Here Come the Russian Shrinks!

By GLENN GARELIK

After years of activists' complaints about abuses in Soviet psychiatric facilities, 26 American psychiatrists, lawyers and interpreters last March toured such institutions in the U.S.S.R. and interviewed more than two dozen patients whose hospitalization had been questioned. The watchdog group concluded that while improvements had been made, disturbing evidence remained of unjustified confinements and fundamental shortcomings in psychiatric practice. Most troubling were the continued use of drugs that appeared to have more punitive than therapeutic value and the domination of the Soviet psychiatric establishment by some of the very officials who ruled it when abuse was rampant.

Thus, when the World Psychiatric Association met in Athens last week, one of the most controversial issues on its agenda was whether to readmit Soviet psychiatrists, who resigned in 1983 rather than face expulsion for human- rights abuses. Eager for acceptance, the Soviets made an eleventh-hour acknowledgment that "previous political conditions in the U.S.S.R. created an environment in which psychiatric abuse occurred for nonmedical, including political, reasons."

Following a stormy final session that began after lunch and lasted well past midnight, the W.P.A. voted to accept the Soviet delegation, provided that the use of psychiatry for nonmedical purposes is banned. Moreover, in a symbolic addendum, the organization agreed unconditionally to admit a new independent Soviet psychiatric union whose members are considered genuine reformers.

Human-rights advocates had looked to the Athens vote as a key test for the W.P.A. Although the Soviet delegation announced no specific personnel changes, it did call for "enlightened leadership in the psychiatric community in the U.S.S.R." That failed to appease the majority, which seemed unwilling to , restore the Soviets' membership. Then vice president-elect Felice Lieh Mak of Hong Kong suggested a compromise: making readmission contingent on a satisfactory W.P.A. visit to Soviet psychiatric facilities in the next year. Only then did the majority swing to the Soviet side. The vote was 291 to 45, with 19 abstentions.

Nonetheless, there remained the central question regarding the Soviet psychiatrists: whether admitting them or barring them was more likely to encourage reform. For a year, outgoing W.P.A. president Costas Stefanis of Greece had doggedly lobbied for readmission on the grounds that it would encourage rehabilitation. He contended that the Soviets as members of the W.P.A. would be subject to greater scrutiny and influence from abroad than they would be as outcasts. Others who favored readmission, including U.S. psychiatrists Alfred Freedman and Abraham Halpern, argued that during the past few years -- especially in the months preceding the Americans' March visit -- the Soviets had satisfied the criteria established for readmission in 1983, which called simply for "amelioration" of past abuses. In the year since the last W.P.A. meeting, for instance, the Soviets have released more than a hundred "patients." In July they purportedly banned the use of pain-inducing sulfazine, the most notorious of the contested drugs.

But that was not enough for the opponents of readmission, who included independent Soviet psychiatrists as well as the Dutch and West Germans. They charged that the Soviets had not even made the limited changes they claimed. The West German-based International Society for Human Rights listed scores of cases of improper confinement. Other critics noted that Soviet diagnostic categories still include "sluggish schizophrenia," a condition whose officially defined symptoms include "delusions of reformism."

Earlier this month, the Soviets had made an unprecedented play for respectability with the Americans, who have been among their most outspoken critics. Speaking before Congressman Henry Waxman's Health and the Environment Subcommittee, a senior Soviet embassy official testified that his government had created an independent commission to ensure that its hospitals would be used for psychiatric purposes only. But other congressional witnesses, including one victim of past abuse, countered that the changes in the Soviet mental-health establishment have been little more than cosmetic.

Not surprisingly, several members of the U.S. delegation came to Athens unconvinced that readmission was justified. Ellen Mercer, director of the American Psychiatric Association's international affairs office, argued that the Soviets' dubious psychiatric theories and their basic lack of medical sophistication made for at least inadvertent abuse. In many cases, explains Dr. Walter Reich, an expert in Soviet psychiatry at Washington's Woodrow Wilson International Center, the Soviets are not intentionally engaging in what the West considers abuse. Instead, because of culture and history, they "actually believe that the dissidents they are hospitalizing, or keeping in hospitals, are ill."

It is partly for that reason, says George Washington University political scientist Peter Reddaway, next year's review by the "more sober-minded" new leadership of the W.P.A. will be especially crucial. In the end, though, the biggest improvement in Soviet psychiatric practice may come not from W.P.A. acceptance or ostracism but from continued changes in the culture, politics and legal structure of Soviet society. Admitted Stefanis after the vote: "It is not just a question of psychiatry. Deeper changes must take place." Until this happens, says Reich, "there are no assurances that can satisfy one fully and eternally that the Soviets won't return to abusive practices."

With reporting by David Aikman/Washington and Mirka Gondicas/ Athens