”
Other psychiatrists, such as Georgi V. Morozov, also of the Serbsky Institute, contributed their own research to strengthening Snezhnevsky’s theories and diagnosis. Morozov claimed that “a shared feature of all the ‘patients’ is their repeated uncritical attitude of their own illness.” Developed treatments for sluggish schizophrenia included high doses of antipsychotic drugs such as sulfazine, administered by injection ten to fifteen times a day; sulfazine side effects included severe pain, immobility, fever, and muscle necrosis. Other treatments included atropin injections and insulin-induced comas to keep patients sedated and compliant to treatment. In addition, patients were commonly physically restrained.
Leonid Plyushch, a Ukrainian mathematician and human rights activist, was one such prisoner who suffered from these treatments. In his autobiography and subsequent testimony before US Congress in 1982, Plyushch recounted the daily torture at these psychiatric prisons. “I was injected not only with triphtazine [an anti-psychotic], but also with large doses of haloperidol [another anti-psychotic] and for a while was not given the corrective for this drug, which was deliberate torture. After the injections I would have convulsions, was unable to speak, could only lie in bed, and lost interest in everything, even my own family.” These medical tortures were also accompanied by physical brutality from hospital staff, which included overdosing patients with sulfur, beating them and preventing them from accessing the bathroom. Plyushch recalled witnessing other political prisoners diagnosed with sluggish schizophrenia who, after refusing to recant their political ideals, were wrapped in wet canvas that shrank when it dried, causing excruciating pain and sometimes death.
In these facilities, medical personnel were protected under Decree No. 345-209 that outlined “measures for preventing dangerous behavior (acts) on the part of mentally ill persons.” Under these guidelines, psychiatrists were allowed to force therapy and psychopharmacological treatment onto dissidents, causing serious mental and physical deteriorations in many patients.
V. The Historical Legacy of Soviet Psychiatric Abuse in Modern Russia
Vestiges of Soviet psychiatric abuse and politicization of mental illness are still evident in contemporary Russian psychiatry and criminal law proceedings. The Serbsky Institute is still operating and highly influential, although it is now referred to as the “Serbsky State Scientific Center for Social and Forensic Psychiatry.” Despite claims from Serbsky representatives and government officials that psychiatric institutes are impervious to political influence, recent evidence has indicated the opposite.
One such case of politicizing mental illness to protect criminals occurred in 2000 during the case of Colonel Yury Budanov, who was tried for kidnapping, raping, and murdering an 18-year-old Chechen woman during his military stint in the Caucuses during the Russo-Chechen War. In his testimony, Budanov denied the rape charges but claimed that he killed the woman in “a fit of rage” after mistaking her for a sniper. During his trial, conflicting reports from various psychiatric institutions emerged concerning his sanity at the time of the crime. His last and final psychiatric examination was conducted by Dr. Tamara Pechernikova at the Serbsky Center.
Pechernikova, a former colleague of Snezhnevsky, is a current practicing psychiatrist. Pechernikova said that the colonel was “overwhelmed by feelings of guilt over the death of his comrades [to] a sniper. As a result…understandably…he killed a woman.” Diagnosed with “temporary insanity,” Budanov served 5 years instead of the intended 10 year sentence. Critics claimed that this diagnosis of temporary insanity was a method of excusing Budanov’s behavior and validating his war crimes by the government that was trying to push a political message of submission onto Chechnya.
Journalist Anna Politikovskaya, in her exposé of corruption in contemporary Russia, points to Pechernikova as a key instrumentalist in political abuse of psychiatry in the USSR:
Pechernikova regarded evidence for the search of social justice as a symptom of mental illness dangerous to society…in the two decades she spent patriotically, as she would see it, defending the Soviet social and state system, [she] mold[ed] psychiatry to fit the needs of the state security apparatus.”
Pechernikova was also instrumental in sending prominent Soviet dissidents and human rights activists such as Natalya Gorbanevskaya to psychiatric prisons by diagnosing them with sluggish schizophrenia.
Another incident of political abuse of psychiatry was introduced in the 2012 case of Mikhail Konsenko. Konsenko, 38 years old and suffering from depression and mental illness said to have originated from a concussion that he sustained from beatings in the army, was arrested for participating in mass riots and resisting police officers. This case attracted significant public attention since there was video evidence of Kosenko’s innocence, in which he moved away from an ongoing police altercation at the Bolotnaya protest in 2012. According to journalist Victor Davidoff of The Moscow Times, the specialists at the Serbsky Center who examined Kosenko made a highly questionable diagnosis after merely one brief interview, and spent more time interrogating him on his political affiliations than his medical history. During custody, the judge presiding over his case would not allow Kosenko to attend his mother’s funeral based on the Serbsky Institute’s assessment of Kosenko as “a danger to himself and others.” This diagnosis, however, did not match his observed behavior during treatment in which there was no recorded history of aggression or suicidal behavior. By using Kosenko’s previous mental health issues as evidence of his violent instability, despite video footage contradicting such statements, Russian officials seemed to be politicizing Kosenko’s mental illness.
A further series of articles published in 2011 by The Moscow Times show that the political abuse of psychiatry is still prevalent in Russia on local levels. In her article “In Soviet Relapse, Critics Sent to Psychiatric Hospitals,” journalist Natalya Krainova investigates increasing claims that Russia’s psychiatric healthcare has not changed much since Soviet times. In her research, Krainova found that many regional authorities use psychiatric examinations as part of intimidation campaigns against people who “file lots of complaints in courts and other state bodies trying to instate justice.” Unlike Soviet times, however, a stay in a current day Russian psychiatric facility is generally limited to weeks and usually includes no mandatory medication.
The past ten years has seen a rise in Russian medical professionalism’s susceptibility to arguably pervasive social norms and ideologies that consequently have an adverse effect on the mental health of marginalized Russian citizens. Since 2005, homosexuality has been targeted as a sign of mental disturbance. Although Soviet sodomy laws were lifted after the fall of the USSR, nontraditional sexual orientations have remained on official lists of mental illnesses. In January 2015, Prime Minister of Russia Dmitry Medvedev signed a bill into law proclaiming those that suffer from the mental illnesses on this list, which also includes schizophrenia, intellectual disabilities, and drug addiction, are unfit to drive.
By diagnosing homosexuality, transsexuality, and sexual preference “disorders” as mental illnesses, Russia is echoing the Soviet practice of pushing a political agenda by using psychiatry to discredit rather than diagnose. By opposing LGBT rights, the Kremlin is able to support Russian Orthodox ideology and appeal to those constituents who are anti-West and anti-liberal. As in the Soviet Union, those marked as psychologically abnormal are stripped of rights and legal protection.
By analyzing Snezhnevsky’s diagnosis of sluggish schizophrenia, I have argued that politicized psychiatry was used by the state to uphold its political agenda and to isolate and discredit dissidents. Instead of creating open, public political trials, as was popular under Stalin, political prisoners were diagnosed behind closed doors and injected with harmful medication to keep them incapacitated and removed from society. In contemporary Russia, we see human rights implications of the politicization of mental illness used against elements of society deemed unwanted or in support of those assisting the State in maintaining its influence.
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