Combatting a Return of Political Abuse of Psychiatry in Russia
Over the past year the issue of political abuse of psychiatry in the former USSR, and in Russia in particular, has reappeared on the international agenda. In particular the case of Mikhail Kosenko stimulated the debate. Kosenko, a Muscovite who was arrested after the demonstrations on Bolotnaya square in 2012, was found in October 2013 to be of unsound mind and sentenced to a compulsory psychiatric treatment in a psychiatric institution. The case resulted in an outcry that Soviet psychiatric abuse had returned in full force.
Reports on the recurrence of political use of psychiatry in Russia have surfaced repeatedly, and with increasing frequency, over the past years. Some NGO’s have called for actions similar to those carried out in the 1970s and 1980s against Soviet psychiatry, which led to the forced departure of the Soviet psychiatric association from the World Psychiatric Association (WPA) in 1983 and, eventually, to a US State Department visit in March 1983 to assess whether Soviet political abuse of psychiatry had come to an end.
The issue is whether current abuses of psychiatry in Russia can be compared to the systematic system of psychiatric repression against dissidents in Soviet times, and what action should be undertaken to end such abuses if the allegations prove to be justified.
In order to understand the current situation in mental health care in the former USSR, one has to analyze the context within which the political abuse of psychiatry developed during the Soviet period. On basis of the now available evidence one can safely conclude that the system of political abuse was carefully designed by the KGB in order to rid the country from undesired elements. However, psychiatry itself lend itself to become such a perfect tool of repression because it had been totally separated from world psychiatry and was monopolized by one school of thought based in Moscow. Hence, through a system of totalitarian control, Soviet psychiatrists could be easily (and often unknowingly) turned into wheels in this repressive machinery.
After the fall of Soviet power, attempts were made to open Soviet psychiatry to the world. However, in some of the former Soviet republics (notably in the Russian Federation and most of the Central Asian Republics) the old nomenklatura maintained its powerbase, effectively keeping post-Soviet psychiatry under their control and free from Western influence. When, after the assumption of Vladimir Putin to power in 2000, the political climate in the Russian Federation started to deteriorate, local officials felt it was possible again to revert to old mechanisms of subduing bothersome citizens by scaring them off with the psychiatric threat.
The case of Kosenko can be considered a turning point as far as international attention is concerned, yet at the same time shows the complexity of the matter. Mikhail Kosenko has a 12-year history of mental illness, yet was living a stable and quiet life in Moscow, living with his sister and spending much of his time reading books. The original diagnosis was sluggish schizophrenia, a diagnosis that very much reminds of past Soviet psychiatry and is rather debatable.
The trial against the 27 Bolotnaya defendants is highly political and even though interest in the West is mostly focused on Pussy Riot and the Greenpeace activists incarcerated in September, the Bolotnaya case is in fact much more significant as a show trial against political opponents. In that sense, Kosenko’s verdict is a purely political one, and thus it is the first time that an opponent is sentenced to a psychiatric hospital in the Russian capital under the eyes of the international media.
While the case of Kosenko can be seen as a litmus test and a re-examination and comparison of the two diagnoses could reveal the state of affairs both in this case in particular and in Russian psychiatric diagnostics in general, the issue of a possible return of political abuse of psychiatry in Russia deserves a much wider and more intense intervention. What is vital in this respect is to develop a clear understanding how to stimulate both resilience and self-regulation within the Russian psychiatric profession, as this is in the long run the only sustainable and lasting way of defending medical ethics and the obligations of the Hippocratic Oath within Russian psychiatry.
Among the interventions to be considered are the development of a Russian-language publication plan for mental health professionals in Russia by making use of modern technology in order to make contemporary mental health literature accessible to rank and file mental health professionals, as well as training seminars, online courses (e-learning) on issued related to patient rights, human rights, medical ethics and the CRPD of the United Nations. Important is the understanding that change needs to come from within, that Russian mental health workers themselves need to find the courage and means to stand up and refuse old practices to return.
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