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18 L. Med. & Health Care 123 (1990)
Soviet Psychiatry and Human Rights: Reflections on the Report of the U.S. Delegation

handle is hein.journals/medeth18 and id is 123 raw text is: Soviet Psychiatry and Human Rights: Reflections on the Report of the U.S. Delegation Richard J. Bonnie For more than 20 years, the Soviet Union has been charged with confining political and religious dissidents in psychiatric hospitals for other than medical reasons.I The repressive use of psychiatric hospitalization has been primarily associated with the maximum security special hospitals, operated by the Ministry of Internal Affairs, to which dissidents have been committed after being found mentally nonresponsible for political crimes. In 1977, the World Psychiatric Association (WPA) con- demned the Soviet Union for such abuses, and six years later the Soviet All-Union Society of Neuropathologists and Psychiatrists resigned from the WPA rather than face almost certain expulsion. Soviet psychiatric officials repeatedly denied these charges of political abuse and refused to permit international bodies or psychiatrists from other countries to see the patients and psychiatric hospitals in question. In the spring of 1989, however, the Soviet government allowed an official delegation of psychiatrists and foren- sic experts from the United States to interview patients, selected by the delegation, in whose cases hospitalization was believed to have been politically motivated. Members of the delegation were also permitted to conduct unrestricted site visits at four hospitals (including two special hospitals) selected by the delegation only a week before its arrival in the Soviet Union. The U.S. delega- tion released a 100-page report in July, 19892 and the Soviet government issued an official response shortly thereafter.3 This article briefly summarizes the delega- tion's findings and provides a personal assessment of the current state of coercive psychiatry in the U.S.S.R. The Mission Planning for the delegation's visit began in the spring of 1988 when the U.S.S.R. Ministry of Foreign Affairs, anx- Editor's Note: At the invitation of the Soviet Government, an official U.S. State Department delegation visited the U.S.S.R. from February 26 to March 12, 1989 to assess recent changes in Soviet psychiatry. The author was one of the two lawyers on the delegation. ious to improve international perception of its human rights policy, issued an invitation for foreign psychiatrists to visit the U.S.S.R. The initial framework for the visit was developed in April 1988 during an exchange between U.S. and U.S.S.R. psychiatrists at a Human Rights Round Table in Moscow. During the fall of 1988, the possibility of such a visit took on greater interest because of ongoing bilateral discussions between the two govern- ments in which the U.S. insisted, as a barometer of pro- gress on human rights issues, that the U.S.S.R. release all political prisoners, including those confined in men- tal hospitals. By late 1988, Soviet authorities stated that they had released all prisoners who had been incarcerated under certain political and religious articles of the Soviet criminal codes. In addition, approximately 50 persons thought to be political and religious prisoners were released from psychiatric hospitals in 1988, leaving an unknown number remaining. The possibility that some dissidents remained in hospitals was of particular con- cern to the U.S. Helsinki, Commission (Commission on Security and Cooperation in Europe). Meanwhile, during this same period of time, the Soviet government had also taken some initial steps to restructure the system of psychiatric services and to pro- vide greater protection for patients' rights. In January, 1988, the Supreme Soviet of the U.S.S.R. enacted statutory protections for persons subject to involuntary hospitalization and transferred jurisdiction over the in- famous special psychiatric hospitals from the Ministry of Internal Affairs to the Ministry of Health.4 The Soviet Ministry of Health had also announced its intention to decrease the use of psychiatric hospitalization in the U.S.S.R. and to remove the names of millions of patients from the outpatient psychiatric register.5 The visit of the U.S. delegation was itself striking evidence of the changing political conditions then emerg- ing in the Soviet Union. The delegation was given an un- precedented opportunity to interview and assess patients of its own choosing, to review the patients' medical records, to discuss their treatment with relatives, friends, and occasionally their treating psychiatrists, and to

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