Beginning in the early 1970s, reports began to reach the West that political and religious dissidents were being incarcerated in maximum security psychiatric hospitals in the Soviet Union without any medical justification. In 1977, the World Psychiatric Association condemned the Soviet Union for this practice, and six years later, the All-Union Society of Neuropathologists and Psychiatrists resigned from the WPA rather than face almost certain expulsion. Soviet psychiatric repression, representing a simultaneous violation of human rights and breach of medical ethics, became a subject of intense concern in human rights circles and also within the world medical community.
Throughout this period, while reports of continued repression multiplied, Soviet psychiatric officials denied the charges of abuse and refused to permit international bodies to see the patients and hospitals in question. In 1989, however, the stonewalling of Soviet psychiatry was overtaken by glasnost and perestroika. Over the objection of the psychiatric leadership, the Soviet government allowed a delegation of psychiatrists from the United States, representing the U.S. Government, to conduct extensive interviews of suspected victims of abuse and to make unrestricted site visits to hospitals selected by the delegation.
The first author was privileged to serve on the 1989 U.S. delegation as well as on a review team of the World Psychiatric Association, which conducted a similar visit in 1991 as a follow-up to the conditional readmission of Soviet psychiatry to the WPA in October, 1989. The second author represented the Soviet side in two days of talks between the U.S. delegation and the Soviet professionals in the USSR Ministry of Foreign Affairs in March, 1989 and provided technical assistance to the WPA review team in 1991. Since 1993, we have been working with a network of reform-minded psychiatrists and other mental health professionals from the successor states of the Soviet Union and other formerly communist regimes to establish improved systems of psychiatric care. Over this period, we have had an opportunity to reflect on the uses of coercive psychiatry in the former Soviet Union and assist the efforts of colleagues who have taken up the challenge of reform.
After briefly summarizing the findings of the 1989 delegation-which confirm a much larger body of evidence compiled by human rights advocates over a 20-year period2-we will summarize our own views about the causes of Soviet psychiatric abuse and the steps that will be necessary to erase the legacy of totalitarian psychiatry in the post-Soviet era.