The MacNeil/Lehrer Report; Soviet Psychiatry

ROBERT MacNEIL: Good evening. Ever since czarist days Russian political dissenters have feared their political views could land them in the infamous arctic labor camps. But what increasingly haunts the Soviet political dissident today is the threat of being declared insane and sent to a mental hospital. While the Soviet authorities strenuously deny it, the dissident movement continues to claim that thousands of people who disagree with Kremlin policy are confined to mental hospitals when their only disease is dissent. There have been numerous reports reaching the West of dissidents being confined to special hospitals for the criminally insane, like this one in Leningrad, or to regular mental hospitals. Last Thursday the World Psychiatric Association-formally censured the Soviet Union. Meeting in Honolulu, delegates from sixty-three countries narrowly passed a resolution condemning what it called "the systematic abuse of psychiatry for political purposes." They also voted to set up an international committee to investigate psychiatric abuse. Soviet delegates called the charges "preposterous", saying there wasn`t a single case of a healthy person being placed in a mental hospital. Tonight we look behind the scenes of Soviet psychiatry and at these charges of systematic abuse. Jim?

JIM LEHRER: Robin, a case well known here in the West is that of Leonid Plyushch, a Ukrainian dissident and leading Soviet mathematician. Plyushch was arrested in 1972 after he joined a human rights defense group and wrote an open letter protesting a political trial in Moscow. After a year in prison he was diagnosed as suffering from "sluggish schizophrenia" and "reformist delusions`.` and he was committed to a special psychiatric hospital. He was released in 1976 and allowed to leave the country. He now lives in Paris. Plyushch told what happened at that hospital in an interview last year conducted by an independent filmmaker and made available to us by Public Station WXXI, Rochester, New York.

LEONID PLYUSHCH, Ukrainian Dissident: The first day was perhaps the most terrible day for me, when I saw people cramped, twisted up from the pain from medication. Their tongues lolled out; their eyes bulged from their sockets; their bodies were contorted. Well, the doctors perhaps all know that it is necessary, along with the drugs that are given to the inmates, it is necessary to add correctors which prevent the physical ... effects of these drugs, to alleviate these cramps, these pains. Yes, but especially in these first days they are not given, and truly, many people during these first days immediately come to understand that they must surrender their will, that they must not protest. It is a terrible thing. I was almost always put among the most aggressively disturbed. And you know, well, for a healthy person to see the suffering of the truly insane, suffering from the medications, suffering from the illness, it is awful. And I would not say that it is less awful than the drug treatment itself.

I was not given drugs in the beginning, but I was given them later -- powerful drugs in very heavy doses. And it was during a visit with my wife that I first experienced convulsions. My body was totally contorted. It was very upsetting because my son was there, my wife. I did not want them to see my suffering, and I asked that the visit be terminated.

But the worst was afterwards, when I was convulsed for three hours from these drugs. Well, in the beginning I was given haloperidol. This is a very powerful drug. Several Soviet psychiatrists have since told me that with my diagnosis -- that is, "sluggish schizophrenia" -- heavy doses are not necessary. I was given very heavy doses.

Then I was given insulin. I was given very heavy doses of insulin. They wanted to bring me into shock, although with my diagnosis insulin was also unnecessary. Nevertheless, I was never brought to the point of shock. This was only because my wife protested this treatment so vehemently.

Then I was also given triftazin. Many patients are given sulfazin -- sulfur. This is formally also considered a treatment, but in truth it is always a method of torture, designed to break one`s will to defend oneself. It induces a very high temperature. The immediate area of the injection becomes very sore. Welts appear all over the body from this injection that are very painful. The person cannot find a place for himself. He cannot lie down, nor walk, nor sit. Yes, and another thing is that during sessions with the doctors they constantly perpetrate mental torture upon you by ridiculing your views, your friends. For example, my doctor constantly ridiculed the letters I received from my wife and children. She hinted that my wife was also insane, that my younger son was insane -- schizophrenic. Only because my wife wrote that my younger son was fascinated with the sciences.

Doctors did not tell me this directly --that is, that I should declare myself to be insane, but they were constantly bringing me around to it. "See? You criticize Soviet rule. That is, you`re sick." In fact, they demanded this from me all the time. Furthermore, a couple of times they proposed to me things to which I couldn`t possibly agree. After several other well-known dissidents broke down and began to recant, to tell lies about themselves and their friends, it was proposed that I should make such a declaration, officially recanting my views in writing. The doctor told me that this would attest to the fact that I was psychologically rehabilitated. I refused. Then a second time it was proposed to me to write an ideological autobiography. "How I became anti-Soviet." This was the first point, and second, "How I came to understand my mistakes." Well, I refused.

MacNEIL: That was a patient`s view; now for that of a Soviet doctor. Marina Voikhanskaya was a practicing psychiatrist in Leningrad hospitals for thirteen years before emigrating to Britain in 1975. Her eleven-year-old son Misha and her mother were not permitted to leave. Dr. Voikhanskaya is visiting the United States after attending the Honolulu psychiatric convention last week. Dr. Voikhanskaya, was the treatment that Leonid Plyushch has just described, is that treatment typical for political prisoners?

MARINA VOIKHANSKAYA: Yes, it`s typical for political prisoners and he describes it very correctly. But I can say about another kind of treatment. It`s wet sheets: they put a patient in nine wet sheets together for some hours, and when the sheets are going to be dry it`s real torture. Sometimes it`s hours, sometimes it can be a day, but it`s real torture. But everything was as Plyushch said. It was all right.

MacNEIL: Including the drug treatments?

VOIKHANSKAYA: That`s right.

MacNEIL: Including the particular drugs that he....

VOIKHANSKAYA: That`s right.

MacNEIL: Are they drugs that are used in the Soviet Union for people who are really mentally ill?

VOIKHANSKAYA: Yes, all of them.

MacNEIL: They are valid drugs for the treatment of mental illness?

VOIKHANSKAYA: That`s right.

MacNEIL: I see. But they are not valid for treating people who are not mentally ill.

VOIKHANSKAYA: Not at all.

MacNEIL: Can those drugs harm people who are mentally healthy?

VOIKHANSKAYA: Yes, they can. They can break liver, they can make harm to a heart, they can make people who are healthy tire very quickly, as Plyushch. Plyushch is tired very quickly, he can`t have a conversation for a very long time; he must go to sleep.

MacNEIL: I see. Now, the diagnosis that they gave him, "sluggish schizophrenia" -- is that a real disease?

VOIKHANSKAYA: It depends which school you believe. In Russia we have two schools of psychiatry, the Leningrad school of psychiatry and the Moscow. But now Moscow school oœ psychiatry domiates in all U.S.S.R. and it is this school that believes in this schizophrenia, "sluggish schizophrenia." People say it`s "slow schizophrenia" or "creeping schizophrenia." It`s the same.

MacNEIL: "Slow" or "creeping" schizophrenia. What about the ailments "reformist-messianism" or "reformist delusions" that were also ascribed to him, are they real illnesses?

VOIKHANSKAYA: Yes, sometimes, but very, very rare. It can be a syndrome of a real illness, but it`s very rare. Most of the people who are diagnosed as having these illnesses, they are sane, and they`re put in mental hospital only because of their real political views or religious beliefs. And it`s nothing to do with delusion.

MacNEIL: Do psychiatrists in the Soviet Union who you worked with treating these patients genuinely believe them to be ill?

VOIKHANSKAYA: I`m sure not at all. I can tell you about my own experience. In my hospital were 100 doctors, and when I knew about sane men in my hospital I began to tell everyone. And most of them didn`t want to know. They knew before, but-they didn`t want to know because they did not want to make trouble for themselves.

MacNEIL: When did you discover that they were putting in the hospitals sane people?

VOIKHANSKAYA: In the end of 1973.

MacNEIL: After you`d been working for many years.

VOIKHANSKAYA: For ten years.

MacNEIL: And you`d never encountered a sane person before.

VOIKHANSKAYA: Never; never. And even before in my hospital there were sane people but I didn`t know about them. And the first sane man whom I met in my hospital, he wasn`t-in my department, he was in another one. And I knew about him only by chance.

MacNEIL: So when you discovered it you went around telling other doctors, and they didn`t want to know about it.

VOIKHANSKAYA: Yes.

MacNEIL: So then what did you do?

VOIKHANSKAYA: Then I began to visit him every day and to bring him books, cigarettes, toothbrush, soap -- very simple things. And I smuggled out things: his autobiography, his self-portrait -- he`s a painter.

MacNEIL: Are none of these cases of political dissidents genuine psychiatric cases? None of them?

VOIKHANSKAYA: It`s not the question, I think. I don`t think we need to discuss who is sane, who is mentally ill. We need to discuss who needs to be in mental hospital and who doesn`t, is first. And second, in every population, like in every part of society, some people may be mentally ill. But it`s nothing do with abuse of psychiatry for political purposes.

MacNEIL: I understand that, but let me just ask the question because it would clear up perhaps some confusion. Are there political dissidents who are in mental hospitals in the Soviet Union who should bo in mental hospitals?

VOIKHANSKAYA: I don`t think so. I met certain people who were former patients who were out of hospital. By that time I became friends with them and I know exactly all of them were sane. And I met in my hospital six people and they were sane forever and they did not need any treatment, and I am absolutely sure. And a lot of my friends told me about other sane people whom they met in mental hospitals, and they are sane, too.

MacNEIL: Can this treatment make sane people mentally ill?

VOIKHANSKAYA:I don`t think medical treatment can make sane people mentally ill, but such a situation in which these people are put -- they are put in mental hospital without ends; they don`t know how long they will be there, maybe years, maybe months, maybe ten years, maybe all their life, maybe forever. This of course can make....

MacNEIL: Can break the mind.

VOIKHANSKAYA: Yes, and they can make them depressed, of course it can.

MacNEIL: Thank you. Jim?

LEHRER: Authoritative information on the full scope of the abuse of psychiatry for political purposes in the Soviet Union is very hard to come by. One person who has devoted much time and energy in trying to put together a factual overview of the situation is writer Ludmilla Thorne. She has written extensively on the subject. Ms. Thorne, how standard a practice is this, committing political dissidents to mental hospitals, based on your research?

LUDMILLA THORNE: Unfortunately, at the present time the process of incarcerating sane human beings in mental homes is increasing, it is not decreasing. For example, right during World War II and after World War II we know of three of these special psychiatric prison hospitals. Today we know of at least fifteen, if not more.

LEHRER: Of course there are not just political dissidents in these special psychiatric hospitals, right?

THORNE: No, it`s true. These are special hospitals created for the criminally insane. But even during Stalin`s time, for example, people were not treated in these hospitals the way they are treated now. For example, during Stalin`s time it was almost a .relief, instead of being shot, to be put into a mental home. Also, you were not given these terrible drugs, as you are now: haldol -- haloperidol--stelazine, etcetera. And now, for example, when a dissident is arrested he is almost immediately threatened with psychiatric incarceration.

LEHRER: Have you got any estimate as to how many dissidents are now in some kind of institution in the Soviet Union?

THORNE: Of course, as you realize, the Soviet government does not give statistics of that sort at all, so what we have tried to do, all of us who are concerned with the problem, is try to piece together information which is available. For example, every dissident that I have interviewed who has been in a psychiatric prison hospital, I`ve AWAY* asked him, "How many people were there altogether," (a). (b) "How many of those were political at the time when you were there?" And by talking to many, many people we have come together to the decision that approximately ten to fourteen percent of all of the in mates of these so-called "prison hospitals" are political. So by following this up we have come to the figure that at the present time, at any one moment there are at least a thousand persons in the Soviet Union today who are incarcerated for their religious, political or national beliefs. Now, this is a minimum number. Vladimir Bukovsky, for example, told me he thinks at least 1,500, not 200. Leonid Plyushch told me he thinks at least 1,500. But just the minimum figure we`ve been using is a thousand people today.

LEHRER: Let me ask you a similar question to the one that Robin just asked the doctor there. Are you sure of these -- whether it`s a thousand, 1,500, whatever the figure is -- are you sure that all those dissidents are in fact sane and have been committed solely because of their political activities?

THORNE: You see, this is a very important question and I think Dr. Voikhanskaya touched on it. The point is that even if some of these thousand people are not totally sane, they should not be given neuroleptic drugs, which make the tongues loll out and go into torture. They should not be forced to recant, they should not be forced to give testimony against their friends. All this pressure should not be -- I mean, even say 999 of them are slightly eccentric or mentally ill. They should not be subjected to this sort of practice. I mean, I live in New York and I see many kooky people in the streets but they`re not injected with drugs. And all of these people are persecuted solely for expressing their views, for reading a certain book. Like Bukovsky had two copies of Milovan Djilas` book,-and so he spent fifteen months in a psychiatric prison hospital. The point is not whether sane or insane, the point is, `should they be there and should they be treated/mistreated?

LEHRER: And your point is that even if they did have some kind of mental problem they would not be treated the way they have been treated.

THORNE: No, I don`t think so. They should not be.

LEHRER: All right, as a general-rule, what kind of, dissidents are those that do go this psychiatric route? Any particular type?

THORNE: We have sort of a number of certain categories of people who are more prone to be incarcerated in mental homes. First among these, of course, are the so-called "dissidents". By "dissident" I mean a person who has continually taken part in the human rights movement in the Soviet Union, who has consistently written something on its behalf or demonstrated, like Bukovsky, like Mr. Plyushch, like Gorbanevskaya, many others. That`s the first category. The second primary category are what we call nationalists: Ukrainians, Balts, who try to secure greater autonomy for their various nationalities. The third prominent category are religious believers. Right now, for example, the Baptists and the Pentecostals are under a great deal of pressure. And we know of many cases where a person who believes in God is told that "Your belief in God is a pathological illness," or "We will beat your-religion out of you." We know of many cases now of people who try to cross the border and leave the Soviet Union; because legally they can`t leave -- at le4At, the can`t if they`re not Jewish -- many people who try to cross the order who are caught wind up in insane asylums. So there are certain categories of people who systematically are incarcerated.

LEHRER: I see. Thank you. Robin?

MacNEIL: There are several ways that Soviet citizens have chosen to fight back against this system, but each has its own dangers. Dr. Voikhanskaya chose to emigrate, but, her son and mother remain behind, unable to follow her. Dr. Semyon Gluzman chose to stay and fight. He challenged the official diagnosis of insanity which led to the incarceration of a famous Soviet general who had fought for human rights. Dr. Gluzman -is now in the Labor Camp No. 36 at Perm in the Ural Mountains But the efforts continue both inside and outside the Soviet Union. Inside Russia there`s a group which calls itself A Working Commission to Investigate Psychiatric Abuses. They publish appeals through the underground press, Samizdat. Right now they`re trying to free Iosif Terelya, who is incarcerated in a small regional psychiatric hospital in the Ukraine. This is the actual Samizdat appeal for his release, smuggled into the West.

But how effective really are these efforts? Jim?

LEHRER: Dr. Voikhanskaya, let me just ask you. Is it getting anywhere, the action that you took while you were there, the action you`ve taken since, and all the other activities that Robin just laid out? Is it having any effect at all?

VOIKHANSKAYA: I don`t understand the question.

MacNEIL: Is the activity of protesting against these practices having any effect?

VOIKHANSKAYA: Yes, of course. It`s very effective. Vladimir Bukovsky was released only because of his own campaign in the West; Leonid Plyushch was released after a very long campaign, especially in France, in the West. Even me, now in the West only because of a campaign in England. Of course it`s very helpful. Everything is very helpful.

LEHRER: You mentioned earlier the role of the doctors -- the psychiatrists in the Soviet Union in this whole program. Why do not more of them speak out, or just flat refuse to judge a sane person insane?

VOIKHANSKAYA: Oh, it`s a very complicated question. It`s really very difficult to speak out, to be inside of Russia. I know how it`s dangerous and how it`s really terrible, and frightening, I must say. And most of them want to live a very quiet life if they can. They want a piece of bread with butter if they can. They want small flat and little bit of furniture which they can get. And because of this they keep quiet.

LEHRER: But it is not true, though, that the doctors themselves could stop it? I mean, without the doctors this program would have to be stopped, would it not?

VOIKHANSKAYA: If doctors can get a job only from the government end thok are very dependent of the government, and KGB as well, it`s very difficult, really, to speak out. But some of the doctors of course are doing this with pleasure, I have to say. It is the top Soviet psychiatrists, as Practitioner Snezhnevsky, Practitioner Nadzharov -- they know exactly what they are doing and for what reasons.

LEHRER: How effective do you think this new international committee to monitor psychiatric abuse will be, that was set up at this Honolulu meeting? Do you think that`s going to do any good?

VOIKHANSKAYA: Of course. Of course, the Soviet doctors can`t read it in Soviet newspapers, it never will be published. But they can listen to the Voice of America and the BBC, and they will know about what happened in Honolulu. And I can imagine a very young psychiatrist who is working in a mental prison hospital and who can think and can say, not really "No," but somehow can stop treatment and quite secretly and privately to say, "Patient, look, you are sane," and bring him some food or a book. And I can imagine a doctor who is in an outpatient department and on whom depend many, many patients and who can say no to the KGB. Because of this, because they don`t want to make their names public in the West.

LEHRER: I see. Robin?

MacNEIL: Do the ordinary people in the Soviet Union know that there are people who are incarcerated in mental hospitals who are political dissidents?

VOIKHANSKAYA: Of course most of the people now listen, as I told you, to the Western radio and they know about this. But of course most of them don`t want to. Like me. First ten years I was a psychiatrist in the Soviet Union I listened to-the BBC and I knew about this practice, but I never came across, and I didn`t believe it.

MacNEIL: You didn`t believe it. Would most Soviet citizens who go along with the regime or support the regime more or less, would they tend to think, "Oh, well, if that person is described as insane and he`s a political dissident he probably is insane"? Would that be the tendency of the ordinary public, to believe that?

THORNE: I don`t think so. I mean, I haven`t been to. the Soviet Union since I was a child, but I don`t think so because I think most people -- I mean, at least who are honest with themselves -- I think most of us have the same criteria for sanity/insanity. I mean, we may have friends who are slightly eccentric, but I just don`t believe that people are that different in the Soviet Union, inside, as we are here. I can`t believe that.

MacNEIL: But would ordinary citizens think, "Oh, well, if that person`s a dissident he must be insane"?

VOIKHANSKAYA: I don`t think so.

MacNEIL: But you genuinely believe that the efforts in the West

to talk about this and to have it better known will actually help.

VOIKHANSKAYA: Oh, yes.

MacNEIL: Why, in your opinion, did some of the Western delegates to the conference in Honolulu not support the resolution? I believe, for instance, the Scandinavians did not support it. Why was that,do you think?

VOIKHANSKAYA: I really understand them. They think in Honolulu, in WPA, they can see Soviet psychiatrists and they can talk to them. And if they will make the resolution, Soviet psychiatrists walk out.

MacNEIL: So they`ll lose their contact with the Soviet psychiatrists.

VOIKHANSKAYA: That`s right, but it`s not true.

MacNEIL: Well, we`ll have to end it there. Thank you both very much for coming, and it was nice to see you. Good night, Jim.

LEHRER: Good night, Robin.

MacNEIL: That`s all for tonight. We`ll be back tomorrow night, and other news permitting our story, which we intended to have tonight but the arrangements changed in Washington, will be: the Senate investigates Bert Lance. I`m Robert MacNeil. Good night.