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Political Abuse of PsychiatryAn Historical Overview

Robert van Voren1,2

2Global Initiative on Psychiatry, Postbus 1282, 1200 BG,Hilversum, The Netherlands

The use of psychiatry for political purposes has been a majorsubject of debate within the world psychiatric communityduring the second half of the 20th century. The issue becameprominent in the 1970s and 1980s due to the systematicpolitical abuse of psychiatry in the Soviet Union, whereapproximately one-third of the political prisoners were

locked up in psychiatric hospitals. The issue caused a majorrift within the World Psychiatric Association, from whichthe Soviets were forced to withdraw in 1983. They returnedconditionally in 1989. Political abuse of psychiatry took alsoplace in other socialist countries and on a systematic scale inRomania, and during the first decade of the 21st century, itbecame clear that systematic political abuse of psychiatry isalso happening in the Peoples Republic of China. The articlediscusses the historical background to these abuses and con-cludes that the issue had a major impact on the developmentof concepts regarding medical ethics and the professionalresponsibility of physicians.

Key words: ethics/human rights/history

Time and again, human rights and mental health organ-izations receive reports on cases of abuse of psychiatryfor political purposes. The fact that these reports comefrom a wide range of countries shows that there is an on-going tension between politics and psychiatry and thatthe opportunity to use psychiatry as a means to stifleopponents or solve conflicts is an appealing one, notonly to dictatorial regimes but also to well-establisheddemocratic societies.

According to a position article of the Global Initiativeon Psychiatry (GIP), political abuse of psychiatry refersto the misuse of psychiatric diagnosis, treatment and de-tention for the purposes of obstructing the fundamentalhuman rights of certain individuals and groups in a givensociety. The practice is common to but not exclusive tocountries governed by totalitarian regimes. In these

regimes abuses of the human rights of those politicallyopposed to the state are often hidden under the guiseof psychiatric treatment. In democratic societies whistleblowers on covertly illegal practices by major corpora-tions have been subjected to the political misuse of psy-chiatry. (The full text of the position article of GIP canbe ordered from GIP.)

Historically seen, using psychiatry as a means of re-pression has been a particular favorite of Socialist-orientedregimes. An explanation might be found in the fact thatSocialist ideology is focused on the establishment of the

ideal society, where all are equal and all will be happy,and thus, those who are against must be mad. In fact,this second part seemed to have had the strongest influ-ence because even in the Soviet Union of the 1970s, wheremany were not happy and society was far from ideal,many psychiatrists still believed that those who turnedagainst the regime must be mad.

The political abuse of psychiatry in the Soviet Unionoriginated from the concept that persons who opposedthe Soviet regime were mentally ill because there was noother logical explanation why one would oppose thebest sociopolitical system in the world. The diagnosis

sluggish schizophrenia, an old concept further devel-oped by the Moscow School of Psychiatry and in par-ticular by its leader Prof Andrei Snezhnevsky,provided a very handy framework to explain this behav-ior. According to the theories of Snezhnevsky and hiscolleagues, schizophrenia was much more prevalentthan previously thought because the illness could bepresent with relatively mild symptoms and only progresslater. As a result, schizophrenia was diagnosed muchmore frequently in Moscow than in other countries inthe World Health Organization Pilot Study on Schizo-phrenia reported in 1973.1 And, in particular, sluggishschizophrenia broadened the scope because according

to Snezhnevsky and his colleagues patients with this di-agnosis were able to function almost normally in the so-cial sense. Their symptoms could resemble those ofa neurosis or could take on a paranoid quality. The pa-tient with paranoid symptoms retained some insight inhis condition but overvalued his own importance andmight exhibit grandiose ideas of reforming society.Thus, symptoms of sluggish schizophrenia could bereform delusions, struggle for the truth, andperseverance.2

1To whom correspondence should be addressed; tel: 31-35-6838727, fax: 31-35-6833646, e-mail: rvvoren@gip-global.org.

Schizophrenia Bulletindoi:10.1093/schbul/sbp119

The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.For permissions, please email: journals.permissions@oxfordjournals.org.

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Schizophrenia Bulletin Advance Access published November 5, 2009

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While most experts agree that the core group of psy-chiatrists who developed this concept did so on the ordersof the party and the Soviet secret service KGB (KomitetGosudarstvennoi Bezopasnosti) and knew very well whatthey were doing, for many Soviet psychiatrists thisseemed a very logical explanation because they couldnot explain to themselves otherwise why somebody

would be willing to give up his career, family, and hap-piness for an idea or conviction that was so different fromwhat most people believed or forced themselves to be-lieve. In a way, the concept was also very welcome be-cause it excluded the need to put difficult questions tooneself and ones own behavior. And difficult questionscould lead to difficult conclusions, which in turn couldhave caused problems with the authorities for the psychi-atrist himself.

On basis of the available data, one can confidently con-clude that thousands of dissenters were hospitalized forpolitical reasons. The archives of the International Asso-

ciation on the Political Use of Psychiatry (IAPUP) con-tained over a 1000 names of victims of whom we hadmultiple data (name, date of birth, type of offense, andplace of hospitalization), all information that hadreached the West via the dissident movement. However,this number excluded the vast gray zone, people whowere hospitalized usually for shorter periods of time be-cause of a complaint to lower officials, conflicts with localauthorities, or unorthodox behavior. It is estimated thatthis group was much larger. Their names were, however,not known to the dissident movement and thus notrecorded in the west. A biographical dictionary publishedby IAPUP in 1990 listed 340 victims of political abuse ofpsychiatry as well as more than 250 psychiatrists involvedin these practices.3 An investigative commission of Mos-cow psychiatrists, who researched the records of 5 prisonpsychiatric hospitals in Russia from 1994 to 1995, foundapproximately 2000 cases in these hospitals alone.4

As indicated before, many of these psychiatrists wereprobably unaware that they engaged in unethical behav-ior and that they were part of a governmental repressivemachinery. For example, Ukrainian psychiatrist AdaKorotenko found out only in the mid-1990s that formercolleagues of her had been involved in the political abuseof psychiatry when she participated in a Ukrainian study

into the origins of political abuse of psychiatry and in thecourse of that study examined 60 former victims. Underthe original Soviet diagnoses, she found the names notonly of former colleagues but also even of some of herfriends. While interviewing the former victims and com-paring their state of mind with the original diagnoses, sherealized not only that they had been hospitalized for non-medical reasons but also that she could have authoredthe original diagnoses herself. (See Korotenko andAlkina4 and private conversations of the author withDr Korotenko. Other former Soviet psychiatrists con-firmed this dilemmasee van Voren.5)

The Soviet Union is certainly not the only countrywhere these abuses took place. Over the past decades,we have seen a lot of documentation on other countries.(The author was one of the founding members of theIAPUP. This organization was later renamed in GenevaInitiative on Psychiatry, and since 2005, it is called GIP.See van Voren5) One of the countries where systematic

political abuse of psychiatry seemed to have taken placewas Romania; in 1997, IAPUP organized an investigativecommittee to research what actually happened and cameto the conclusion that several hundred people had beenvictims of systematic abuse.6 Like in the Soviet Union, onthe eve of Communist festivities, potential trouble-makers were delivered to psychiatric hospitals by bus-loads and released when the festivities had passed.

In the 1980s, we also received information on cases inCzechoslovakia, Hungary, and Bulgaria, but all thesecases were individual, and there was no evidence thata system of abuse was in place. Information on political

abuse of psychiatry in Yugoslavia, received in the 1980s,was inconclusive. (The Review Committee of the WorldPsychiatric Association came to the same conclusion. Seetravel report of Prof J. Neumann on the WPA ExecutiveCommittee meeting in Sydney, May 1987: p3. The privatedocument is in the authors possession.) An extensive re-search on the situation in Eastern Germany concludedthat there had not been any political abuse of psychiatry,although in this Socialist country politics and psychiatryappeared to be very closely intermingled.7 Later, infor-mation appeared on the political abuse of psychiatryin Cuba, which was, however, short lived.8 In the1990s, the successor organization to IAPUP, the GIP,was involved in a case of political abuse of psychiatryin The Netherlands, in the course of which the Ministryof Defense tried to silence a social worker by falsifyingseveral psychiatric diagnoses. The case took many yearsto be resolved, and although the victim was compensatedand even knighted by the Dutch Queen, it is still not fullyresolved as the Ministry refuses to discard his medicalfiles and keeps him on regard as a mental patient. (Forthe case of Fred Spijkers, see Nijeboer.9)

And, finally, since the beginning of this century, theissue of political abuse of psychiatry in the Peoples Re-public of China is again high on the agenda and has

caused repeated debates within the international psychi-atric community. The abuses there seem to be even moreextensive than in the Soviet Union in the 1970s and 1980sand involve the incarceration of followers of the FalunGong movement, trade union activists, human rightsworkers and petitioners, and people complainingagainst injustices by local authorities.10,11

During the years of our existence, we were regularlyapproached with requests to deal with abusive situationsin psychiatry in countries such as South Africa, Chile,and Argentine. However, on basis of research, we con-cluded that in these cases one could not speak of political

R. van Voren

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abuse of psychiatry. In the case of South Africa, severeabuses were the result of the policy of apartheid, whichresulted in very different conditions in mental health serv-ices for the white ruling class and the black majority ofthe population. Claims that psychiatry was abused asa means of political or religious repression were neverconfirmed. In South America, the abuse concerned

psychiatrists themselves, not psychiatry as such: Psychia-trists were used to determine which forms of torturewere the most effective, and although these abuses clearlyconstituted a serious violation of the Hippocratic Oath,they could not be classified as political abuse ofpsychiatry.

Admittedly, those involved in the struggle against po-litical abuse of psychiatry never reached full consensus onwhat the exact boundaries were between political abuseof psychiatry and more general misuse of psychiatricpractice. The definition of political abuse of psychiatryas worded in the GIP position article is the closest we

got to a consensus. In the course of the years, many in-dividual cases were discussed extensively, determiningwhether it should be considered as one of political abuseof psychiatry or not. The issue continues to be discussed,in particular, because recent cases are often more com-plex and involve a less overt government involvement.

The question remains whether political abuse of psy-chiatry is on the wane or still used as extensively as be-fore. On one hand, it seems that the number of countriesthat have a system of political abuse of psychiatry hassignificantly decreased since the collapse of communismin Eastern Europe. The only country that seems to abusepsychiatry for political purposes in a systematic manneris the Peoples Republic of China, and in spite of inter-national criticism, this appears to be continuing. Onthe other hand, reports on individual cases continue toreach us, including reports from Russia where the dete-riorating political climate seems to create an atmospherein which local authorities feel that they can again use psy-chiatry as a means of intimidation.

Looking back, the issue of Soviet political abuse of psy-chiatry had a lasting impact on world psychiatry as well ason the World Psychiatric Association. The most positiveconclusion is that the issue triggered the discussions onmedical ethics and the professional responsibilities ofphysicians (including psychiatrists), resulting in the Dec-laration of Hawaii and subsequent updated versions. Also

many national psychiatric associations adopted suchcodes, even though adherence was often merely a formal-ity, and sanctions for violating the code remained absent.

References

1. World Health Organization.The International Pilot Studyon Schizophrenia. Geneva, Switzerland: World HealthOrganization; 1973.

2. Bloch S. Soviet psychiatry and snezhnevskyism. In:v an Vor en R, ed. Soviet Psychiatric Abuse in theGorbachev Era. Amsterdam, The Netherlands: IAPUP;1989:5561.

3. Koppers A. A Biographical Dictionary on the Political Abuseof Psychiatry in the USSR. Amsterdam, The Netherlands:IAPUP; 1990.

4. Korotenko A, Alkina N. Sovietskaya PsikhiatriyaZabluzh-deniya I Umysl. Kiev, Ukraine: Sphera; 2002:29.

5. van Voren R. On Dissidents and Madness. Amsterdam, TheNetherlands: Rodopi; 2009:168171.

6. Mueller GOW, Ayat M, Adler N. Psychiatry Under Tyranny.An Assessment of the Political Abuse of Romanian PsychiatryDuring the Ceaucescu Years. Amsterdam, The Netherlands:IAPUP; 1998.

7. Suss S. Politisch Missbraucht? Psychiatrie und Staatssicher-heit in der DDR. Berlin, Germany: Ch. Linke Verlag;1998.

8. Brown Ch, Lago A. The Politics of Psychiatry in Revolution-ary Cuba. New York, NY: Transaction Publishers; 1991.

9. Nijeboer A. Een man tegen de Staat. Breda, The Netherlands:Papieren Tijger; 2006.

10. Munro R. Judicial Psychiatry in China and its Political Abu-ses. Amsterdam, The Netherlands: GIP; 2001.

11. Munro R. Chinas Psychiatric Inquisition. London, UK:Wildy, Simmonds & Hill; 2006.

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