No Asylum: State Psychiatric Repression in the Former U.S.S.R.

The story of the use of psychiatry for nonmedical purposes in the former Soviet Union is an important one. It can be in turn horrifying and inspiring, given the abuse of our humane profession, on the one hand, and the bravery of those who fought against the abuse, on the other.

Unfortunately, this book makes the story seem a boring one. The authors are, respectively, a professor of international relations and a computer and information technology specialist. The book proves beyond a statistical shadow of a doubt that abuse of psychiatry did indeed occur in the former U.S.S.R. It also describes the chronology, estimated extent, and varied causes of this abuse and the demographic characteristics of those affected.

The crucial omission is the human detail. In the midst of all the analyses of the abuse phenomenon, there is not a single personal story of a victim or a profile of a specific abuser. Reading this book is like reading statistics or a sociological tract about crime without any description of the individual victims, survivors, or perpetrators.

Books like these can be useful for reference purposes, and the data the authors collected and analyzed are good to have on the permanent record. However, if any book is to be read widely enough to have an impact, it must be readable, and the lack of human detail in what is essentially a human story makes this book very difficult to read. As there is no dearth elsewhere of first-hand accounts by abuse victims, the authors' decision to leave out all human details is puzzling, because their important points could have been made so much more effectively.

Contrast, for example, the difference in readability, to say nothing of impact, between the following two paragraphs, both of which deal with the ability of some individuals to exhibit extraordinary courage in the face of the most extreme threats. The first paragraph is from the book being reviewed.

"Would-be dissuaders may encounter undeterrable or uncompellable individuals whose political, religious, or ethical objectives are so highly valued that no conceivable threat is large enough to counterbalance pursuit of their cherished goals. Individuals holding such objectives cannot be dissuaded from seeking to achieve them. It follows that a class of undeterrable acts may exist, which has a prior probability of virtually 1.0 and therefore will not be prevented by application of any state penalty. Some dissident behavior in the Soviet period may fall into this class."

The second paragraph, from a book by Bloch and Reddaway (1), is a quotation of Dr. Anatoly Koryagin, a Soviet psychiatrist, at the time of his trial for "anti-Soviet activities," which included protesting the abuse of psychiatry.

"My investigation and trial do not constitute an act of justice, but a means of suppressing me for my views. I know that the sentence will be harsh. I do not ask anything of this court. Regardless of the sentence imposed on me, I state that I will never accept the situation which exists in our country, where mentally healthy people are imprisoned in psychiatric hospitals for trying to think independently. I know that long years of physical imprisonment, humiliation, and mockery await me. Fully aware of this, I embark on it in the hope that it will increase the chances for others to live in freedom."

Dr. Winslow, who has a master's degree in Russian literature and a special interest in psychiatry in the former U.S.S.R. and its successor states, practices community psychiatry in Seattle.