The Soviet Case: Prelude to a Global Consensus on Psychiatry and Human Rights22
When in 1971 the Soviet dissident Vladimir Bukovsky sent his first documentation of several prominent Soviet psychiatric-abuse cases to the World Psychiatric Association (WPA), the Soviet delegation threatened to withdraw from the international body, and the notion that this would hurt the WPA instead of the Soviets themselves was so strong that the issue was shelved. Bukovsky was subsequently sentenced to twelve years' imprisonment, but a Pandora's box had now been opened, and in the next twenty years the attitude of world psychiatry towards the problem of political psychiatric abuse would change almost 180 degrees. Professional bodies such as the WPA, which had initially strongly resisted getting involved in the issue, would be triggered into adopting firm, clear ethical codes and setting up investigative bodies that would ensure that these new codes of conduct would be adhered to and any violators sanctioned.
During the six years between Bukovsky's revelations and the next WPA congress in Honolulu, increasing numbers of well-documented cases reached the West and international protests started to mount. The first committee against the political abuse of psychiatry was founded in 1974 in Geneva, lending the Geneva Initiative on Psychiatry its current name. National psychiatric associations became active, in particular the British Royal College of Psychiatrists and the American Psychiatric Association, and when the next World Congress convened in Honolulu in 1977, the question of Soviet political psychiatric abuses could not be kept off the agenda. This congress led not only to the first official international condemnation of those abuses, but also to the Declaration of Honolulu, a document that for the first time set forth a set of basic ethical standards guiding the work of psychiatrists everywhere. Soviet psychiatric abuse had begun to have an impact reaching far beyond the issue itself.
After Honolulu, pressure on the Soviets continued to mount, led by rights groups and psychiatrists. The campaign had two main goals: to pressure the Soviet authorities to a point where they would decide that it would be more profitable to end the abuses and send political prisoners only to labor camps, and to mobilize world psychiatry to take a stand against such abuses in general and to take measures to prevent them from occurring elsewhere. The latter goal proved to be quite difficult, as many psychiatrists felt that the issue was a "political" rather than an ethical one, and it was several years before the realization sank in that the campaign against politically abusive psychiatry in the Soviet Union was in fact aimed at taking politics out of psychiatry, rather than at bringing it in. In the corridors of power in Moscow, however, this campaign of public pressure worked quite well. Those hospitalized by the police were increasingly less-prominent political prisoners, and soon after international campaigns began on particular cases, those concerned were either released or moved to "normal" places of detention. In 1982, facing imminent expulsion from the WPA, the Soviets withdrew voluntarily from the world body, and the following year a resolution was adopted at the WPA's World Congress in Vienna placing strict conditions on their return.
Over the next six years, the Soviet authorities tried to find a compromise position between campaigning for a return to the WPA - showing that they saw their forced departure as a loss of face - and continuing the abuses in a less conspicuous manner. As in China in recent years, documenting cases of political psychiatry became increasingly difficult due to the intensified crackdown on the dissident movement in the early to mid-1980s, but after Mikhail Gorbachev assumed power and started his campaign of glasnost, the Soviet press itself soon started publicly to address the issue. Increasingly cornered by their own newspapers, by evidence from victims of political abuse freed under the policy of perestroika, and by a damaging report issued by a 1989 U.S. State Department mission to Moscow to investigate the political abuse of psychiatry, the Soviet delegates to the WPA's 1989 World Congress in Athens finally agreed to acknowledge that the systematic abuse of psychiatry for political purposes had indeed taken place in their country. As a condition for its return to the WPA, the Soviet psychiatric association (the All-Union Society of Psychiatrists and Neuropathologists) promised to discontinue these abuses, rehabilitate the victims, and democratize the psychiatric profession. The latter proved to be an unnecessary promise, since three years later the Soviet Union itself fell apart and new national psychiatric associations soon sprang up across the country. When a WPA delegation visited the USSR in 1991, they met newly founded associations in Lithuania and Ukraine, set up by psychiatrists who were to play a key reforming role in all areas of the profession in the years that followed. Conditions remained generally poor in most parts of the mental healthcare system, and it soon became clear that the twenty-year-long international campaign had been directed at only the tip of an iceberg: massive human rights abuses were found to have occurred at all levels, in a highly institutionalized and biologically oriented system of psychiatry that had taught society to ostracize its mental patients and see them as distinctly second-class citizens. But the misuse of psychiatry as a tool against political dissent had finally come to an end
Moreover, the campaign against politically abusive psychiatry had helped put the issues of human rights and medical ethics high on the agenda of post-Soviet countries, and these concerns now form the cornerstone of the work of mental health reformers there. Internationally, too, the issue has continued to have an impact. In 1996 the WPA adopted the Madrid Declaration at its World Congress in the Spanish capital, further deepening and fine-tuning the Honolulu Declaration adopted nine years earlier - and when during that congress reports reached the West of new cases of political psychiatric detention in Turkmenistan, one letter of protest from an international group that included psychiatrists from the former USSR sufficed to immediately halt those abuses. Today, with the issue of political abuse of psychiatry in China placed on the agenda, there is no discussion as to whether or not it is an issue that the WPA should address. To the contrary, the WPA is taking an active role in this campaign, through its Review Committee and other relevant bodies, and its discussions with organizations such as Geneva Initiative on Psychiatry concentrate on matters of tactics, not of content.
23 This article by Robin Munro was first published in the Columbia Journal of Asian Law, vol. 14, no. 1 (2000) (actual publication date: January 2001). The initial phase of the writing was done by the author in his former capacity as China researcher and director of the Hong Kong office of Human Rights Watch. The original footnotes have been stylistically amended in the present edition and a small number of documentary source corrections have been made (notably in Section VII.: "Official Statistics on Political Psychiatry").