No Asylum: State Psychiatric Repression in the Former USSR

The authors of No Asylum refuse to label their work a postmortem on the forced hospitalization of political and religious dissenters in the Soviet Union because of their concern that a stake still has not been driven through the heart of punitive psychiatry in the countries of the former USSR. However, barring further revelation from Soviet sources, No Asylum is as thorough an account of that perversion of psychiatry as is now possible. The primary sources for the book are the pioneering work of Bloch and Reddaway, plus the case records collected by Koppers, Ellen Mercer, Podrobinek, and by Smith and Oleszczuk themselves—but other materials are not neglected. The data are analyzed closely and subjected, when appropriate, to statistical treatment, sometimes comparing Soviet practices with those in other countries.

Smith and Oleszczuk’s hypothesis is that forced psychiatric internment represents “instrumental state use of psychiatric medicine to manipulate, deflect, defuse, discredit, or disperse the multifaceted dissident and non-conformist movements” (p. 2). Post-Stalin, and especially after the fall of Khrushchev, dissent in the Soviet Union was a powerful and persistent force, and it was just as persistently met by repressive measures featuring psychiatric hospitalization, through either civil commitment or criminal trials undertaken without human rights safeguards. Dissent took many forms: attempts to emigrate illegally; nationalistic, religious, and human rights activities; and forbidden forms of communication, such as samizdat. Much of this seems to have coalesced into anticommunist protests (although, interestingly, “true Communists” were also treated as dissenters).

Who were these subversive individuals? Basing their conclusions largely, but not wholly, on 674 identified cases (the total number was certainly larger), the authors analyze the data in accordance with a number of different parameters: gender (predominantly male), religion (many Jews), occupation (predominantly intellectual, but, of interest in the worker state, blue-collar workers also dissented), national and geographic origin (perhaps surprisingly, in view of the opposition of Leningrad psychiatrists to the Moscow-oriented diagnostic scheme that facilitated hospitalization, there were more hospitalizations from Leningrad than from Moscow), age (as time went on, dissenters were younger), and type of offense (symbolic opposition to the Union in any form was risky).

The frequency of hospitalization varied from 1929 to the present, depending on internal and external political events. It reached its peak in the early 1970s, probably as a coercive response to the wave of dissent following Khrushchev’s ouster. The somewhat ironic but gratifying conclusion is reached that although forced hospitalization had some influence on individuals, it failed to stem the waves of dissent, which continued until the end of the regime in the early 1990s.

Under Gorbachev and Yeltsin, psychiatric hospitalization gradually vanished, due to what appear to be extensive progressive political, legal, and constitutional changes in Russia. However, the authors of No Asylum remain skeptical that as long as “social danger” remains a viable concept (p. 175), and changes have not dislodged the old infrastructure of psychiatry, this convenient way to suppress unwelcome voices may revive. The recent law in Russia limiting religious freedom is a troubling indicator of the persistence of intolerance for unpopular views.

Why did successive Soviet regimes over many years opt for punitive hospitalization to suppress dissent? The authors provide four possible explanations. First are cultural and historical factors, the residue of an intolerant, authoritarian, autocratic culture inherited from Tsarist times. Intergenerational conflicts—not in the usual life cycle sense, but rather the reaction of a particular generation to political events, like those who came of age after Stalin—also played a role. An important contributor was the professional socialization of Soviet psychiatrists, who were often inadequately and narrowly trained, and strongly influenced by Andre Snezhnevsky’s formulations of schizophrenia, which allowed individuals with no abnormal symptoms to be diagnosed with “sluggish schizophrenia.” To my mind the authors do not sufficiently emphasize that the livelihood and careers of Soviet psychiatrists depended entirely on KGB-influenced state requirements...