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12 March 2018

The Return of Punitive Psychiatry

Activists and journalists are increasingly being punished with forced psychiatric detention — an authoritarian means of silencing, discrediting and “correcting” dissent. 

Over the past decade, particularly since the outbreak of war in Ukraine in 2014, the political use of psychiatry in the former Soviet Union has been on the rise.

A recent report by the Federation Global Initiative on Psychiatry (FGIP) lists more than 30 new cases – from 2012 to April, 2017 –  where journalists and activists have been imprisoned in psychiatric hospitals.

Most of the cases concern the Russian Federation and Crimea, particularly after it was illegally annexed from Ukraine in 2014.

It represents a worrying revival of Soviet political practice. In the later decades of the soviet-era, psychiatry was a systematic instrument political repression. Current allegations indicate that medical professions in the post soviet space are still susceptible to political perversion, and citizens are not protected from these sorts of gross human rights violations.

Psychological violence against the Crimean Tatars

In Crimea, psychiatry is said to have been used in the fraudulent criminal trials of Crimean Tatar activists for punishment and intimidation.  Since Crimea was annexed by Russia in March 2014, the Crimean Tatars –  an indigenous ethnic group and currently around 15 percent of the population –  have become a special target of repression by the authorities due to their opposition to Russian rule. According to Emil Kurbedinov, a human rights lawyer, 10 Crimean activists have been forcefully sent to psychiatric hospitals, where they were interrogated about their alleged involvement in "extremism" and questioned about their views of the government. All these Crimean activists were arrested on suspicion of involvement in the Hizb ut-Tahrir organisation, which Russia has declared a terrorist group. The Kharkiv Human Rights Protection Group (KHPG) asserts that there is no evidence to suggest that the organisation is connected to terrorism, nor is there any proof that these men were involved in the group.

In a particularly high-profile case, Ilmi Umerov, a prominent Crimean Tatar activist, was forcibly transferred to a psychiatric hospital by police in August 2016 and illegally held for 21 days. A few months earlier, the Russian Federal Security Service (FSB) had opened a criminal investigation against Umerov, who is also former deputy chairman of the Mejlis, the Crimean Tatars' elected representative body, on  charges of "separatism.” Umerov’s detention sparked international outrage and was widely considered politically motivatedHuman Rights Watch, for example, called it "a shameful attempt to use psychiatry to silence him and tarnish his reputation."

The historical roots of punitive psychiatry

Sufficient evidence now shows that over the course of the late 1960s, Yuri Andropov, who at the time ran the KGB, developed the political use of psychiatry, leading to the systematic confinement of hundreds or even thousands of dissidents in Russia. Robert van Voren, Chief Executive of the Global Initiative on Psychiatry, believes that psychiatry became a “centerpiece” in the KGB’s struggle against ideological dissent.

The abuse of psychiatry was largely facilitated and justified by the view that all deviant behaviour, including all anti-Soviet behaviour, was a sign of mental illness. This is reflected in Khrushchev’s declaration in 1959 that “a crime is a deviation from the generally recognized standards of behaviour, frequently caused by a mental disorder. Can there be diseases, nervous disorders among people in communist society? Evidently there can be […] we can now say, too, there are people who fight against Communism […] but clearly the mental state of such people is not normal’. A disease unique to the Soviet Union – called "sluggish schizophrenia" became a convenient framework for explaining anti-soviet behaviour. As the symptoms included "anti-Soviet thoughts," "delusions of reformism" and "infantilism", almost anyone who was critical of the regime could be diagnosed as mentally ill.

Psychiatry was a more convenient method than imprisonment because unlike a prison sentence, the term of hospitalization was indefinite. A person could be locked away for as long as they continued to be a thorn in the side of the existing power structure.

In the 1990s, along with the collapse of the USSR, punitive psychiatry practically ceased to exist. But since Vladimir Putin's rise to the presidency in 2000, various indications of punitive psychiatry return have emerged.

Soviet attitudes

The existence of ‘soviet’ attitudes in psychiatry is thought to be a major factor facilitating today’s abuse. In a 2012 interview, Mikhail Vinogradov, a Russian psychiatrist and head of the Centre for Legal and Psychological Help in Extreme Situations, declared that "there are occasions when medicine must have a police function […] we must return to the law that existed in the USSR […] the current law on psychiatry must be completely changed. We cannot give ill people the right to decide their fate." The soviet-era law that Vinogradov was referring to allowed a person to be involuntarily incarcerated without his/her consent, whereas post-Soviet reforms in psychiatry excluded this practice and were hailed as a major achievement. 

Yuri Savenko, a psychiatrist and head of Independent Psychiatric Association (IPA) considers this view “monstrous." He argues that psychiatry should be focused on protecting an individual patient in society. Rather, it is concerned with protecting society from that individual patient. Such is the essence of 'police' psychiatry. Discussions over the reinstatement of the law are reportedly continuing in government.

Denials of punitive psychiatry among prominent doctors have aroused deep concern among human rights activists. Psychiatrist Fyedor Kondtrativ called accusations of psychiatry's punitive use "slander, which was [previously] used for anti-Soviet ends but is now being used for anti-Russian ends," writes Julie Fedor in Russia and the Cult of State Security: The Chekist Tradition, from Lenin to Putin (2011), while Dr. Vinogradov has said punitive psychiatry is a "fairy tale" and that the majority of diagnoses have "proved correct." For Savenko, such renunciations are "direct evidence of the restoration of police psychiatry. The past cannot be overcome if it is forgotten or distorted."

Different, but the same

Many argue that the psychiatric imprisonment of activists is more preventative than punitive. As Gerhard Mangott, a professor of political science at Austria's University of Innsbruck, said in an interview with Deutsche Welle’s Russian service, punitive psychiatry sends a "signal" to politically active citizens to not participate in anti-government rallies. In this way, it enhances the existing culture of fear around criticizing the Russian government. According to a poll conducted by Moscow's independent polling agency, the Levada Centre last September, 82 percent of respondents said they would most likely not participate in mass protests under political slogans, and 73 percent thought it was highly unlikely that such protests would occur.

Opposition figures view it as a form of deterrence as well. Sergei Kovalyev, a former head of Human Rights Commission under President Boris Yeltsin (1993-1996),  sees punitive psychiatry is part of a long-standing effort by authorities to enforce political conformity.

A barometer for the level of political freedom

In Soviet times, punitive psychiatry was nurtured in a society that only answered to the Communist Party's directives. A person's culpability depended not on their adherence to the rule of law, but on their loyalty to the party. Even branches of medicine were corrupted by this logic, enabling the interests of the party to override those of patients. In psychiatry, this led to a normalization of systematic human-rights abuses and the weaponisation of medical knowledge.

Just as punitive psychiatry spoke to the lack of political freedoms in Soviet times, so too, in modern Russia it reflects an atmosphere of intensifying authoritarian repression. Over the past decade, the country's human-rights record has deteriorated sharply, particularly after the 2012 presidential elections that saw Putin inaugurated for a third term, which marked an unprecedented crackdown on political opposition. 

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