November 15, 2023
Source: Encyclopedia
Photo Source: Unsplash,
During the holidays it behooves us to remember how such abuses can find their way into our homes during the holidays and how abuses are typically built on lies and sinister motives.
Soviet Psychiatric Abuse In summary, ill-defined boundaries, the subjective basis of assessment, and the authority to treat a person involuntarily combine to make psychiatry especially vulnerable to abuse. The most clear-cut illustration of this was the use of psychiatry in the former Soviet Union to suppress political, religious, and other forms of dissent. These practices have been analyzed at length by several observers (Bloch and Reddaway 1977, 1984; see also Bukovsky; Plyushch). Soviet psychiatry's boundaries were drawn in such a way that made the entire discipline subordinate to the pervasive influence, overt and covert, of the Soviet state and, more particularly, of the Communist Party. The monolithic form of the administrative structure, with power wielded by a small, compliant group of psychiatrists, allowed a political authority to mould the functions of all Soviet psychiatrists. Even if professional boundaries had been clearer, the totalitarian nature of the Soviet state prevented psychiatrists from functioning autonomously. The fact that boundaries were blurred made it all the easier for the state to exert control and influence the profession in terms of its ideology. The Soviet government's avowal that the interests of society were as pertinent as those of the individual paved the way for the principle of respect for autonomy to be undermined. The Soviet abuse is a blatant reminder that psychiatrists may function in a state whose interests do not serve those of the society. The corollary is obvious—psychiatrists must act independently with regard to ethical standards.
The lack of objective criteria for diagnostic evaluation permitted the evolution of an idiosyncratic taxonomic scheme in Soviet psychiatry for virtually four decades. Andrei Snezhnevsky rapidly ascended to the pinnacle of the psychiatric establishment during the 1950s, and from that impregnable position launched a unique classificatory system of mental illness. A crucial result was the profound shift in the way schizophrenia was conceptualized. Snezhnevsky advanced several claims, among them the notion that since the illness could be present in a person showing minimal features, schizophrenia was much more common than previously thought. A form of the illness, sluggish schizophrenia, named thus because of its slow progression, accounted for the wider limits placed on the use of the diagnosis. When suppression of dissent by psychiatric means escalated in the 1960s, the label sluggish schizophrenia, was commonly applied to political, religious, and other dissidents whom the state wished to disempower and punish (Reich; Bloch and Reddaway, 1977). Although this framework was not originally devised to curb dissent, the vagueness of its concepts enabled application of a disease label to people whom psychiatrists elsewhere would have regarded as normal, mildly eccentric or, at worst, neurotic.
The inadequacy of criteria to appraise the risk of harm of a person to himself and/or to others makes psychiatry open to the improper use of its sanction to detain. As an element of the Soviet pattern, the notion of "social danger" was promulgated. In a letter to the Western press in 1973 (Guardian), the psychiatric establishment, fending off allegations that psychiatry was being misused, asserted that in a proportion of patients, their disease process could result in antisocial activity, including "disturbances of public order, dissemination of slander, and manifestations of aggressive intentions." They commented further on the "seeming normality" of these patients when they committed dangerous acts. Aggression in the mentally ill leading to self-harm or harm to others was conflated with disturbance of public order and slander. Well-documented cases of dissenters in Soviet hospitals pointed to an obvious conclusion: Psychiatrists there had broadened the concept of dangerousness in an ethically dubious way.
Chinese Abuse The allegation of the systematic, political abuse of psychiatry in China, comparable to what occurred in the former Soviet Union, has been widely debated since Robin Munro, a Research Fellow in the University of London and formerly an observer of the human rights situation in China employed by Human Rights Watch, produced a report detailing most methodically its prevalence and procedures (Munro, 2001; Dangerous Minds). According to Munro, a small number of political dissenters were arrested as enemies of the state, diagnosed with a major psychiatric disorder and then compulsorily hospitalized as far back as the 1950s. Having stumbled across evidence of this practice in 1989 in a Chinese textbook on legal aspects of psychiatry, Munro scrutinized the official psychiatric literature—books and journals in the main—only to find repeated references to political patients. In one series of forensic psychiatric assessments, no less than one in five related to counterrevolutionary behavior.
The Cultural Revolution from 1966 to 1976 saw further ethical disarray in psychiatry. On the one hand, genuine patients forced by the Red Guards into confessing that they were truly counterrevolutionary, were thereupon promptly imprisoned or even executed. Conversely, genuine political dissidents were dispatched to institutions for the criminally insane. As one prominent forensic psychiatrist, Zheng Zhanpei, put it in 1988, the turmoil within Chinese psychiatry "… had to do with the particular historical circumstances of the time" (Munro, 2002, p.102). Munro provides extracts from Chinese psychiatric publications during this turbulent period which reveal just how politicized the profession became. For instance, mental illness was seen as being bound up with the class struggle and, given the tussle between the proletariat and capitalist positions, most patients had a bourgeois outlook. Following the Cultural Revolution, the Soviet pattern of abuse returned but became more prominent in the late 1990s in association with the state-led campaign to stamp out the religious Falun Gong movement. As the pressure began to mount against the movement's members, so a proportion of them were falsely detained in general psychiatric hospitals under the rubric of a newly devised psychiatric condition with the bizarre title of "evil cult-induced mental disorder."
The response of Western psychiatrists to Munro's findings and conclusions have differed substantially, ranging from total incredulity that any country would be silly enough to repeat the Soviet saga and thus earn universal disapproval and condemnation to a solid conviction that the allegations are well-founded. The Royal College of Psychiatrists for instance resolved at its 2001 Annual General Meeting to call on the World Psychiatric Association to organize a fact-finding visit to China. How prominent Western figures in psychiatry have arrived at their conclusions, one way or the other, is difficult to fathom. Alan Stone, Professor of Law and Psychiatry at Harvard University, sharply criticizes Munro's research and regards Chinese psychiatrists as more victims than victimizers.
It is relevant here that Stone remains adamant that Soviet psychiatrists also did not misuse their knowledge and skills to curb dissent. Sing Lee, and Arthur Kleinman, a distinguished anthropologist and psychiatrist, also at Harvard, similarly argue that "… there is simply no evidence of systematic abuse of mental hospitals for reasons of political oppression by the profession as a whole" (p.124) although they do concede that some psychiatrists are more open to "abusive practices" (p.124) when under police or Communist Party pressure. Among psychiatrists who contend that abuse almost certainly has taken place and continues are Jim Birley, past President of the Royal College of Psychiatrists, who opines thus: "There is certainly a strong case, more than a suspicion, that psychiatry is once again being used for political purposes" (p. 147); and Sunny Lu and Viviana Galli, two American psychiatrists, who have provided a detailed account of the role of Chinese psychiatrists in dealing with the Falun Gong specifically. The latter conclude that the psychiatric gambit is part of a "… comprehensive and brutal campaign to eradicate Falun Gong" (p. 129).
Western psychiatrists and human rights organizations had to toil long and hard before the abuse of psychiatry ceased in the former Soviet Union. The toll of suffering was tragically high as thousands of dissenters were victimized through psychiatry. In the case of the Chinese allegations, a similar delay should not ensue.
Preventing Abuse Legislation, professional self-regulation, establishment of watchdog committees, and adherence to appropriate codes of ethics are complementary means to deal with and prevent psychiatric abuse. Legislation has the potential to safeguard patients's civil rights, hold psychiatrists accountable, and specifically define their functions. Such mental health laws promote patients's rights and protect them from abusive psychiatry, and set requirements of practice whose transgression is tantamount to illegal conduct (e.g., Mental Health Act, 1986). Peer review and quality assurance may help identify ethically suspect judgments or actions. Many national associations of psychiatrists have procedures to discipline members who violate principles of clinical care: informal warning, reprimand, suspension, or expulsion (see for example, Royal Australian and New Zealand College of Psychiatrists). The Royal College of Psychiatrists in Britain and the American Psychiatric Association have developed procedures to investigate abuse.
As a professional collective, psychiatrists, both nationally and internationally, need to maintain vigilance when governmental or nongovernmental entities try to exploit them to apply their knowledge and skills for purposes other than serving the interests of patients and the community at large. Psychiatrists operating in totalitarian states may not be in an equivalent position without jeopardizing their professional or personal interests. For instance, Semyon Gluzman and Anatoly Koryagin experienced years of incarceration for condemning the misuse of psychiatry in the former Soviet Union.
As part of their ethics, psychiatrists have an obligation to protest against the misuse of their profession wherever and whenever it occurs. Such action points to a political role psychiatrists may be required to play. Finally, psychiatrists need to familiarize themselves with, and adhere to, relevant ethical codes, from the Oath of Hippocrates which stipulates that the doctor will "keep [the sick] from harm and injustice," to their own national and international codes, many of which affirm that they should never use their professional authority to maltreat people.
The 1998 ethical code of the Royal Australian and New Zealand College of Psychiatrists explicitly covers abuse by incorporating the principle that "Psychiatrists shall not allow the misuse of their professional knowledge and skills." A series of annotations follows which deal with such issues as never diagnosing a person as mentally ill solely on the basis of political, religious, ideological, moral, or philosophical belief; the impermissibility of using nonconformity with a society's prevailing values as the determining factor in diagnosis; and the unacceptability of participation in torture and executions.
Conclusion The history of psychiatry has been dreadfully tarnished by the occurrence of gross abuses, the Soviet and Nazi cases being especially prominent. Attention to such cases has led to greater ethical sensitivity among psychiatrists and beyond. Although this may serve as a safeguard against abuse now and in the future, both the profession and society need to maintain a vigorous defense against any malignant force that is tempted to exploit psychiatry and thus jeopardize its integrity. How can such practices impact your health? How? Why?
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