Commentary Magazine


Soviet Psychiatry on Trial

The Norwegian psychiatrist said he was worried. He was sure that his Soviet colleagues were abusing their profession in order to suppress dissent. But he was afraid that if the World Psychiatric Association voted to condemn them, as the British were proposing, then all contact might end, and with it any chance for quiet moral suasion.

It was Monday, August 28, 1977, the first day of the WPA’s Sixth World Congress of Psychiatry, and the vote would be taken Wednesday. Six years before, at the WPA’s Fifth World Congress in Mexico City, attempts to condemn the Soviets had been unsuccessful; the issue had never reached a vote. Since then, reports of Soviet abuse had built up. Appeals had been made that they end the practice of diagnosing political dissidents as mentally ill and of confining them in prison hospitals. The number of known or suspected cases had risen to several hundred. Formerly hospitalized dissidents, such as Leonid Plyushch and Vladimir Bukovsky, were extruded abroad and struck Western psychiatrists who interviewed them as healthy. Groups of psychiatrists around the world began to pressure their national societies to condemn Soviet practices.

After years of uncertainty, a few did. In May of 1977, Britain’s Royal College of Psychiatrists, one of the WPA’s member societies, voted to ask the world body to condemn “the systematic abuse of psychiatry for political purposes in the USSR” at its upcoming congress. Two weeks later, the Royal Australian and New Zealand College of Psychiatrists, hoping to make the British resolution more acceptable to other psychiatric societies, proposed that it be amended to condemn political abuses not only in the USSR but also “in all countries in which they occur.” Then in August, three weeks before the Sixth World Congress was to consider these proposals, the American Psychiatric Association, the WPA’s most powerful member society, added one more. It asked the WPA to set up monitoring machinery—a Committee to Investigate Abuse of Psychiatry. The three proposals became items on the congress agenda. Many vowed that the shame of Mexico City would be wiped away in Honolulu.

In fact, though, opinion at the congress was fractured. Six of the world’s continents—sixty countries—were depleted of psychiatrists for the occasion. Of the four thousand who came, many were passionate about the issue. Some, like the Norwegian, felt that the resolutions should be defeated in order to maintain ties that could be used to soften Soviet practices. Others doubted the truth of the accusations, or argued that since psychiatrists everywhere served as agents of social control, it would be hypocritical to single out Soviet abuses that were different only in degree. Still others, primarily from the Eastern bloc, denied the accusations altogether, labeling them the inventions of anti-Soviet slanderers. The remainder, mainly from the U.S. and Western Europe, felt that anything short of condemnation would represent a second betrayal of psychiatry.

Throughout the congress, the Soviets complained that a conspiracy was afoot. In a way, they were right. Some weeks before, Sidney Bloch, an Oxford psychiatrist who had co-authored a book arguing that Soviet psychiatrists were systematically abusing their profession for political ends,1 wrote to colleagues in Europe and North America asking them to work together in Honolulu in the interest of passing the resolutions. About two dozen met in his hotel room on the eve of the congress, and, of these, a core group—about fifteen—continued to meet through the rest of the week to exchange information and offer mutual support. As the vote drew near, others joined, including the British and Australian voting delegates. Most had never met before. About half were from the United States; a third from England, Canada, and Australia; and a few from France and West Germany. Two were Soviet psychiatrists who had emigrated to the West. Izvestia would later refer to this loose caucus as a Zionist clique. In fact, its members shared no particular ideology or religion—not even a unanimous view about the motivations behind the Soviet misdiagnoses. What they did share, besides their profession, was the conviction that the misdiagnoses had occurred and that they had to be condemned.

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II

The giant congress-eve welcome party on the Royal Hawaiian’s vast lawn—torches, hulas, and mahimahi—stood in bizarre contrast to the struggle that would follow. It was Sunday evening, the congress would begin the next day, but it was still unclear how many votes there would be in all, how many would be allotted to each psychiatric society, and which delegate would be voting for that society.

The WPA, the caucus eventually discovered, was made up of 76 societies representing psychiatrists in almost as many countries. The exact number varied from year to year. In some countries, the profession is so fragmented along theoretical or ideological lines that several societies coexist. France, for example, has had, during the past seven years, at least seven; three of them quit the WPA between 1972 and 1976. Each society names a delegate to the WPA’s General Assembly, and it is that delegate who has the right to cast his society’s votes on the items placed on the congress agenda.

The number of votes each delegate may cast depends, first of all, on the number of paid-up members his or her society has. A society is granted one vote for each 100 members, up to a maximum of 30 votes. Most societies have fewer than 200 members, and so are entitled to only one or two votes. The large societies, with several thousand members, have the potential right to cast up to the maximum complement of 30. But if a society fails to pay its full assessment of WPA dues, it$ vote is cut proportionately. This makes little difference to the majority of the societies—those from Asia, Africa, and Latin America—since, in the main, they have only one or two votes to begin with; and, so long as they pay something, they keep at least one. The greatest effect is on the large societies. The American Psychiatric Association, with 18,800 members, had paid enough of a subsidy to the WPA to be accorded the maximum of 30 votes. The USSR’s All-Union Society of Psychiatrists had paid much less; and so, although it also could have had 30 votes for its 21,000 members, it had only 23. Britain’s Royal College of Psychiatrists, in its years of economic decline, could buy only 5 votes for its 4,450 members, despite its theoretical entitlement to the maximum, while Canada’s smaller but richer society had 13.

That first night at the welcome party, the number of votes and the identities of the voting delegates were still not public. But some trends were already evident. It was clear that the Scandinavian delegates were planning to vote against the resolution condemning Soviet abuses. One of the caucus members, who had been active in the British campaign against Soviet psychiatry for half a dozen years, confronted Clarence Blomquist, a Swedish psychiatrist and professor of medical ethics:

We don’t like the Swedish position.

We don’t have a position.

Your position is to vote against the Royal College resolution.

We’re concerned that the Soviets will withdraw. We’re concerned about contacts in the long run.

But they’ve pulled that on us for too long. By now there’s just so much proof that they’re abusing psychiatry.

I’m not sure it’s abuse. I think that those dissidents would have been declared ill in the West.

What? In the West?

Yes, in Sweden.

Well, not in the U.S.A., not in Great Britain, and not in Canada. And I’d certainly be surprised about Sweden.

Soviet lobbying, possibly more subtle, also made itself felt. The Israeli delegate, with one vote, was a candidate for the WPA’s new executive committee, on the same slate with a Saudi and a Pakistani. Marat Vartanyan, a Soviet psychiatrist who held the post of associate secretary of the WPA, embraced the Israeli. “I’ll vote for you!” he assured him.

It was easy to spot the Soviets. They wore suits. I wondered if it was true that all Soviet delegations traveling abroad were watched by the KGB. All I could see was that they always moved in twos.

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III

Ironically, the Sixth World Congress was devoted to the theme of psychiatric ethics. After a formal opening ceremony—which featured local politicians boosting island attractions, a Hebrew-speaking Christian minister praying for sunshine, and a high-school glee club offering a sacred paean to the Royal Hawaiian Hotel—the congress got down to business. A plenary session on the “Ethical Aspects of Psychiatry” became the first skirmish in the battle of Hawaii.

The centerpiece of the plenary session—in fact, of the congress—was the Declaration of Hawaii. That document, designed to set out the guidelines for the ethical practice of psychiatry, had been ushered through nine drafts by Clarence Blomquist, the same Swedish psychiatrist who had argued the night before that the Soviets should not be condemned. Although some countries, particularly developing and socialist ones, had reservations about it on the ground that it emphasized individual rather than social needs, it was, in the main, widely accepted. Its injunction against the compulsory hospitalization of persons without mental illness, and against the use of the profession for maltreatment of individuals or groups, should have been sufficient to eradicate political abuses. But it was not enforceable: there were no provisions for monitoring and investigation.

The audience seemed impatient with Blomquist’s disquisition on the philosophical origins of his declaration. They seemed impatient with the plenary session’s other speakers, too. Although the session was not focused on the Soviet issue—a special session would address that issue the following night—the absence of any discussion of it in that environment of watching and waiting seemed odd and annoying. In fact, the only statements that received any applause were elliptical references to the issue by the speakers representing West Germany and the United States.

And then came Eduard Babayan, the chief of the Soviet delegation. He would pull out all the stops at Wednesday’s debate, but he used the Monday morning plenary session to map out his delegation’s position. Soviet laws and procedures, he insisted, offered the psychiatric patient the greatest possible protection from diagnostic mistakes and arbitrary treatment. He insisted that anti-social behavior could never serve as sufficient grounds for hospitalization. He emphasized that no group of forensic psychiatrists, not even the staff at the Serbsky Institute of Forensic Psychiatry, was more equal in the eyes of a Soviet court than any other group. He denied that the theories of any particular psychiatric school could possibly have any bearing on the finding of legal responsibility.

Each of these statements was an implicit refutation of major Western accusations: that dissidents were systematically misdiagnosed, that their only symptoms were their politically unacceptable views, that it was the Serbsky psychiatrists who would render a diagnosis of illness despite a previous diagnosis of health rendered elsewhere by more honest psychiatrists, and that the theories of the Snezhnevsky school of psychiatry were being used to justify political hospitalizations.

But Babayan did not step beyond implications. He made no mention of the condemnatory resolutions. He made no mention of the accusations themselves. He was only setting up the structure of the Soviet side’s position. Soviet psychiatry functioned ethically, he said; reports to the contrary were only anti-Soviet agitation and slander.

Just as Babayan was speaking at Waikiki, his adversaries were agitating across town. The evening before, at the first meeting of the pro-condemnation caucus, Neil Abercrombie, a Hawaii state senator, had offered the state capitol for a press conference. The psychiatrists were afraid that such an extravaganza would rub the voting delegates the wrong way, but Abercrombie was impatient with their timidity. “I’m a politician,” he admonished them. “You’re holding this meeting to tell the world about the abuses. Who cares about a hundred psychiatrists? Who cares about the meeting if it’s not reported?”

It was reported. At least, it got better coverage than Babayan. Leonid Plyushch, one of the formerly hospitalized Soviet dissidents, was there, together with two emigré Soviet psychiatrists and several members of the caucus. Among the press were two Soviet reporters.

Plyushch, a Ukrainian mathematician, had gotten into political trouble for the first time in 1968, when he was thirty, for a letter he wrote to a newspaper complaining about a political trial. He lost his job and eventually became a member of a dissident group. He was arrested in 1972 and accused of “especially dangerous crimes”—possessing copies of the underground Chronicle of Current Events; writing “anti-Soviet” literary criticism and showing it to others; belonging to an illegal organization; and signing open letters to the UN. He was sent for psychiatric examinations. At one, Georgi V. Morozov, the head of the Serbsky Institute, diagnosed him as suffering from “sluggish” schizophrenia. At a second, Andrei V. Snezhnevsky, the head of the Institute of Psychiatry of the USSR Academy of Medical Sciences, also considered him schizophrenic. Plyushch’s trial was held without him. The psychiatrists recommended compulsory hospitalization in an ordinary psychiatric hospital, but the court insisted on a “special” prison hospital, one in which the lot of patients is much harsher and in which security is much greater. There he was given high doses of medication and suffered severe side effects.

Plyushch was finally released and deported early in 1976, primarily in response to protests by fellow mathematicians in the West. He was seen by a number of French, British, and American psychiatrists, including me; they could find no evidence of schizophrenia. Plyushch told his story at the Honolulu press conference and issued a plea that the WPA condemn Morozov and Snezhnevsky—both of whom were there in Hawaii as members of the Soviet delegation.

More accusations were made by the two emigré Soviet psychiatrists. One, Marina Voikhanskaya, told of her experiences with political “patients.” Another, Boris Zoubok, described the mass hospitalizations that would take place during public events, such as Nixon’s visit. Western psychiatrists used the occasion to warn that the American, British, Canadian, Australian, and New Zealand psychiatric societies, as well as others in Western Europe, might quit the WPA if Soviet abuses were not condemned.

By Monday night, the close of the congress’s first day, it was clear that the demand for condemnation would not be deflected, as it had been in Mexico City. It was also clear that the Soviets would fight.

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IV

As it turned out, Tuesday belonged to the West. Indeed, by default. The scheduling of a special open session that night, in which statements could be made from the floor, guaranteed that. Set up in response to Western pressures, the session would feature a talk by an American psychiatrist who would air the accusations for the first time in an official meeting. The Soviets knew that and avoided it.

In fact, they seemed to avoid contact all day. The important ones, at least, were apparently planning strategy. Some voting delegates were afraid that Babayan was gearing up for a filibuster that would prevent them from voting on Item ll—the condemnatory resolution—at the second session on Wednesday. By evening, none of the Soviets could be seen. The special session was packed; except for the Soviets, almost all of the congress participants gave up the delights of Honolulu night life to attend it.

The main speaker was Paul Chodoff, a Washington psychiatrist. He presented the case for condemnation. Retaliation against dissidents, he insisted, should not be concealed behind the psychiatric fig leaf. “It is abhorrent,” he said, “that people should be labeled insane solely because it suits the state for various reasons to handle them in this fashion, or because psychiatrists can be found to collaborate in this masquerade.” He argued that the documentation of systematic, widespread abuse of Soviet psychiatry for political ends was convincing. If the WPA were to sidestep the issue by not voting condemnation Wednesday night, Chodoff warned, “it may survive, but it will have forfeited its moral vigor.”

Following Chodoff, thirty psychiatrists lined up at microphones to add their voices. They overwhelmingly supported the resolution to condemn the Soviets.

Marina Voikhanskaya again told about the four cases of healthy dissidents she had seen in her own hospital in Leningrad. She also described the way colleagues she had known for years began to turn against her as soon as she started to question the diagnoses of hospitalized dissidents. Some of them even suspected her of mental illness. She singled out Snezhnevsky, Vartanyan, Morozov, and Nadzharov—all then in Honolulu—as having corrupted medical ethics, as having “blurred the borderline between police functions and medicine.”

She told of an underground book by a Soviet dissident that had just reached the West. It contained a “white list” of some two hundred cases of dissidents in mental hospitals. It also contained a “black list” of the psychiatrists who put them there. “Who knows?” Voikhanskaya asked eerily. “You may well be sitting next to one of them at this moment.”

Of course, she was wrong. They were not there. But the psychiatrists who were stood up in tribute as she returned to her seat. If that audience could have voted, it would have condemned the Soviets on the spot. But only the voting delegates could do that, and they would not cast their ballots until the General Assembly session the next night.

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V

The congress participants were mainly from the U.S. and Western Europe, where feeling against the Soviets ran high. The voting delegates, on the other hand, represented societies around the world, and were sensitive to the political meanings of their votes. Many had come to Honolulu with instructions on how to cast them. Those who had not were not about to be overwhelmed by the passions of the Western majority that happened to be there. If on Tuesday they were exposed to the Western prosecution, on Wednesday they were offered the Soviet defense.

It was a defense built of denials, expressions of outrage, and intimations that the push for condemnation was nothing but a political hatchet job. The same strategy had been evident six years before in Mexico City. At the Fifth World Congress in 1971, Andrei Snezhnevsky, the foremost Soviet psychiatrist, had told Mexico City’s Excelsior that the charges were “a maneuver of the cold war, carried out at the hands of experts.” His message in Hawaii was much the same. Those charges, he told the Honolulu Advertiser, were just “a psychiatric variant of anti-Soviet propaganda.” He again denied that abuses were occurring: “In mental hospitals, nobody is being detained for political or religious reasons.” He also said that no more than about ten dissidents had ever been psychiatrically hospitalized, and insisted that all of them were ill. Some, he charged, had been re-hospitalized after emigrating to the West. And, in any case, it was better for a dissident to be hospitalized than jailed, since the period of confinement is almost always shorter.

Snezhnevsky is a remarkable figure, a real Soviet man. He is a survivor. Born in 1904, he persevered through every stage of Soviet psychiatry. When it was ideologically necessary to reject genetics, he rejected genetics. When it became possible to resurrect it, he resurrected it. When Stalin demanded an attack on “anti-Pavlovians” in psychiatry, Snezhnevsky attacked them. When, after Stalin’s death, Pavlovianism was forgotten, he forgot it. Through all that time, he methodically accumulated professional power. In 1932, at the uncommon age of twenty-eight, he became head of a psychiatric hospital near Moscow. In 1938, he was appointed deputy director of the important Gannushkin Institute. During the war, he ran a military hospital. In 1950, he was named chief of the Serbsky Institute of Forensic Psychiatry. In 1951, possibly because of his participation in the official campaign against the “anti-Pavlovians”—many of whom also happened to be “cosmopolitans,” which is to say, Jews—he was appointed to the chair in psychiatry at the prestigious Central Postgraduate Medical Institute. Finally, in 1962, he became a full member of the USSR Academy of Medical Sciences—still the only psychiatrist to be so honored—and the head of the Academy’s Institute of Psychiatry. On the way he gained some of his country’s highest honors, including the Order of the Red Banner of Labor and the Order of Lenin. And, too, he gained control of Soviet psychiatry—its theory, its teaching, its research, its publication, and its professional activities.

Snezhnevsky’s system of diagnosing schizophrenia has become the dominant one in the Soviet Union. And it is precisely that system which has been used to hospitalize dissidents, both by Snezhnevsky and by his colleagues. As it happens, I had studied that system for some years. In fact, by the time I arrived in Honolulu, I knew Snezhnevsky well, having spent days talking about him with former colleagues and students who had found their way to the West.

Snezhnevsky had always insisted that only psychiatrists could understand the complex nature of clinical diagnosis. Well, I was a psychiatrist, and one of the few in the West acquainted with his approach to diagnosis. Since the vote would be taken that night, and the opportunity would never come again, I called his room at the Holiday Inn. Yes, he would see me.

The translator, a serious young Russian on his first assignment abroad, apologized for not being acquainted with psychiatric terms. Snezhnevsky cheerfully agreed to my use of a tape recorder. I set it down in the middle of the table, next to his Gideon Bible. He would be happy, he said, to talk about anything, but would have to stop in an hour; his delegation had called a press conference that he was obliged to attend.

I wanted to get away from the realm of simple accusations and simple denials. After a long immersion in Snezhnevsky’s system, I had questions I wanted to ask.

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Snezhnevsky sees schizophrenia as a lifelong condition. He defines three forms. The first, “continuous,” is said to be characterized by a progressive, usually steady development, without any significant remissions. The second, “periodic,” can be recognized by its attacks; but each attack is followed by a remission, during which the patient returns to mental health. The third form, “shift-like” or “schub” schizophrenia, is described as a cross between the other two. The shift-like schizophrenic has attacks followed by remissions, but in the remission after each attack, or shift, the patient is not quite as well as he had been before the shift. This third form, then, is characterized by attacks, like periodic schizophrenia; but its course, like that of continuous schizophrenia, leaves the patient progressively worse, even in between the attacks.

Over the years, Snezhnevsky and his students have elaborated on these three themes, describing several subtypes within each form and many syndromes within each subtype. Most important for the problem of dissident diagnoses is the fact that each of the three forms, particularly the continuous and the shift-like, is seen as representing a spectrum of clinical states, ranging from very mild to very severe. The mildest are typified by “symptoms” that merge into normality: social withdrawal, confrontations with parental and other authorities, philosophical concerns, and “reformism,” which is to say, the wish to change society. These mild states would almost never be considered schizophrenic in the West; they would be called normal, or neurotic, or, if persistent, signs of a character disorder. Western forensic psychiatrists—those psychiatrists called by courts or lawyers to examine individuals accused of crimes in order to determine whether they should be considered responsible for their actions or not responsible on account of mental illness—would rarely declare such persons not responsible.

What the Snezhnevsky system has done has been to corral these mild states into the realm of schizophrenia. The mild states are simply the mild ends of one of the three schizophrenic spectra, with each spectrum, or form, considered a separate genetic illness, with variable degrees of clinical expression. So a person with a mild form of continuous schizophrenia—known as “sluggish” schizophrenia—is, according to the canons of the Snezhnevsky system, just as schizophrenic in the biological sense as is a person at the clinically more severe end of the same form, and is considered to have the illness, in active or inactive form, for the rest of his life. The same holds for persons at the mild end of the shift-like form. And so when Soviet forensic psychiatrists evaluate dissidents without classical schizophrenic symptoms (such as hallucinations and delusions) but with reformist tendencies and other characteristics that are sometimes seen in genuine schizophrenics, they can render a diagnosis of schizophrenia; and, on the theory that schizophrenics should not be held accountable for their actions, they can pronounce them legally non-responsible.

What happens when they do this is that the diagnosed dissident is put on trial, a trial that may be held without him because he is considered too sick to attend; the judges almost always accept the psychiatrists’ diagnosis and finding of non-responsibility; and the dissident is sent not to a prison or labor camp but to a psychiatric hospital, usually of a “special,” high-security type, one designed to hold the criminally insane.

According to Western critics, what is accomplished by all this is that dissenting views are pronounced the sick products of sick minds; dissidents are deprived of the opportunity to defend themselves at open trials; and, without being given definite sentences that end after, say, three to seven years, they are sent to hospitals until they are pronounced well, a judgment that may not be made until the KGB decides they are well. Finally, should they ever dissent again, that dissent may be considered a sign of the recurrence of their lifelong disease.

Snezhnevsky’s system was not designed for dissidents alone. It has been used in hundreds of psychiatric hospitals and clinics on thousands of ordinary patients. It is just that its qualities make it possible for a dissident with mild personality quirks and with an insistent wish to reform society to be diagnosed as belonging within the schizophrenic fold, with all the legal and social liabilities that flow from that diagnosis.

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Given the Snezhnevsky system’s variations and permutations, it is nearly impossible to question a diagnosis. But I decided to try. I asked Snezhnevsky about Plyushch. I reminded him that, according to his own writings, Plyushch should have residual signs of the illness, even in remission. But neither I nor several other Western psychiatrists, I said, had found any. Snezhnevsky generously forgave my simplicity. He pointed out that while it was usually true that residual signs of illness could be found, Plyushch had a variant of shift-like schizophrenia, in which the first few remissions are characterized by normal functioning. Soviet treatment had been successful; ultimately, however, Plyushch would become ill, and progressively deteriorate. “Being a psychiatrist,” he told me, “you must know that there are long remissions and short ones. I don’t exclude the possibility that Plyushch will have a very long remission. And then an attack and another attack. Nor do I know when they will come. They might come at any time.”

I asked Snezhnevsky to describe Plyushch’s symptoms, the ones that had made him render a diagnosis of schizophrenia.

Earlier, Snezhnevsky explained, Plyushch had had an attack, a shift, during which he had given up mathematics and had begun studying psychology and entertaining the idea that he had a mission. His second attack was characterized by ideas of abstract political philosophy which were anti-Soviet in nature and which led to his arrest when he tried to distribute them in written form to others in violation of the criminal code.

I asked if Plyushch had any symptoms that Western psychiatrists would have required for a diagnosis of schizophrenia, such as hearing voices or believing in plots that did not exist.

Snezhnevsky laughed. “Yes, those are the classical teaching cases,” he said, the ones in textbooks. Plyushch and other mentally-ill dissidents did not have that kind of schizophrenia. Their symptoms were more subtle.

I told Snezhnevsky about Plyushch’s own version of his history. He had explained his interest in psychology by saying that he had just been dismissed from his job as a result of his dissenting activities, and, out of work, spent his time trying to help his wife in research on the psychology of children’s games. Both he and his wife felt that games could be devised that would help pre-school children mature in specific directions.

Snezhnevsky remembered the explanation and smiled in a way that suggested that I, too, could see that the notion was not a scientific theory but the preposterous obsession of a sick mind. I continued with Plyushch’s explanation. Plyushch had pointed out that the idea was not his alone—that a famous Soviet psychologist by the name of Elkonin had similar notions. “And if I’m crazy,” I quoted Plyushch as saying, “then so is Elkonin.”

“Well, then, probably Elkonin is crazy!” Snezhnevsky burst into laughter.

I tried to generalize from the Plyushch case. Even if the dissidents were ill, they were obviously only mildly ill. Why were they pronounced in need of hospitalization? Why were they treated with drugs?

Snezhnvesky dismissed the questions. He countered that, really, we were dealing with the same tired list of ten or so cases; and that even those ten fared much better in hospitals than they would have fared in prisons or in labor camps. In the end, he said, despite a theoretical possibility of indefinite hospitalization, in practice their hospital stays were almost always shorter than their sentences would have been had they not been declared legally non-responsible. To my question about the use of special hospitals rather than ordinary ones—special hospitals being much more restrictive and harsh—he answered that under Soviet law, dissent was a serious, dangerous crime and that those who dissented were considered dangerous criminals. A sick murderer had to be kept in strict confinement, since escape would endanger society; the same obtained in the cases of sick political dissidents.

Much of the interview was spent jockeying around subtle psychiatric distinctions. Whenever I thought I had laid out reasonable grounds within his own system for a precise question, Snezhnevsky cited an exception or a complication. When I was able to point to a clear conflict between his assumptions about the validity of his theories and the results of more objective measures and studies, he did not acknowledge that a conflict existed.

Snezhnevsky looked at his watch. The press conference would start in half an hour. He had to get dressed. He seemed sorry that we could not go on. All my thrusts, however pointed and learned, had been parried.

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Snezhnevsky has developed his diagnostic system over a period of many years. He has, in addition, taught it to generations of psychiatric students, several of whom have told me that he believes in its validity. He really believes that there are persons with mild symptoms and personality eccentricities who can—and should—be considered schizophrenic. He has fought for that concept, his students have accepted it, and intelligent Soviet psychiatrists accept it too. One, who emigrated from Leningrad after working there as a forensic specialist, told me that, despite his rejection of things Soviet, he thinks the Snezhnevsky approach, at least in non-dissident cases, makes sense—that it is better than the approach that prevailed in Leningrad before Snezhnevsky’s supplanted it in the mid-60’s, and that it is even better than approaches used in the West. The World Health Organization has given enough credence to the system to allow its use in the recent International Pilot Study of Schizophrenia.

After talking with Snezhnevsky, and after considering what I know about him, I too tend to think that he does indeed believe in the scientific validity of his basic approach to psychiatric diagnosis. While he must have knowingly misdiagnosed some of the dissident cases he has seen—he is just too adept politically not to know what to do when asked by the KGB to examine a prominent case—he may also believe that others have actually met his criteria for schizophrenia and have required that diagnosis. And even if that is not the case with Snezhnevsky himself, it may well be the case in diagnoses of dissidents done by his students or by those influenced by his teachings.

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If the Soviet private defense was played out in Snezhnevsky’s hotel room, the public one was presented at the well-prepared press conference a short time later. The tone was very different. The big guns were all there. No subtleties were discussed. Dmitri Venediktov, the Deputy Minister of Health, ran it. He introduced Babayan, Snezhnevsky, and the rest of the Soviet psychiatrists, including Nadzharov and Morozov, the two who were, together with Snezhnevsky, most closely associated with the diagnosis of dissidents. Venediktov also introduced a Soviet priest, who happened to be touring Honolulu. (In 1975, during a similar press conference in Copenhagen, the Soviets had not only introduced a Soviet priest who “happened to be touring” Copenhagen, but a Soviet rabbi who was also on tour, equipped with a large yarmulka. Dissident sources later identified the “rabbi” as a Moscow engineer.)

Much of the press conference was devoted to an attack on Psychiatric Terror, the book by Sidney Bloch and Peter Reddaway, which contains a list of some 210 dissidents said to have been wrongly diagnosed. Babayan cited the case of someone he said was on the list who was obviously ill. Grigorenko, one of the famous cases, was, he said, also ill. So were all the others. Bloch, Venediktov added, was a “doubtful” psychiatrist. Reddaway, Snezhnevsky suggested, was just someone who was bitter about having been expelled from Moscow ten years before.

The conference was boring. As with all press conferences, the fact that questions could not be followed up in a substantive way made it a forum for the organizers. Besides, the press had no idea what to ask. The only significant question was a plant. The Izvestia correspondent stood up. Wasn’t it curious, he asked, that the voting power of the various delegations was based on the payment of dues? He implied that the West, which had most of the votes, had in that way fixed the decision on the condemnatory resolution. That gave Venediktov the opportunity to agree and to criticize the organization of the congress and its rules on voting. The issue would become a lively one that night.

The hours between the press conference and the vote were dotted with meetings and counter-meetings. A medical student of Ukrainian descent, an active pro-condemnation lobbyist, introduced me to someone he thought would be able to get through to the Brazilian delegate. At a cocktail party, I watched as two Soviet psychiatrists, Nadzharov and Zharikov, weaving through the throng, found themselves face to face with a former colleague, one who had been fired from their institute after applying to emigrate. Wordlessly, they executed a military right turn. In the Sheraton’s lobby, Venediktov, who had just told the world that Sidney Bloch was a “doubtful” psychiatrist, brushed by him; neither knew who the other was.

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VI

The General Assembly debate began with an objection from Babayan. The official Soviet delegate was bitter. The West had had six years to heap calumnies on Soviet psychiatry. Scurrilous literature had been stacked in the lobby for days. How could the WPA impose a half-hour time limit on the debate? How could the delegates vote without a sufficient chance to hear the Soviet side?

The American delegate argued against Babayan’s motion for unlimited debate. So did the WPA’s parliamentarian. And so did the WPA’s own executive committee. The General Assembly voted 23-21 to limit debate.

Then, Item 10, the Declaration of Hawaii, came up. Babayan, anticipating Item 11, the one calling for condemnation of his society, was testy. He complained that the declaration assumed a confrontation between the doctor and the patient, with society on the side of the doctor. Doctor and patient were, he insisted, in league with each other. There was no need for patient advocacy. There was no need to question the allegiance of the doctor. For years the Soviets had been insisting that their laws did not call for judicial review of psychiatric commitments because the Soviet psychiatrist could not possibly have any reason to misdiagnose or mistreat a patient. But Babayan did not press his complaint. He would save his words for the next two agenda items. He agreed to the declaration, and it was passed unanimously.

The Australian-New Zealand delegate, John Grigor, explained his society’s amendment to the British resolution, which, because it added to that resolution, took its place on the agenda. It called for condemnation of psychiatric abuse “in all countries in which they occur” and asked psychiatrists in those countries to “renounce and expunge those practices.” It further asked “that the WPA implement this resolution in the first instance in reference to the extensive evidence of the systematic abuse of psychiatry for political purposes in the USSR.”

Grigor had begun attending the regular meetings of the pro-condemnation caucus the day before, together with Peter Sainsbury, the British delegate. He was now sitting next to Babayan, who had scrawled JABBERWOCKY across his copy of the Declaration of Hawaii. Grigor told the General Assembly that psychiatrists had to look at themselves without fear. If they don’t police themselves, he warned, others will. He urged that they vote for his society’s resolution. It was strong and it had to be.

Babayan was sarcastic. “You speak about systematic abuse. I’d like you to present official materials . . . do you have any official data in addition to the materials presented in the lobby?”

Grigor explained that it had been difficult to visit the Soviet Union. Documentation of abuse had been collecting for years. Jack Weinberg, the American delegate, backed up Grigor. The documentation had come from Amnesty International and from psychiatrists who had left the Soviet Union.

Babayan was not satisfied. He referred to the documentation as “allegations.” “It’s not enough to say, ‘we have voluminous materials.’” He wanted to see certificates by Western psychiatrists who had examined formerly hospitalized dissidents. In fact, the Western societies had not prepared well enough. Such signed certificates could have been assembled; several Western psychiatrists had examined dissidents who had been hospitalized and found them to be well. But no formal certificates had been prepared, and Babayan knew it. He continued to press the point. How could the General Assembly approve false and unsupported allegations? Did it know that several of the so-called dissidents had been hospitalized once they reached the West? That at least one had committed suicide? (He was right, in a few cases. Others he cited were not dissidents. The famous ones who had reached the West, however, had remained out of hospitals.)

Babayan pressed on. The charges against Soviet psychiatrists were slanderous. They do not, he insisted, use drugs as punishments. They use the same drugs used in the West. In fact, unlike the West—this, in an apparent allusion to emerging revelations about the CIA—the USSR had outlawed the use of LSD. Read our case histories, he urged. Your information is based on the testimony of sick patients and ignorant people.

Grigor bounced back with equal sarcasm. “If Dr. Babayan had been born in the West, he would have made an excellent Jesuit.” He accused Babayan of shifting the issue by introducing the assumption that the dissidents were ill and concentrating on the irrelevant question of drug dosages. Babayan seemed hurt; he was, he complained, “insulted by being called a Jesuit.”

The East German delegate warned that “serious consequences” would ensue if the resolution were carried. The Cuban delegate jumped up in a white heat. The accusations, he said, were monstrous, cowardly, and disgusting. Years before, he too had been accused of similar abuses. Now the Soviets were getting the same treatment. The Bulgarian delegate added his voice: “We consider these allegations as totally unfounded, tendentious, and malicious.” The Swedish delegate suggested that the WPA was not the right place to air the issue.

_____________

 

The momentum began to turn against the resolution, but time was on its side. The president of the WPA called for a vote. Babayan protested but the president refused to recognize him. The Soviet psychiatrist Vartanyan, present at the meeting in his capacity as associate secretary of the WPA, called for “justice.” The president insisted on a vote. The Japanese delegate asked if he could abstain. The secretary-general said he could. One light-yellow ballot was passed to each delegate marked with the number of votes his society was empowered to cast. The ballots were filled in secretly and returned to the tellers. The secretary-general announced the results: total votes cast, 186; invalid (abstaining), 8; yes, 90; no, 88. The resolution was passed by two votes.

The narrowness of the victory was startling. Had the Poles shown up in Honolulu with their three votes, the decision would have gone the other way. Had the Soviet Union been prescient enough to pay its dues—actually, only $280 more—it would have had three more votes to cast.

In fact, the delegates were overwhelmingly against the resolution. Of the 55 casting ballots, 33 had said “no” and only 19 “yes,” with three abstaining. Most of the delegates voting against, however, had only one or two votes. Since the balloting was secret, it would never be possible to be sure which countries had gone which way. The U.S., Canada, Britain, Australia, and New Zealand had certainly supported the resolution. They accounted for 57 votes. Two of France’s 9 votes were also affirmative. That made 59. Others in the yes column probably included West Germany (9), Israel (1) and, possibly, the Netherlands (8), Belgium (2), and Italy (6). On the negative side were the Eastern-bloc societies, almost surely the Scandinavians, and the vast bulk of Asians and Africans, most of whom had only one vote. Japan presumably abstained.

The next agenda item was the American resolution calling on the WPA to set up a committee to perform on-site investigations in cases of alleged abuse on the part of any WPA member society. Babayan fought on. Such a committee would be too expensive. It would be an illegal infringement on national sovereignty. It Was obviously aimed at the Soviet Union. He again protested the use of weighted ballots. He turned to Grigor and complained, “This is all political.” Grigor responded: “No, it’s an issue of human rights.” Apparently, the delegates agreed with Grigor. This time, given the chance to vote for future purity rather than present blame, they passed the American resolution by a greater margin, 121-66.

Babayan left the room, the press after him. He would not say whether or not his society would quit the WPA.

_____________

 

The midnight victory party overflowed into the hall. Thirteen caucus members were there, three delegates, and, passing through, a half-dozen well-wishers.

Predictions abounded. Snezhnevsky, Nadzharov, and Morozov would be removed, or their future activities curtailed. Those Soviet psychiatrists who had maintained a low profile until then would rise: Kabanov, for example, a party man who had never diagnosed a single dissident. A shift away from Snezhnevsky’s theories would take place. The Soviets would have to stop diagnosing dissidents. They would be unable to come to the follow-up conference on the Helsinki agreements in Belgrade claiming, as they had before, that everyone approves of their behavior. The WPA, through its actions in Hawaii, would regain the respect it lost in Mexico City.

A Ukrainian present announced that inmates of Soviet labor camps had been prepared to stage mass hunger strikes if the resolutions had not been passed. He circulated postcards addressed to one of those inmates, Semyon Gluzman, a young Kiev psychiatrist who had been arrested for writing an underground critique of a dissident’s misdiagnosis. The celebrants stopped for a moment to pen him the news.


Footnotes

1 Psychiatric Terror, by Sidney Bloch and Peter Redd-away, Basic Books, 510 pp., $12.95.

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