Loren Roth and the abuse of psychiatry and psychiatrists collection

While it is understood that the misuse of psychiatry for non-medical reasons allegedly started in the U.S.S.R. after the October Revolution of 1917, its widespread and systematic use as a tool to silence political dissent became well-documented during Khrushchev’s era. In a 1959 speech attributed to Khrushchev, he allegedly attempted to justify putting dissidents in psychiatric hospitals by saying that only a mentally ill person may be opposed to Communism (1). While there also were “political” parts of the R.S.F.S.R. Criminal Code that criminalized anti-Soviet agitation and slander of the Soviet state, psychiatry was often used to isolate dissidents, punish them with psychiatric drugs, discredit their ideas, and avoid criminal law procedures.

The “Sluggish schizophrenia” concept developed by academician Snezhnevsky had overly broad diagnostic criteria that allowed the diagnosis of schizophrenia in patients who showed no symptoms, on the assumption that these symptoms would appear later (2). In almost every case, dissidents were examined at the Serbsky Central Research Institute for Forensic Psychiatry. Information about Soviet repressive psychiatry became well-known in the West after 1971 dissident Vladimir Bukovsky smuggled over 150 pages documenting the political abuse of psychiatric institutions in the Soviet Union into the West. The papers were studied by independent psychiatrists in several countries and released to the press (3). “Bukovsky’s papers” galvanized human rights activists worldwide and those within the Soviet Union.

While the attempt to bring the matter to the official agenda of the World Psychiatric Association (W.P.A.) at their 1971 World Congress in Mexico was unsuccessful, it kept gaining more and more outcry worldwide. So, in 1977, the W.P.A. adopted the Hawaii Declaration – a milestone defining principles of good and ethical medical practice. The All-Union Society of Psychiatrists and Narcologists, the official Soviet professional organization, was bound to withdraw from the W.P.A. at its next Congress in 1983—the allegations of the political abuse of psychiatry inflicted irretrievable damage on the prestige of Soviet medicine.

In 1975, the Soviet Union, the United States, and other countries signed the Helsinki Accords - the key document of the Conference of Security and Cooperation in Europe (C.S.C.E.). The Accords signaled a détente between the East and the West and built the foundation for the end of the Cold War, the U.S.-Soviet disarmament talks, and the “third basket” on human rights and freedoms in the Soviet Union.

Mikhail Gorbachev, who became the head of the Soviet Communist Party in 1985, prioritized the improvement of U.S.-Soviet relations. Also, Gorbachev launched the domestic “perestroika” (restructuring) and “glasnost” (openness) initiatives. These combined foreign and domestic policy developments fostered interest, internally and externally, in the plight of Soviet political prisoners. The Soviet Union released many political prisoners from labor camps, and in April 1987, Secretary Schultz and Soviet Minister of Foreign Affairs Shevardnadze agreed on a human rights dialog (4). As part of this broader dialog, in September 1987, the Soviet representatives began to try to assure their American counterparts that the abuse of psychiatry had ended (5).

Notes:

1. Khrushchev had said this in a speech published in the state newspaper Pravda on 24 May 1959: A crime is a deviation from generally recognized standards of behaviour frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offences, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal. Knapp, Martin, et al. Mental Health Policy and Practice Across Europe: The Future Direction of Mental Health Care, McGraw-Hill Education, 2006. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/uva/detail.action?docID=316293.

2. Sfera, Adonis. Can psychiatry be misused again?. Frontiers in Psychiatry. 9 September 2013;(4):101. doi:10.3389/fpsyt.2013.00101. PMID 24058348.

3. For more information, see Reddaway, Peter (12 March 1971). "Plea to West on Soviet 'mad-house' jails". The Times. p. 8.; Bloch, Sidney; Reddaway, Peter (1984). Soviet Psychiatric Abuse. The Shadow Over World Psychiatry. London: Gollancz.

4. Schifter-Adamishin book, timeline, page xix

5. Id, pages xix and xx

During the late 1980s, U.S.-Soviet discussions about the abuse of psychiatry led to the formation of a special U.S. delegation to the Soviet Union. In February 1989, the U.S.S.R. allowed the delegation to independently assess 27 Soviet citizens believed to have been psychiatrically committed for non-medical reasons. The U.S.S.R. also allowed the delegation to inspect ordinary psychiatric hospitals and other hospitals known as "psychoprisons." The U.S. delegation's psychiatric leader was Dr. Loren Roth of the University of Pittsburgh. The U.S. State Department organized the trip, closely cooperating with the American Psychiatric Association and the National Institute of Mental Health. Their Soviet counterparts were the Ministry of Foreign Affairs. The Soviet Ministry of Health and the conservative leadership of Soviet psychiatry, both believed to have been deeply involved in abuse, internally opposed the visit. However, the Ministry of Foreign Affairs overcame this opposition, and their support was critical to the U.S. delegation's success.

The U.S. delegation consisted of leading experts in psychiatry, forensic psychiatry, forensic psychology, law, and Sovietology. Also, it included a representative of the American Psychological Association (A.P.A.), and émigré Soviet psychiatrists living in the United States.

From April 1988 onward, Dr. Loren Roth engaged in extensive negotiations with his Soviet counterparts on the details of the visit. They discussed the list of people ("patients") to be assessed by the delegation and the processes for obtaining their consent. There were difficult negotiations over the presence of Soviet psychiatrists during the examinations, and the need to protect the interviewees from potential intimidation and retaliation.

The U.S. delegation advocated for and adopted critical precautions to ensure the transparency of the mission and its findings. They used scientifically developed structural psychiatric interview schedules, brought U.S. interpreters to assist the delegation, avoided sharing the cost of the trip with the Soviet side, collected urine samples to rule out overmedication, videotaped the interviews, and spoke with friends/relatives of those interviewed.

Although there was a significant risk that the Soviet Union would cancel the delegation's visit, it occurred between February and March, 1989. The American team evaluated 27 Soviet citizens and inspected special psychiatric hospitals in Kazan and Chernyakhovsk as well as ordinary psychiatric hospitals in Vilnius and Kaunas.

Among those interviewed by the U.S. team were people still hospitalized, and those who had been previously discharged. The American team was greatly assisted by Mr. Aleksandr "Sasha" Podrabinek, the Soviet and, subsequently, Russian dissident. He was an expert on the issue of abuse of psychiatry and author of the 1979 book "Punitive Medicine" (see references). Mr. Podrabinek facilitated access to those who had been previously released and claimed to be unavailable by Soviet counterparts.

The U.S. team detailed their conclusions in their final report, "Assessment of Recent Changes in Soviet Psychiatry" (available in this collection), which researchers are encouraged to read. The Soviet Union responded officially with its own report.

The 1989 visit laid a foundation for subsequent collaboration between the two countries in the area of mental health. The U.S.-Russia Health Committee met from 1994 to 2000 as a part of a larger Gore-Chernomyrdin Commission. It focused, in particular, on mental health care during disasters and the primary care physician's role in caring for patients with depression.

Shortly after the American mission was over, the W.P.A. congress in Athens decided to provisionally readmit the Soviet All-Union Society after receiving an official, although somewhat vague, admission of the past wrongdoings (covered in detail in On Dissidents and Madness by Robert van Voren). In 1991, the W.P.A. undertook an ad hoc psychiatric inspection of the Soviet Union that Dr. Jim Birley headed. Dr. Loren Roth and other experts who served on the 1989 U.S. State Department mission joined this inspection.

In 1990, a delegation of Soviet psychiatrists and politicians visited the United States for an educational trip to American psychiatric services and scholarly dialogues.

Researchers are encouraged to read the resources listed below to gain a better understanding of the historical events surrounding the 1989 delegation:

- the Schizophrenia Bulletin (supplement to Vol 15, # 4, 1989), which contains the brief overview of the reasons, methodology, and findings of the American team in the U.S., the final report of the U.S. delegation both in English and Russian, as well as the Soviet response in both languages (Hyperlink1) - The New York Times article “Accord Is Sought by U.S. And Soviet on Mental Wards” of May 22, 1988 - The Journal of the American Academy of Psychiatry and the Law, Volume 49, Number 4, 2021 “Jonas Rappeport: A Direct, Accomplished AAPL Leader” by Dr. Loren Roth - Report by the World Psychiatric Association Team on the Visit to the Soviet Union, 9-29 June 1991, headed by Dr. Jim Burley - Human Rights, Perestroika, and the End of the Cold War co-authored by Anatoly Adamishin and Richard Schifter in 2009

In 2021, three decades after the 1989 trip to assess the conditions of Soviet citizens confined in psychiatric hospitals for political reasons, an oral history project was initiated to document it. Loren H. Roth, Ellen Mercer, and Richard Bonnie, three members of the delegation, had always wanted to evaluate if the mission had had any lasting impact on the lives of the people interviewed and on the quality and ethical integrity of psychiatric care in the countries of the former Soviet Union. The oral history project began in conjunction with the donation of Loren Roth's papers to the University of Virginia School of Law Library. Olena Protsenko, a Ukrainian human rights lawyer, organized Roth’s papers and began researching related collections. Richard Bonnie’s papers and Saleem Shah’s files on the abuse of psychiatry, also part of the University of Virginia Law Library manuscript collections, were essential to the project's development.