TIME: Almanac 1993/TIME Almanac 1993.iso/time/103089/10308900.011

Text File | 1992-09-23 | 5.9 KB | 117 lines

                                                                                BEHAVIOR, Page 78

Here Come the Russian Shrinks!


The Soviets confess and are accepted by their colleagues

By Glenn Garelik


    After years of activists' complaints about abuses in Soviet
psychiatric facilities, 26 American psychiatrists, lawyers and
interpreters last March toured such institutions in the
U.S.S.R. and interviewed more than two dozen patients whose
hospitalization had been questioned. The watchdog group
concluded that while improvements had been made, disturbing
evidence remained of unjustified confinements and fundamental
shortcomings in psychiatric practice. Most troubling were the
continued use of drugs that appeared to have more punitive than
therapeutic value and the domination of the Soviet psychiatric
establishment by some of the very officials who ruled it when
abuse was rampant.

    Thus, when the World Psychiatric Association met in Athens
last week, one of the most controversial issues on its agenda
was whether to readmit Soviet psychiatrists, who resigned in
1983 rather than face expulsion for human-rights abuses. Eager
for acceptance, the Soviets made an eleventh-hour acknowledgment
that "previous political conditions in the U.S.S.R. created an
environment in which psychiatric abuse occurred for nonmedical,
including political, reasons."

    Following a stormy final session that began after lunch and
lasted well past midnight, the W.P.A. voted to accept the
Soviet delegation, provided that the use of psychiatry for
nonmedical purposes is banned. Moreover, in a symbolic addendum,
the organization agreed unconditionally to admit a new
independent Soviet psychiatric union whose members are
considered genuine reformers.

    Human-rights advocates had looked to the Athens vote as a
key test for the W.P.A. Although the Soviet delegation announced
no specific personnel changes, it did call for "enlightened
leadership in the psychiatric community in the U.S.S.R." That
failed to appease the majority, which seemed unwilling to
restore the Soviets' membership. Then vice president-elect
Felice Lieh Mak of Hong Kong suggested a compromise: making
readmission contingent on a satisfactory W.P.A. visit to Soviet
psychiatric facilities in the next year. Only then did the
majority swing to the Soviet side. The vote was 291 to 45, with
19 abstentions.

    Nonetheless, there remained the central question regarding
the Soviet psychiatrists: whether admitting them or barring them
was more likely to encourage reform. For a year, outgoing
W.P.A. president Costas Stefanis of Greece had doggedly lobbied
for readmission on the grounds that it would encourage
rehabilitation. He contended that the Soviets as members of the
W.P.A. would be subject to greater scrutiny and influence from
abroad than they would be as outcasts. Others who favored
readmission, including U.S. psychiatrists Alfred Freedman and
Abraham Halpern, argued that during the past few years --
especially in the months preceding the Americans' March visit
-- the Soviets had satisfied the criteria established for
readmission in 1983, which called simply for "amelioration" of
past abuses. In the year since the last W.P.A. meeting, for
instance, the Soviets have released more than a hundred
"patients." In July they purportedly banned the use of
pain-inducing sulfazine, the most notorious of the contested
drugs.

    But that was not enough for the opponents of readmission,
who included independent Soviet psychiatrists as well as the
Dutch and West Germans. They charged that the Soviets had not
even made the limited changes they claimed. The West
German-based International Society for Human Rights listed
scores of cases of improper confinement. Other critics noted
that Soviet diagnostic categories still include "sluggish
schizophrenia," a condition whose officially defined symptoms
include "delusions of reformism."

    Earlier this month, the Soviets had made an unprecedented
play for respectability with the Americans, who have been among
their most outspoken critics. Speaking before Congressman Henry
Waxman's Health and the Environment Subcommittee, a senior
Soviet embassy official testified that his government had
created an independent commission to ensure that its hospitals
would be used for psychiatric purposes only. But other
congressional witnesses, including one victim of past abuse,
countered that the changes in the Soviet mental-health
establishment have been little more than cosmetic.

    Not surprisingly, several members of the U.S. delegation
came to Athens unconvinced that readmission was justified. Ellen
Mercer, director of the American Psychiatric Association's
international affairs office, argued that the Soviets' dubious
psychiatric theories and their basic lack of medical
sophistication made for at least inadvertent abuse. In many
cases, explains Dr. Walter Reich, an expert in Soviet psychiatry
at Washington's Woodrow Wilson International Center, the Soviets
are not intentionally engaging in what the West considers abuse.
Instead, because of culture and history, they "actually believe
that the dissidents they are hospitalizing, or keeping in
hospitals, are ill."

    It is partly for that reason, says George Washington
University political scientist Peter Reddaway, next year's
review by the "more sober-minded" new leadership of the W.P.A.
will be especially crucial. In the end, though, the biggest
improvement in Soviet psychiatric practice may come not from
W.P.A. acceptance or ostracism but from continued changes in the
culture, politics and legal structure of Soviet society.
Admitted Stefanis after the vote: "It is not just a question of
psychiatry. Deeper changes must take place." Until this happens,
says Reich, "there are no assurances that can satisfy one fully
and eternally that the Soviets won't return to abusive
practices."