The politics of mental illness

Thomas Szasz

The present popular protest against Soviet Psychiatric abuses is not only a flagrant case of selective indignation, it is, so far as prominent American psychiatrists and the American Psychiatric Association (APA) are concerned, also a case of crass hypocrisy. Since the late 'sixties, many leading American psychiatrists as well as the APA have heaped praise on the Soviet mental health system and on several leading Russian psychiatric criminals. I propose to exhume this body of American (and British) support for Soviet psychiatry and use it, much as a pathologist might use a corpse, to establish the responsibility for Russian psychiatric repressions that Western psychiatric totalitarians share with their Soviet colleagues. Western awareness of, and concern with, Psychiatric abuses in the Soviet Union began in 1965, with the publication in Bri

tain of Valery Tarsis's book Ward 7, a thinly

disguised autobiographical novel setting forth the psychiatric persecution, incarc eration, and torture of a writer critical of the Soviet system. Although Tarsis titled his book, still probably the best account of Soviet psychiatry that we have, so as to alert the reader to the fundamental similarities between Soviet psychiatry as he exposes it and Czarist psychiatry as Chekhov exposed

it in 1892 in his Ward No. 6, the Western press and Western psychiatrists have stub

bornly ignored the historical continuity

characteristic of institutional psychiatry throughout the world. Tarsis recognised

that the real enemy was psychiatric power, Wherever it existed and whatever shape it assumed. The result of his book, however, Was the unleashing of a journalistic and pro fession criticism of coercive psychiatry that in fact, doubly selective: it is aimed

c'ttlY at Soviet psychiatry and ignores the Parallel problems and practices in Western countries; and it is aimed only at protecting so-called 'sane intellectuals' or 'political

dissidents from psychiatric imprisonment and torture and ignores the predicament of

'Insane intellectuals' or 'non-political dissidents' subjected to identical persecutions and punishments. I shall remark on each of these matters presently. Before doing so, irlowever, I want to deliver the exhumed body I promised. In the November 1969 issue of the Interilational Journal of Psychiatry, Mike Gor man, then the celebrated Executive Direct°r of the National Committee Against Ill ness, published a report entitled 'Soviet PsYchiatry and the Russian Citizen.' To call Gorman's article adulatory would be an understatement. A single quotation from it should suffice to illustrate his views: 'Leav

ing aside the paramount virtue of a psychiatric system that brings a high quality of care to all those in trouble without any invidious economic distinctions, it is my considered opinion that the tailoring of psychiatric care in all kinds of settings – in the school, in the factory, in the dispensary, in the emergency services, in the home –to the individual needs of each patient is the crowning achievement of Soviet psychiatry.'

Accompanying Gorman's article was a 'critical evaluation' of it by Zigmond Lebensohn, a card-carrying institutional psychiatrist and long-time spokesman for APA policies. 'As a Gorman-watcher of many years standing,' wrote Lebensohn, 'I !read his paper and could hardly believe my eyes. Gone were the sharp barbs and telling innuendoes, which have characterised so many of his diatribes on practically all aspects of psychiatry in the United States. Instead, we find him in a mellow and expansive mood, describing Soviet psychiatry in roseate terms with enthusiasm, eulogy, and panegyrics.'

In the late 1960s, Gorman was, of course, articulating the then 'correct' American psychiatric position on Russian psychiatry. His voice was in perfect harmony with the views of leading American psychiatrists and the APA. For example, in 1968, Dr An Kiev, a recognised expert on Soviet psychiatry, edited and contributed two chapters to a book entitled Psychiatry in the Communist World, in which there is not a single reference, however oblique, to the psychiatric incarceration of political dissenters. (Both the Tarsis case and the case of General Grigorenko had at that time already been widely reported in the newspapers.) In 1969, Dr Kiev published an article in the magazine Attitude reviewing Soviet psychiatric theory and practice, again without any reference to psychiatric abuses.

I should like to pause here in my presentation of the evidence against American psychiatry's posture vis-a-vis Soviet psychiatry and note that, even before 1970, the American mental health establishment's hypocrisy on this subject was glaringly obvious. When American newspapermen then looked at Soviet psychiatry, they saw its horrors clearly and reported them honestly. In December 1969, for example, Time magazine ran a piece entitled 'Dissent = insanity,' reporting on General Grigorenko's psychiatric persecution. On February 2, 1970, Parade magazine published a long essay by Lloyd Shearer denouncing Soviet psychiatric atrocities. However, when American psychiatrists and mental health experts looked at the same scene, all they saw was a Russian psychiatric paradise which Americans could not emulate fast enough.

To appreciate fully the APA's support of, and indeed complicity in, Soviet psychiatric abuses, it is necessary now to name two of the leading Soviet psychiatrists responsible for them. The highest ranking, best known, and most influential psychiatrist in the Soviet Union is Professor Andrei V. Snezhnevsky, director of the Institute of Psychiatry of the Academy of Medical Sciences. All Russian critics of Soviet psychiatry identify Snezhnevsky as the person most responsible for the psychiatric persecution of dissidents. In 1970, at the annual meeting of the APA held in San Francisco, the Association named Snezhnevsky a 'distinguished fellow' for his 'outstanding contribution to psychiatry and related sciences.' Also named as a 'distinguished fellow' was Dr Boris Lebedev, the director of the World Health Organisation's project on 'Psychiatric Diagnosis, Classification, and Statistics,' who, too, has been identified as a leading figure in the psychiatric disposition of dissidents.

Viewed against this background, it is not surprising that the efforts of some groups to secure the condemnation of Soviet psychiatric abuses by official Western psychiatric bodies have met with something less than resounding success. One of the earliest such attempts was a report by a committee of the Canadian Psychiatric Association, issued in January 1971, which condemned 'the alleged wrongful detention in mental hospitals in the USSR of seemingly healthy individuah: whose views and attitudes are in conflict with those of the regime.' That report became the nucleus of a more broadly based effort to pass a resolution at the fifth congress of the World Psychiatric Association (WPA), meeting in Mexico City in November 1971. The attempt was foiled by the Russian and pro-Russian forces in the WPA, led by its secretary-general, Dr Denis Leigh, whose concluding report declared: 'Nowhere in the statutes is there any mention of the WPA making itself responsible for the ethical aspects of psychiatry.'

Dr Leigh did not have long to wait for his reward for that intervention. The following year, both Dr Leigh and Professor Linford Rees, the treasurer of the WPA, were made honorary members of the All-Union Society of Neurologists and Psychiatristi. According to Sidney Bloch and Peter Reddaway, Leigh at that time asserted 'that in his opinion the campaign against Soviet abuse was a sophisticated and expensively organised operation, with CIA participation; that he doubted the authenticity of the evidence; and that 'Vladimir] Bukovsky lone of the psychiatrically incarcerated dissidents] was indeed a schizophrenic, or at any rate had a history of the condition.' Professor Snezhnevsky concurred: 'It jthe attempt to condemn alleged Soviet psychiatric abuses] is a "cold war" manoeuvre carried out by expert hands.'

In 1973, in an interview in the Observer, Leigh explained his position in this way: 'We ,[the WPA1 are not concerned with political matters... . Schizophrenia is the most important topic in psychiatry. It's the scourge of the world. The Russians have

about 200 people researching on it and they have a good chance of solving it. That's all there is to it.' Sean MacBride, the chairman of Amnesty International, supported Leigh and the Russians, declaring: 'I think there has been a good deal of exaggeration in the foreign press reports in regard to the extent, if any, to which psychiatric hospitals are being used in dealing with political prisoners.'

During the years since then, the popular as well as the psychiatric press have continued their campaign of selective indignation and protest. Typically, articles in the popular press would condemn Soviet emigration policies preventing Russian Jews from leaving the country; the writers of such articles must believe that it is quite proper for the Soviet government to prevent Russian Christians from leaving their country. Similarly, articles in both the popular press and in psychiatric journals would condemn Soviet mental health policies preventing Russian dissidents from leaving mental hospitals; the writers of such articles must likewise believe that it is quite proper for the Soviet government to prevent Russian non-dissidents from leaving mental hos pitals. That Soviet Russia is a police state that it is, as it were, one big prison, con centration camp, or mental hospital is a fact at once too simple, obvious, and unpalatable for many observers of the contemporary political and psychiatric scene to admit.

At long last, on September 1, 1977, Western psychiatry won a Pyrrhic victory over Soviet psychiatry. At the sixth con gress of the WPA, meeting in Honolulu, the British Royal College of Psychiatrists intro duced a resolution condemning 'the systematic abuse of psychiatry for political

purposes in the USSR.' The General Assembly of the WPA passed that resolution by a vote of 90 to 88. In August 1977 I was on a lecture tour ill Australia. Anticipating just such an outcome in the tragi-comic struggle between the forces of psychiatric good and evil, I repeatedly called attention to the basic similarities between institutional psychiatry on both sides of the Iron Curtain. After the resounding victory of the forces of good over evil in Honolulu, Frank KnOPfelmacher, professor of psychology at Melbourne University, offered the following perceptive comments on the crucial similarities, and differences, between the political-psychiatric situation in Russia and America: 'In a strict sense there is not much difference between Soviet and American psychiatry in terms of moral rectitude and intellectual probity, as Szasz was fully justified in pointing out. As professions, they are both much of a muchness. This may very well be the reason why the Western psychiatric profession showed its now notorious reluctance to condemn Soviet psychiatry, and why they had to be shamed from without, sometimes by the most elaborate methods, to "protest". The difference between our own and Soviet uses of psychiatry lies elsewhere. , It is a very complex difference but its gist lean be indicated thus. Unlike General Grigorenko and the psychiatrist Gluzman, who revealed the uses of Soviet psychiatry, Senator Goldwater and Thomas Szasz are not in concentration camps. And they certainly do not depend for their physical survival on pleas and protests from the psychiatrists of the Serbsky Institute lone of the notorious Soviet "special hospitals"1.'

However obvious they might be, certain elementary facts about Soviet society must be stated and restated, lest one succumb to the temptation to engage in the debate between Soviet psychiatrists and their Western critics on their own false terms. Russia is a closed society: one cannot leave it at will. In Russia, the state is the psychiatrist's only employer: Soviet psychiatrists either work for the state or get out (if they can), or get locked up (as insane). In Russia, rejecting the moral and political principles of Marx

ism and Communism is regarded as a characteristic symptom of schizophrenia: the Russian psychiatrist may be quite 'sin

cere' in believing that dissidents are demented.

It is clear, then, that from a libertarian viewpoint the line betweeti the Soviet uses

and abuses of psychiatry is an invisible one:.

All of Soviet psychiatry is an instrument or the political power of the Russian state, just, as most of our psychiatry is an instrument °I the political power of the American state. Wrenching analyses of psychiatric practices out of their historical, economic and polit: ical contexts is an exercise not only in bail ity but also in foolishness.

This article has been reprinted from /pupil magazine, San Francisco.