Psikhushka

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Psikhushka
Informal practice commonly found in Post-Soviet States
FSU map.png
Map of Post-Soviet States, where Psikhushka commonly takes place.
Entry written by Robert van Voren.
Robert van Voren is affiliated to Human Rights in Mental Health-FGIP.

Original text by Robert van Voren

In most Western European countries, destigmatisation campaigns have slowly changed the perception of psychiatry. Several decades ago psychiatric institutions were generally seen as places of horror, and either euphemistically referred to with their location (‘Santpoort’ in Amsterdam, or ‘Vasaros 5’ in Vilnius) or with names that confirmed the general perception: madhouse, nuthouse or, in Russian equivalent, durdom.

Psikhushka is a much more benign name and in fact the abbreviation of the Russian term for psychiatric hospital, psikhiatricheskaya bolnitsa. Yet in Soviet times it also acquired a much more ominous meaning because of the many dissidents who wound up in the psikhushka for political reasons. Among the well-known victims were poetess Natalya Gorbanevskaya, biologist Zhores Medvedev, General Pyotr Grigorenko and the Ukrainian cyberneticist Leonid Plyushch.

Photograph of the Chernyakhovsk Special Psychiatric Hospital, where a General Grigorenko was interned. This photograph is from 2006, but everything looks exactly like in Soviet times. Artist: Robert Van Noren

Political abuse of psychiatry in the Soviet Union was widespread. There were individual cases in the early Soviet period, but during Stalinist times the psikhushka was mainly used to save people from the Gulag, and basically to hide individuals from Stalin’s executioners. Life in psychiatric hospital was considered better than in the concentration camps of the Gulag, and thus the chances of survival were higher. The same happened later in Poland after martial law was declared in 1981 and some Solidarność leaders were hidden in psychiatric institutions to avoid arrest. Similarly during the last years of the Soviet Union a number of young men had themselves hospitalised in a psikhushka in order to avoid being drafted into the army with the risk of being sent to the war in Afghanistan.

The practice of using psychiatry to hide people from the repressive organs changed in the late 1940s, and even more so after Stalin’s death when Khrushchev claimed that he had released all political prisoners and had to explain why people were still arrested for political reasons. ‘They are mad’, he claimed, explaining that there was no objective reason for people to go against the Communist system and that thus the only logical explanation was that they were mentally ill (Bloch & Reddaway 1977[1]).

The political abuse of psychiatry became systemic under Yuri Andropov, who became Chairman of the KGB in 1967 and set himself the task to fight the internal enemy, the dissident movement that was in his view a perfidious creation of Western intelligence agencies designed to undermine the Soviet state. As we know now, he convinced the Politburo that there were many thousands of especially dangerous criminals in the USSR who were mentally ill, and based his proposal to the Politburo on a report by one of his subordinates who maintained that only a quarter of the necessary psychiatric beds were available and that many more were needed. The report also cited ‘especially dangerous crimes’- these included trying to meet with foreigners, trying to flee the Soviet Union, disseminating leaflets and – the worst – calling for control mechanisms over the Communist Party (Van Voren 2010[2][3]).

Photograph of Dr. Pyotr Morozov at the General Assembly of the World Psychiatric Association in October 1989. During this Assembly he publicly acknowledged that there had been a systematic misuse of psychiatry for non-medical reasons. Artist: Robert Van Noren

Andropov’s plans prevailed and in the mid-1970s many hospitals were enlarged or newly built. About one third of the political prisoners wound up in psychiatric hospital, where they were subjected to ‘treatment’ with neuroleptic drugs or tortured with other concoctions, such as being wrapped in wet linen which would shrink when drying causing horrible pain. Other treatments included the use of outlandish ‘drugs’ like sulphozine- a mixture of peach extract and sulphur which when injected caused high fevers often leading to comatose conditions. The suggestion was that the fever ‘burned out the poison of mental illness.’

The diagnosis usually used to incarcerate people was that of ‘sluggish schizophrenia’, a slowly developing schizophrenia that was hard to detect by the patient or his environment, but held to be extremely dangerous with alleged symptoms presenting as a struggle for the truth, perseverance, reform ideas or religious delusions. The theories on which the concept of ‘sluggish schizophrenia’ were based had been developed by Academician Andrei Snezhnevsky, who with his Moscow School of Psychiatry achieved an almost complete monopoly over psychiatry in 1950. Other views were not allowed and that remained the case until the Soviet Union disintegrated in the years 1989-1991.

During the 1960s-1980s thousands of completely sane individuals found their way to the psikhushka for political reasons, and many more people were incarcerated on the basis of faulty diagnoses, often people who in a normal environment would have benefitted from psychotherapeutic help and would have subsequently continued their lives without issue. By 1988 ten million Soviet citizens were on a psychiatric register, marked as having a mental illness and required to report regularly to a psychiatric outpatient clinic (Van Voren 2012[4]).

The political abuse of psychiatry in the Soviet Union came to an end during the last years of the country’s existence, yet for many people the psikhushka remained a terrifying institution, which they took measures to avoid at all cost. In some of the former Soviet republics this perception is slowly changing, but it will take decades to undo the damage caused by the Soviet regime. At the present time in Russia and other former Soviet republics like Belarus and Kazakhstan there is yet again concern that political opponents are being sent to the psikhushka or being given a psychiatric diagnosis. Recent cases in Russia include the prosecution case against members of the feminist protest band Pussy Riot in 2012, who were put on trail for “blasphemy” and in the course of the investigation psychiatrically examined. The psychiatrists claimed they suffered from ‘personality disorders’, with symptoms almost identical to the Soviet diagnosis of “sluggish schizophrenia”. Also the arrest and subsequent psychiatric diagnosis of paranoid schizophrenia in the case of anti-government protestor Mikhail Kosenko attracted much international attention. He was eventually released from hospital but still put on compulsory out-patient treatment. Regrettably, in many former Soviet republics attempts to humanise psychiatry have stalled altogether or failed and progress made over the past twenty-five years is gradually being undone (Van Voren 2016[5]).

References and Bibliography

  1. Bloch, S and Reddaway, P. 1977. Russia's Political Hospitals. London: Gollancz.
  2. Bloch, S and Reddaway, P. 1984: Soviet Psychiatric Abuse - The Shadow over World Psychiatry. London: Gollancz.
  3. Fulford, K.W.M., Smirnov, A.Y.U, and Snow, E. 1993. ‘Concepts of Disease and the Abuse of Psychiatry in the USSR’, British Journal of Psychiatry, 162:801-810.
  4. Gluzman, S. 1989: On Soviet Totalitarian Psychiatry, Amsterdam: IAPUP.
  5. Keukens, R. and Van Voren, R. 2015. ‘Political Abuse of Psychiatry’, in Fulford, B., Sadler, J. and Saden, C.: The Oxford Handbook of Psychiatric Ethics, Volume 1, Oxford: Oxford University Press.
  6. Korotenko, A & Alikina, L. 2002: Sovetskaya Psikhiatria: Zabluzhdeniya i Umysel. Kyiv: Sfera.

Notes

  1. Bloch, S and Reddaway, P. 1977. Russia's Political Hospitals. London: Gollancz.
  2. Van Voren, R. 2010.Cold War in Psychiatry. Amsterdam: Rodopi.
  3. Van Voren, R. 2010. ‘Abuse of psychiatry for political purposes in the USSR: a case-study and personal account of the efforts to bring them to an end’, in Helmchen, H. and Sartorius, N. (eds): Ethics in Psychiatry – European contributions, Berlin: Springer
  4. Van Voren, R. 2012. ‘Political abuse of psychiatry’, in M. Dudley (ed.), Oxford Textbook on Mental Health and Human Rights. Oxford: Oxford University Press.
  5. Van Voren, R. 2016. ‘Ending Political Abuse of Psychiatry: where we are at and what needs to be done’, Psychiatric Bulletin 40 (1).