shattered hologram
2023-08-11 07:21:10 UTC
Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry
By Jason Luty
EXCERPTS
"The patients were then collected from the institutions
in the now infamous grey buses, and brought to
six psychiatric institutions in which gas chambers
had been installed (Grafeneck, Brandenburg,
Hartheim, Pirna-Sonnenstein, Bernburg and
Hadamar). Psychiatrists supervised the transport
and the execution of their patients. The presence
of physicians and other health professionals in the
euthanasia centres gave a false sense of security to
the victims, who did not realise their fate until the
very end. Faked death certificates were intended
to disguise the deaths as natural in order to hide
the victim’s fate from their family and the public
(Strous 2007). Between 1939 and 1941, 80 000
to 100 000 mentally ill people in institutions were killed,
including 5000 children (Lifton 2000). ...
Hitler ordered the cancellation of the T-4
programme in August 1941, following protests
from the Catholic and Protestant Churches.
Although public opposition ended these quasi-legal
killings, they continued in secret in asylums and
hospitals until the end of the war. Psychiatrists
and doctors often poisoned or starved mentally
ill hospital patients to death (Breggin 1993). ...
Medical observers from the USA and Germany
at the Nuremberg Trials concluded that the
Holocaust might not have taken place without the
involvement of psychiatrists in the T-4 programme
(Breggin 1993)."
"The diagnosis of sluggish schizophrenia was
based on the idea that people who opposed
Communism were mentally ill since there was no
other logical reason why anyone would oppose
the Soviet system."
"Szasz regarded psychiatric diagnosis
as a way of controlling people whose behaviour
does not conform to existing social norms.
He dismissed psychiatric diagnoses as moral
judgements rather than scientific categories. He
believed that mental health legislation is used
by the state and psychiatrists as a form of social
control supported by the fraudulent claim that
psychiatry is based on science. In
Ceremonial Chemistry (1974), he posited that mental health
legislation is used to target social scapegoats (such
as drug addicts and ‘insane’ people) in the same
way that witches, Jews, Gypsies and homosexuals
have been persecuted. Contrary to popular belief,
Szasz was not opposed to the practice of psychiatry
if it is non-coercive."
SUMMARY
Psychiatrist Thomas Szasz fought coercion
(compulsory detention) and denied that mental
illness existed. Although he was regarded as a
maverick, his ideas are much more plausible when
one discovers that between 1939 and 1941, up to
100 000 mentally ill people, including 5000 children,
were killed in Nazi Germany. In the course of the
Nazi regime, over 400 000 forced sterilisations took
place, mainly of people with mental illnesses. Other
countries, including Denmark, Norway, Sweden
and Switzerland, had active forced sterilisation
programmes and eugenics laws. Similar laws were
implemented in the USA, with up to 25 000 forced
sterilisations. These atrocities were enabled and
facilitated by psychiatrists of the time and are only
one example of the dark side of the profession.
This article reviews some of these aspects of the
history of psychiatry, including Germany’s eugenics
programme and the former USSR’s detention of
dissidents under the guise of psychiatric treatment.
Declaration of interest
None
THE ARTICLE
‘Men (wretched creatures that they are) worry less
about doing an injury to one who makes himself
loved than to one who makes himself feared’ (
The Prince, Niccolo Machiavelli, 1532).
The objective of this article is to familiarise
mental health professionals and lay readers
with the rather colourful and disdainful history
of psychiatry, particularly the political abuses
of mental health legislation. The debate about
legislative changes (including legislation for
‘dangerous severe personality disorder’ in the UK)
often seems arcane and unnecessary until set in
the context of these historical abuses of the mental
health system.
Some psychiatrists have abused power in
general. For example, although the war crimes for
which Radovan Karadžic´ is currently standing
trial do not arise from his psychiatric practice, it
is salutary to note that he is far from being the
first psychiatrist to be accused (or convicted) of
crimes against humanity. However, Thomas Szasz
controversially argued that there is something
inherent in psychiatry, particularly the power to
restrict liberty, that tends towards abuse if not
regulated by the legal or political system. In the
past, there have been abuses of psychiatrists’
powers to detain people, but these have been
instigated at the direction of governments such
as that in Nazi Germany (leading to genocide of
mentally ill people) and the USSR (where political
dissidents were detained with a diagnosis of
‘sluggish schizophrenia’).
Psychiatry and eugenics
The science of eugenics emerged during the
late Victorian era, with the aim of reducing the
rates of physical and mental illness, hereditary
diseases and ‘morally deviant behaviours’. It was
promoted throughout industrial countries amid
fears of ‘degeneration, race suicide, and the threat
of disordered sexualities’ (Mottier 2008: p. 34).
The 1933 Law for the Prevention of Hereditarily
Diseased Offspring (
Das Gesetz zur Verhütung
erbkranken Nachwuchses ) required German
doctors to register hereditary illnesses in their
patients. In the course of the Nazi regime, over
200 ‘hereditary health courts’ were set up, which
authorised over 400 000 sterilisations. Most of the
people sterilised between 1934 and 1939 in Nazi
Germany were labelled ‘mentally ill’ (Cocks 1997;
Mottier 2007).
Eugenics and forced sterilisation programmes
tend to be associated with Nazi Germany. However,
other countries had active forced sterilisation
programmes and eugenics laws, among them the
USA, Denmark, Norway, Sweden and Switzerland
(Weiss 2010). In 1912, Switzerland introduced laws
prohibiting marriage for the ‘mentally deficient’
and ‘legally irresponsible’ (Mottier 2007). Eugenics
sterilisation laws were introduced in the US State
of Indiana in 1907 (Fig. 1), and in two-thirds of the
remaining states by the 1930s. Havelock Ellis was
a British physician and psychologist who actively
promoted eugenics, although these programmes
were never enacted in the UK. Eugenics was
supported by many leading psychiatrists, such as
Emil Kraepelin, Eugen Bleuler and especially the
Swiss psychiatrist Auguste Forel, who pioneered
the first sterilisations without consent in German-
speaking nations in 1886 (Kuechenhoff 2008).
Psychiatrists were particularly active in the
eugenics field and were often directly involved in
identifying victims for forced sterilisation. In 1934,
the
Journal of the American Medical Association
published a lengthy report on the German eugenics
law and its many expected benefits. In 1936, the
authors of
Eugenical Sterilization , led by Abraham
Myerson, one of America’s most respected psy-
chiatrists, praised Hitler’s eugenics legislation.
Indeed, the prosecution at the Nuremberg Trials
of 1945–1949 felt unable to classify forced
sterilisations as war crimes, because similar laws
had been implemented in the USA, where up to
25 000 such sterilisations took place (Cocks 1997;
Mottier 2007).
Psychiatry and the Holocaust
The Nazi regime considered that life was a matter
of survival of the fittest. Concepts such as equality
and justice were creations of ‘inferior’ groups
designed to weaken the true, pure stock of the
‘master race’. Hence, it became the responsibility
of the state and true Aryan people to ensure that
racially desirable members of society thrived and
that biologically inferior or defective people were
extinguished (‘racial hygiene’). Poverty and disease
were thought to arise from hereditary defects due
to non-Aryans contaminating the gene pool and
also to misguided ideals of welfare and equality.
Nazi policy recognised that German people had to
be trained to extinguish their biological inferiors,
to prevent both ‘racial degeneration’ and their
continued drain on resources (Cocks 1997).
The Nazi regime considered people with incur-
able mental illness as having a ‘life not worth living’
or ‘life unworthy of life’. German psychiatrists
were therefore required to identify people with
these forms of ‘hereditary’ mental illness.
The rise of eugenics
Psychiatrists in Germany and abroad had been
enthusiastically promoting eugenics programmes
involving sterilisation of the mentally ill decades
before Hitler came to power. Many German psychi-
atrists collaborated eagerly with the Nazis from the
very beginning, including enforcement of the 1933
Law for the Prevention of Hereditarily Diseased
Offspring, which required sterilisation of people
with many illnesses, including schizophrenia, manic
depression (bipolar disorder) and alcoholism. Pre-
war propaganda emphasised the financial demands
of these patients on the state (Fig. 2).
Aktion T-4
The procedures devised in eugenics programmes,
such as psychiatric assessment of competence
and disability, were crucial predecessors of the
euthanasia programmes for the murder of mentally
ill people in Germany. The T-4 ‘euthanasia’
programme
Aktion T-4, named after the Berlin
address of its coordinating office (Tiergartenstrasse
4), was established in 1939 to ensure the ‘genetic
purity of the German population’ by killing or
sterilising German and Austrian citizens who were
disabled or mentally ill (Cocks 1997). Eminent
German psychiatrists were actively involved in the
T-4 euthanasia programme at all stages, including
selection and execution. Again, propaganda was
used to promote the programme.
Under the T-4 programme, hundreds of
euthanasia forms, completed by two doctors at the
mental institution or hospital in question, were
sent to Berlin for approval by one of fifty experts,
including several professors of psychiatry. The
patients were then collected from the institutions
in the now infamous grey buses, and brought to
six psychiatric institutions in which gas chambers
had been installed (Grafeneck, Brandenburg,
Hartheim, Pirna-Sonnenstein, Bernburg and
Hadamar). Psychiatrists supervised the transport
and the execution of their patients. The presence
of physicians and other health professionals in the
euthanasia centres gave a false sense of security to
the victims, who did not realise their fate until the
very end. Faked death certificates were intended
to disguise the deaths as natural in order to hide
the victim’s fate from their family and the public
(Strous 2007).
Between 1939 and 1941, 80 000 to 100 000
mentally ill people in institutions were killed,
including 5000 children (Lifton 2000). Figures
for murders committed under the T-4 programme
outside institutions vary, from estimates of 20 000
(according to Dr Georg Renno, the deputy director
of one of the euthanasia centres) to 400 000
(according to Frank Zeireis, the commandant
of Mauthausen concentration camp) (Cocks
1997). Hitler ordered the cancellation of the T-4
programme in August 1941, following protests
from the Catholic and Protestant Churches.
Although public opposition ended these quasi-legal
killings, they continued in secret in asylums and
hospitals until the end of the war. Psychiatrists
and doctors often poisoned or starved mentally
ill hospital patients to death (Breggin 1993).
(Although the 1933 Law for the Prevention of
Hereditarily Diseased Offspring did not require
these patients to be killed, it did permit doctors
to kill them.) However, equipment, including gas
chambers, was moved to the concentration camps
and staff from the mental hospitals, including
psychiatrists, advised and staffed the camps.
Medical observers from the USA and Germany
at the Nuremberg Trials concluded that the
Holocaust might not have taken place without the
involvement of psychiatrists in the T-4 programme
(Breggin 1993).
The psychiatrists involved
Among the German and Swiss psychiatrists actively
and enthusiastically involved in the T-4 programme
were four presidents of the German Psychiatric
Association: Ernst Rüdin, Werner Villinger,
Friedrich Mauz and Friedrich Panse. Although
none of these four was subsequently punished for
their involvement, at least three other professors of
psychiatry were eventually captured. Karl Brandt
(Fig. 3), Hitler’s personal physician and Professor
of Psychiatry at Würzburg University, and Paul
Nitsche, Professor of Psychiatry and Neurology at
Heidelberg University, were both executed following
the Nuremberg Trials for crimes against humanity
(Faith 2010). Professor Werner Heyde of the
University of Würzburg hanged himself in prison
awaiting trial in 1964, having evaded capture for
20 years. Unfortunately, the German Psychiatric
Association and its successor organisation refused
to acknowledge the involvement of their members
for 65 years (Focus 2010).
Although psychiatrists were not the only health
professionals involved in abuses of mentally ill
people in Nazi Germany, many reports indicate it
was not a minority activity among them. Indeed, it
is likely that a majority of practising psychiatrists
in Germany at the time supported the Nazi regime
and a large proportion identified their patients for
the T-4 euthanasia programme. Similarly, many
American psychiatrists and academics, such
as Robert Foster Kennedy, supported Hitler’s
euthanasia campaigns. In an editorial in the
American Journal of Psychiatry (Kennedy 1942),
Kennedy warned that American mothers might
respond with ‘guilt’ over the killing of their
mentally ill children. The editorial suggests a
public education campaign to overcome emotional
resistance to such euthanasia.
Psychotherapy in the third reich
Under the Nazi regime, psychiatric patients were
subject to ruthless programmes of sterilisation
and eventually murder. By contrast, the regime
did not have the same attitude towards patients of
psychotherapists. Indeed, ‘Aryans’ were naturally
expected to be emotionally sensitive and could
reasonably receive psychotherapy. Hence, there
was a great incentive for patients, and families
of patients, with psychiatric disorders to be
treated by psychotherapists to avoid the dreadful
consequences of receiving a psychiatric diagnosis.
In 1933, the General Medical Society for Psycho-
therapy was created in Berlin and it quickly became
one of the major organisations in Central Europe
for teaching and research in psychotherapy (Cocks
1997). At the time, many German doctors and
medical students supported National Socialism,
not least because its plans to prevent foreigners,
Jews and women from practising medicine
promised to reduce competition for scarce jobs.
Psychotherapy in Germany flourished from 1936
under the auspices of the German Institute for
Psychological Research and Psychotherapy and
later, the Göring Institute.
The Göring Institute: the sanction of a name
Psychotherapy was surprisingly well tolerated
in Nazi Germany. Indeed, it was encouraged by
the regime. Psychotherapy was able to expand
as a professional discipline and it was subject to
much less oppression and restriction than many
other disciplines (such as psychiatry, history
and even physics). For example, a Luftwaffe
officer could take up to 2 years’ leave to study
psychotherapy. This was largely because the
principle base of German psychotherapy became
the Göring Institute, led by the psychiatrist and
student of Kraepelin, Matthias Henrich Göring
(Fig. 4). Dr Göring was reported to be a shy, gentle
man with a stammer. However, he was cousin
of Reichsmarschall Hermann Göring (Hitler’s
Deputy, Head of the Luftwaffe and founder of the
Gestapo), and the Göring name therefore protected
the Institute and psychotherapists from excessive
interference by Nazi bureaucrats. By 1941, the
Göring Institute had 240 members, including 100
doctors (although very few were psychiatrists).
However, Jews were banned as patients from 1938.
Psychoanalytic psychotherapy
As the Third Reich expanded, psychoanalysis
moved from Vienna and became centralised in
Berlin. Of course, psychoanalytic psychotherapy
had been established by a Jewish psychiatrist
(Sigmund Freud) and had many Jewish practition-
ers. In an article entitled ‘The Role of the Jew
in Medicine’ published in the newspaper
Die
Stürmer in 1933, Julius Streicher, the ‘Jewbaiter of
Nuremberg’, stated: ‘Freud’s aim […] was to strike
the Nordic race at its most sensitive spot, its sex
life’ (Cocks 1997: p. 59). This view was described
as a Jewish ‘poisoning of the soul’.
Psychoanalysis was considered a mercenary
perversion of the work of the Aryan German creators
of ‘depth psychology’, Novalis, Schopenhauer and
Goethe. Psychotherapists could do little to protest
in this environment and by the mid-1930s Freud’s
work was being burned in German universities and
Jews were banned from the executives of medical
societies (and later from the medical profession
altogether). As a ‘Jewish science’, psychoanalytic
psychotherapy was aggressively repressed by
the Nazi regime. Most Jewish psychoanalysts in
Germany emigrated, although 15 who did not
were tortured and murdered in Nazi concentration
camps. However, other forms of psychotherapy,
including Jungian and Adlerian psychotherapy,
became well established in Nazi Germany (despite
the fact that these variants were based on Freudian
psychoanalysis). Psychotherapy was actively
practised and supported by the Nazi government
throughout the war, but a distinct ‘German
psychotherapy’ was never created (Cocks 1997).
Political abuse of psychiatry in the uSSr
Political abuse of psychiatry has been defined
as the misuse of psychiatric diagnosis, detention
and treatment for the purposes of obstructing
the fundamental human rights of certain groups
and individuals in a society, especially political
dissidents (van Voren 2010).
From the 1960s, Soviet psychiatric hospitals
were used by the authorities as prisons in order
to isolate thousands of political prisoners from
the rest of society, discredit their ideas and punish
them both physically and mentally (van Voren
2010). Psychiatry, unlike many areas of medicine,
allows doctors to deprive people of their liberty to
protect them from coming to harm themselves or
to protect society. Although this form of detention
is carried out on the basis that these individuals
are mentally ill and unable to reason, the power
that detention gives psychiatry can be perverted
into a form of social control. Psychiatric detention
often allows society to by-pass cumbersome
legal procedures such as proof of guilt in public
courts. This became particularly popular in the
USSR from the late 1940s as a more convenient
alternative to sending dissidents to the Gulag (the
system of Soviet prison camps in Siberia).
One of the first Soviet psychiatric hospitals to
imprison political dissidents was in the city of
Kazan (van Voren 2010). It came under control of
the Soviet secret police in 1939. The psychiatric
detention of dissidents became much more
common from 1950 and the practice gradually
expanded to involve hundreds of mental hospitals
throughout the Soviet bloc.
‘Sluggish schizophrenia’
Throughout this period, Soviet psychiatrists
diagnosed ‘sluggish schizophrenia’ in political
dissidents (Metzl 2010). This disorder was based
on ideas developed by Andrei Snezhnevsky (1904–
1987), director of the Institute of Psychiatry of
the USSR Academy of Medical Sciences and, until
his resignation was requested, a Corresponding
Fellow of the Royal College of Psychiatrists in
London. Snezhnevsky was actively involved in the
detention of political dissidents.
The diagnosis of sluggish schizophrenia was
based on the idea that people who opposed
Communism were mentally ill since there was no
other logical reason why anyone would oppose
the Soviet system. Although psychiatric detention
of dissidents was instigated by the Soviet secret
police, many Soviet psychiatrists sympathised with
the idea that dissidents may be deluded: why else
would someone abandon their happiness, family
and career for a belief that contradicted what most
Soviet people claimed to believe? The concept
of sluggish schizophrenia obviated the need to
diagnose on the basis of such ‘delusions’. Antisocial
behaviour, anxiety, poor social adaptation, ideas
about reforming society, religious convictions and
confrontation with the authorities could be used
as diagnostic features of sluggish schizophrenia.
Clinical features also included the capacity to
behave normally for considerable periods, thereby
allowing the diagnosis to be made in people who
showed no overt signs of mental illness or people
who did not express politically dissenting opinions
at the time of examination. Patients with sluggish
schizophrenia were considered to be able to
function almost normally in social circumstances.
Anti-Marxist reactionary science
In October 1951, several leading Soviet neuro-
scientists and psychiatrists were charged with
practising ‘anti-Pavlovian, anti-Marxist, idealistic,
reactionary’ science (Lavretsky 1998). The
defendants had to admit in public to their wrong-
doing and several were dismissed from their posts.
Some were also imprisoned and tortured. Many
of their accusers were scientists themselves and
several were subsequently promoted.
On 29 April 1969, Yuri Andropov, head of the
Committee for State Security (the KGB), began
the creation of a network of mental hospitals
to defend the ‘Soviet Government and socialist
order’ from dissenters. This involved ‘measures
for preventing dangerous behaviour (acts) on the
part of mentally ill persons’. Under this policy,
psychiatrists could fabricate a diagnosis and
detain political dissenters indefinitely without
any court proceedings (Possony 1975: pp. 28–30).
The majority of dissenters who were detained
were examined at the Serbsky Central Research
Institute for Forensic Psychiatry in Moscow.
Some victims of the Serbsky Institute
Between 1954 and 1987, Viktor Rafalsky was
three times committed to psychiatric hospitals,
for belonging to a Marxist group, for writing
anti-Soviet prose and for possessing anti-Soviet
literature. By the time of his final release he had
spent a total of 24 years in detention. Between
1957 and 1963 Alexander Esenin-Volpin, later a
Professor of Mathematics at Boston University,
was also detained in mental hospitals on three
occasions, for writing anti-Soviet poems. He was
detained on a fourth occasion in 1969 but released
and permitted to emigrate to the USA following
protests by mathematicians and other Soviet
scientists. Vladimir Borisov was detained in
mental hospitals for a total of 9 years in the 1960s
and 1970s as a human rights activist and leader of
the Free Interprofessional Association of Workers.
Whistle-blowers
In January 1971, the Soviet psychiatrist Semyon
Gluzman wrote a psychiatric report that refused
to diagnose a political dissident as having a mental
illness. For this he was eventually sentenced to
serve 7 years in a labour camp. Later that spring,
Gluzman was instrumental in the smuggling to
the West of case reports on the use of psychiatric
hospitals in the USSR to detain political dissidents.
But when the practice was exposed at the World
Psychiatric Association (WPA) meeting in
Mexico in November 1971, members of the Soviet
delegation were said to have outmanoeuvered
the leaders of the WPA and no action was taken,
possibly owing to a reluctance to alienate Soviet
members. However, the first voices had been
heard and by the late 1970s protests were more
widespread among psychiatrists in the USSR.
In 1977, the Russian journalist Alexandr
Podrabinek completed a book titled
Punitive
Medicine (
Karatel’naya Meditsina ). Circulated
unofficially in the USSR, it contained lists of people
detained in Soviet mental hospitals and the names
of over 100 medical staff and doctors who took
part in detaining political dissenters. The work
appeared in English translation in the USA a few
years later (Podrabinek 1980). Podrabinek had
also been instrumental in setting up the Working
Commission to Investigate the Use of Psychiatry for
Political Purposes. Between 1977, the year of its
establishment, and 1983 the Commission reported
details of 50 dissidents and non-conformists who
were wrongly given a psychiatric diagnosis. This
information was instrumental in convincing
psychiatric associations in the West of political
abuses in the Soviet psychiatric system. However,
senior members of the Commission were sentenced
to periods of up to 8 years’ imprisonment and/or
internal exile by the Soviet authorities.
Reaction in the West
Opposition in Britain (including the creation of the
Campaign Against Psychiatric Abuse) led the Royal
College of Psychiatrists to establish the Special
Committee on the Political Abuse of Psychiatry
in 1978. These activities were denounced by
Communist governments. During its 1977 World
Congress, the WPA made a declaration that a
psychiatrist must not take part in compulsory
psychiatric treatment in the absence of mental
disease (Declaration of Hawaii). The declaration
did not specifically identify detention of political
dissidents as its primary objective. Similarly, the
terms of a WPA Review Committee, created at the
Congress, were subsequently widened to include
any unethical practice by psychiatrists – not just
detention of political dissidents. Furthermore, the
Committee was to examine only specific abuses by
individual psychiatrists, not systematic abuses by
governments. A British resolution put to the WPA
Committee condemning the abuse of psychiatry
in the USSR was passed by only the narrowest of
margins (90 to 88 votes). The USSR’s All-Union
Society of Neurologists and Psychiatrists resigned
from the WPA, along with other Soviet bloc
members, prior to a threat of expulsion in 1983.
Thankfully, the ascent of Mikhail Gorbachev
in the USSR in 1985 and the political freedoms
that followed ended the period of widespread
political abuses of Soviet psychiatry. Still, it was
not until 1989 that a delegation of US psychiatrists
was allowed to interview victims of alleged
political abuses of psychiatry. The All-Union
Society of Neurologists and Psychiatrists was
controversially readmitted to the WPA in 1989,
on the understanding that it cooperated sincerely
with investigations of political abuse of Soviet
psychiatry. The USSR (and the Society) dissolved
in 1993.
Psychoanalysis in the uSSra
Psychoanalysis shares several common themes
with Marxist theory. Marxists suggest that there
are no economic accidents or coincidences and
that all social and political events are deliberately
determined to oppress and exploit the worker. This
mirrors Freud’s views of the ‘illusion of psychical
free will’ – the illusion that our random thoughts
and impulses arise from free will rather than being
the expression of clearly defined subconscious
rules. ‘Class consciousness’ and ‘revolutionary
will’ are popular Marxist themes which have
common ground with Freudian psychoanalytic
theory. Similarly, the idea that everything should
be conscious, planned and intellectually controlled
is similar to Marxist ideas that behaviour and
belief are socially determined (primarily so that
the bourgeoisie could control and exploit the
worker). Nothing should be spontaneous, random
or unconscious. Marxists in Russia recognised
that psychoanalysis was a tool that could be used
to address this. In 1912 Freud wrote to Jung: ‘In
Russia [Odessa] there seems to be a local epidemic
of psychoanalysis’.
The founders of psychoanalysis had been
intimately concerned with discussions of
Bolshevism and Marxist politics. Freud’s parents
spent several years in Russia and Freud had a
number of Russian friends and acquaintances,
many of whom were Jewish exiles. In 1909,
the first Russian translations of Freud’s books
appeared. Alfred Adler’s wife, Raisa Epstein-
Adler, was a Russian Jew with radical socialist
views who published frequent articles in the
Russian journal
Psychotherapy in the 1920s.
The Russian Ministry of Education officially
established the Russian Psychoanalytical Society
in 1922 under the leadership of Otto Schmidt,
who ensured that Freud’s books were published
by the State Publishing House. His wife, Vera
Schmidt, became head of the Detski Dom, which
was also known as the Solidarity International
Experimental Home. Attached to Moscow’s
recently founded Psychoanalytic Institute, the
purpose of this residential school/home was to
‘help model the future “new man”, the builder of
communism’ (de Mijolla 2005). Stalin’s youngest
son Vasilii was a pupil. The Psychoanalytic
Institute was founded and financed directly by the
Ministry of Education.
The rise and fall of psychoanalysis
Psychoanalysis had a major influence on medical
practice in Russia following the revolution due
to the influence of Leon Trotsky. Trotsky had
personal experience of psychoanalysis while in
Vienna in 1908 and he was friends with Adler. In
1931, Trotsky sent his own daughter to a Berlin
psychoanalyst. Unfortunately, psycho analysis
became increasingly unpopular as Trotsky’s
influence declined in the newly formed USSR from
1924 to 1927 and the Russian Psychoanalytical
Society collapsed.
One of the most famous figures in early Russian
psychoanalysis was Sabina Spielrein (Fig. 5). She
was treated for psychosis in Austria and became
the lover of Carl Jung before becoming an analyst
herself and treating Jean Piaget. She devised the
concept of the death instinct. She returned to
Russia in 1923 and became a staff member of the
Psychoanalytic Institute in Moscow. Her work,
like that of all psychoanalysts in the USSR, was
gradually suppressed and she and her daughters
were murdered in a massacre of Russian Jews
following the Nazi invasion in 1941.
As psychoanalysis declined in Russia with
Trotsky’s fall, it was replaced by ‘paedology’,
a school of psychological theory based on the
‘Construction of the New Mass Man’, although
this was led by ex-psychoanalysts (Etkind 2012).
There was little psychoanalytic research published
in the USSR in the 1930s as the Stalinist regime
became increasingly rigid. Pavlovian ideas became
dominant and psychoanalysis was regarded as an
elitist Western practice. Paedology was prohibited
in 1936 and replaced by ‘collectivist pedagogy’
which reinforced obedience to the leader and
aggression to outsiders. Marxist psychology
became heavily influenced by theories developed
by Karl Kautsky. In 1906, Kautsky had suggested
that human beings have a ‘social instinct’, with a
natural tendency for altruism and self-sacrifice,
submission to the will of society, fidelity to the
community, obedience and truthfulness to protect
the collective. Clearly, these ideas had great value
in a totalitarian regime such as Stalin’s Russia
and they were actively promoted. Furthermore,
according to Marxist theories, illness without
physical cause could only have a social cause.
Hence, psychiatry in Russia gradually adopted
social and moral norms as criteria of sanity, and
political dissent became a symptom of psychiatric
illness. Despite its great initial influence,
psychoanalysis disappeared from Russia from the
1930s until collapse of the totalitarian regime in
the 1980s.
thomas Szasz
The controversial psychiatrist Thomas Szasz was
born in 1920 in the Hungarian city of Budapest,
son of a Jewish businessman (Stadlen 2012). By
1938, Hungary had sided with Nazi Germany, and
the Szasz family moved to the USA. Szasz died on
8 September 2012.
A prominent and outspoken adversary of
coercion (compulsory detention), Szasz denied
that mental illness exists. In his books
The Myth of Mental Illness (1961) and
The Manufacture of Madness (1970) he criticised the ‘Free World’
Advances in psychiatric treatment (2014), vol. 20, 52–60 doi: 10.1192/apt.bp.112.01033059Psychiatry and the dark side
as well as the Communist states for their use of
psychiatric diagnosis to deprive people of their
liberty. Szasz argued that there are no objective
methods for detecting the presence or absence of
mental disease and that so-called ‘mental illness’
is simply voted into existence by members of
organisations such as the American Psychiatric
Association. Szasz regarded psychiatric diagnosis
as a way of controlling people whose behaviour
does not conform to existing social norms.
He dismissed psychiatric diagnoses as moral
judgements rather than scientific categories. He
believed that mental health legislation is used
by the state and psychiatrists as a form of social
control supported by the fraudulent claim that
psychiatry is based on science. In
Ceremonial
Chemistry (1974), he posited that mental health
legislation is used to target social scapegoats (such
as drug addicts and ‘insane’ people) in the same
way that witches, Jews, Gypsies and homosexuals
have been persecuted. Contrary to popular belief,
Szasz was not opposed to the practice of psychiatry
if it is non-coercive.
Maverick, crank or pioneer?
Although Szasz was often dismissed as a crank
by other psychiatrists, a variety of sources
have supported his beliefs, especially following
publicity of the misuse of psychiatric detention
against political dissidents in the former USSR.
Furthermore, seminal research on literary
sources by Fulford
et al (1993) has suggested
that the concept of disease employed in the USSR
was similar to that still used in the UK and
USA. Indeed, the case that psychiatric diagnosis
is strongly supported by objective scientific
research was promoted in each jurisdiction (in the
Communist East and free Western democracies)
despite the rather arbitrary nature of psychiatric
classification. Szasz himself stated that the
activities of the Western psychiatrists condemning
their colleagues in the USSR for their abuse of
mental health legislation was ‘an exercise in
hypocrisy’ (Szasz 1970).
Discussion
Does the past offer any solutions to prevent
abuses of mental health legislation and diagnosis
of mental illness for political purposes? In reality,
few professionals in a dictatorship would dispute
instructions to detain an individual from a senior
state official. Soviet psychiatrists were coerced
with the threat of imprisonment themselves if they
failed to follow the repressive orders of the state.
However, a lamentable lack of coercion appears to
have been a feature in Nazi Germany, where many
psychiatrists enthusiastically complied with their
role in the eugenics programme.
In the analysis of abuses of mentally well
political dissidents by totalitarian regimes there is
a certain degree of naivety. Although life in a Soviet
psychiatric hospital would be most unpleasant for
all inmates by current standards, before the 1950s
many Soviet political dissidents would have been
shot or died of starvation in Siberian work camps.
The WPA could be criticised for its lethargy
in failing to take punitive action against the All-
Union Society of Neurologists and Psychiatrists
and its individual members. However, it is prudent
to observe that the WPA could not have had any
significant influence on these totalitarian regimes
by expelling their associations or trying individual
psychiatrists for political abuses.
Thomas Szasz argued that a diagnosis should
not be simply voted into existence, especially as it
may then be used to deprive people of their liberty.
In light of this, political and legal restraints need
to be placed on psychiatrists’ powers to detain
people on the grounds of mental illness, not least
of which is multidisciplinary consensus that a
person has a mental illness and should be detained
and the right to demand judicial review in open
court. Although legal challenge is unlikely to
prevent state-sponsored abuses of mental health
legislation, secrecy and the lack of transparency
in these proceedings could draw international
attention to potential abuses.
Activities which are now discredited, such as
the detention of political dissidents and forced
sterilisation, had vocal adherents who could
produce apparently plausible scientific reports to
show their effectiveness. There was highly visible
support in the media from respected medical
and political leaders. This raises concerns about
the ability to detain people under the Dangerous
and Severe Personality Disorder Programme in
the UK, by which patients are not required to
have been convicted of any offence, nor do the
proceedings require any public hearings in court
(although in practice most of the 200 or so patients
subject to these proceedings are likely to have
been diverted from the courts) (Buchanan 2011).
Regrettably, detention of people with ‘dangerous
severe personality disorders’ was politically
inspired (Feeney 2003). Although it is unlikely
that there is currently abuse of the system for
detaining such people, there remains a worrying
potential for this within the system.
references
Breggin PR (1993) Psychiatry’s role in the Holocaust. International Journal
of Risk and Safety in Medicine, 4: 133–48.
Taken from:
[1] https://www.cambridge.org/core/services/aop-cambridge-core/content/view/5A5950F52D74D0B5FC5418642C5211D1/S1355514600011378a.pdf/div-class-title-psychiatry-and-the-dark-side-eugenics-nazi-and-soviet-psychiatry-div.pdf
By Jason Luty
EXCERPTS
"The patients were then collected from the institutions
in the now infamous grey buses, and brought to
six psychiatric institutions in which gas chambers
had been installed (Grafeneck, Brandenburg,
Hartheim, Pirna-Sonnenstein, Bernburg and
Hadamar). Psychiatrists supervised the transport
and the execution of their patients. The presence
of physicians and other health professionals in the
euthanasia centres gave a false sense of security to
the victims, who did not realise their fate until the
very end. Faked death certificates were intended
to disguise the deaths as natural in order to hide
the victim’s fate from their family and the public
(Strous 2007). Between 1939 and 1941, 80 000
to 100 000 mentally ill people in institutions were killed,
including 5000 children (Lifton 2000). ...
Hitler ordered the cancellation of the T-4
programme in August 1941, following protests
from the Catholic and Protestant Churches.
Although public opposition ended these quasi-legal
killings, they continued in secret in asylums and
hospitals until the end of the war. Psychiatrists
and doctors often poisoned or starved mentally
ill hospital patients to death (Breggin 1993). ...
Medical observers from the USA and Germany
at the Nuremberg Trials concluded that the
Holocaust might not have taken place without the
involvement of psychiatrists in the T-4 programme
(Breggin 1993)."
"The diagnosis of sluggish schizophrenia was
based on the idea that people who opposed
Communism were mentally ill since there was no
other logical reason why anyone would oppose
the Soviet system."
"Szasz regarded psychiatric diagnosis
as a way of controlling people whose behaviour
does not conform to existing social norms.
He dismissed psychiatric diagnoses as moral
judgements rather than scientific categories. He
believed that mental health legislation is used
by the state and psychiatrists as a form of social
control supported by the fraudulent claim that
psychiatry is based on science. In
Ceremonial Chemistry (1974), he posited that mental health
legislation is used to target social scapegoats (such
as drug addicts and ‘insane’ people) in the same
way that witches, Jews, Gypsies and homosexuals
have been persecuted. Contrary to popular belief,
Szasz was not opposed to the practice of psychiatry
if it is non-coercive."
SUMMARY
Psychiatrist Thomas Szasz fought coercion
(compulsory detention) and denied that mental
illness existed. Although he was regarded as a
maverick, his ideas are much more plausible when
one discovers that between 1939 and 1941, up to
100 000 mentally ill people, including 5000 children,
were killed in Nazi Germany. In the course of the
Nazi regime, over 400 000 forced sterilisations took
place, mainly of people with mental illnesses. Other
countries, including Denmark, Norway, Sweden
and Switzerland, had active forced sterilisation
programmes and eugenics laws. Similar laws were
implemented in the USA, with up to 25 000 forced
sterilisations. These atrocities were enabled and
facilitated by psychiatrists of the time and are only
one example of the dark side of the profession.
This article reviews some of these aspects of the
history of psychiatry, including Germany’s eugenics
programme and the former USSR’s detention of
dissidents under the guise of psychiatric treatment.
Declaration of interest
None
THE ARTICLE
‘Men (wretched creatures that they are) worry less
about doing an injury to one who makes himself
loved than to one who makes himself feared’ (
The Prince, Niccolo Machiavelli, 1532).
The objective of this article is to familiarise
mental health professionals and lay readers
with the rather colourful and disdainful history
of psychiatry, particularly the political abuses
of mental health legislation. The debate about
legislative changes (including legislation for
‘dangerous severe personality disorder’ in the UK)
often seems arcane and unnecessary until set in
the context of these historical abuses of the mental
health system.
Some psychiatrists have abused power in
general. For example, although the war crimes for
which Radovan Karadžic´ is currently standing
trial do not arise from his psychiatric practice, it
is salutary to note that he is far from being the
first psychiatrist to be accused (or convicted) of
crimes against humanity. However, Thomas Szasz
controversially argued that there is something
inherent in psychiatry, particularly the power to
restrict liberty, that tends towards abuse if not
regulated by the legal or political system. In the
past, there have been abuses of psychiatrists’
powers to detain people, but these have been
instigated at the direction of governments such
as that in Nazi Germany (leading to genocide of
mentally ill people) and the USSR (where political
dissidents were detained with a diagnosis of
‘sluggish schizophrenia’).
Psychiatry and eugenics
The science of eugenics emerged during the
late Victorian era, with the aim of reducing the
rates of physical and mental illness, hereditary
diseases and ‘morally deviant behaviours’. It was
promoted throughout industrial countries amid
fears of ‘degeneration, race suicide, and the threat
of disordered sexualities’ (Mottier 2008: p. 34).
The 1933 Law for the Prevention of Hereditarily
Diseased Offspring (
Das Gesetz zur Verhütung
erbkranken Nachwuchses ) required German
doctors to register hereditary illnesses in their
patients. In the course of the Nazi regime, over
200 ‘hereditary health courts’ were set up, which
authorised over 400 000 sterilisations. Most of the
people sterilised between 1934 and 1939 in Nazi
Germany were labelled ‘mentally ill’ (Cocks 1997;
Mottier 2007).
Eugenics and forced sterilisation programmes
tend to be associated with Nazi Germany. However,
other countries had active forced sterilisation
programmes and eugenics laws, among them the
USA, Denmark, Norway, Sweden and Switzerland
(Weiss 2010). In 1912, Switzerland introduced laws
prohibiting marriage for the ‘mentally deficient’
and ‘legally irresponsible’ (Mottier 2007). Eugenics
sterilisation laws were introduced in the US State
of Indiana in 1907 (Fig. 1), and in two-thirds of the
remaining states by the 1930s. Havelock Ellis was
a British physician and psychologist who actively
promoted eugenics, although these programmes
were never enacted in the UK. Eugenics was
supported by many leading psychiatrists, such as
Emil Kraepelin, Eugen Bleuler and especially the
Swiss psychiatrist Auguste Forel, who pioneered
the first sterilisations without consent in German-
speaking nations in 1886 (Kuechenhoff 2008).
Psychiatrists were particularly active in the
eugenics field and were often directly involved in
identifying victims for forced sterilisation. In 1934,
the
Journal of the American Medical Association
published a lengthy report on the German eugenics
law and its many expected benefits. In 1936, the
authors of
Eugenical Sterilization , led by Abraham
Myerson, one of America’s most respected psy-
chiatrists, praised Hitler’s eugenics legislation.
Indeed, the prosecution at the Nuremberg Trials
of 1945–1949 felt unable to classify forced
sterilisations as war crimes, because similar laws
had been implemented in the USA, where up to
25 000 such sterilisations took place (Cocks 1997;
Mottier 2007).
Psychiatry and the Holocaust
The Nazi regime considered that life was a matter
of survival of the fittest. Concepts such as equality
and justice were creations of ‘inferior’ groups
designed to weaken the true, pure stock of the
‘master race’. Hence, it became the responsibility
of the state and true Aryan people to ensure that
racially desirable members of society thrived and
that biologically inferior or defective people were
extinguished (‘racial hygiene’). Poverty and disease
were thought to arise from hereditary defects due
to non-Aryans contaminating the gene pool and
also to misguided ideals of welfare and equality.
Nazi policy recognised that German people had to
be trained to extinguish their biological inferiors,
to prevent both ‘racial degeneration’ and their
continued drain on resources (Cocks 1997).
The Nazi regime considered people with incur-
able mental illness as having a ‘life not worth living’
or ‘life unworthy of life’. German psychiatrists
were therefore required to identify people with
these forms of ‘hereditary’ mental illness.
The rise of eugenics
Psychiatrists in Germany and abroad had been
enthusiastically promoting eugenics programmes
involving sterilisation of the mentally ill decades
before Hitler came to power. Many German psychi-
atrists collaborated eagerly with the Nazis from the
very beginning, including enforcement of the 1933
Law for the Prevention of Hereditarily Diseased
Offspring, which required sterilisation of people
with many illnesses, including schizophrenia, manic
depression (bipolar disorder) and alcoholism. Pre-
war propaganda emphasised the financial demands
of these patients on the state (Fig. 2).
Aktion T-4
The procedures devised in eugenics programmes,
such as psychiatric assessment of competence
and disability, were crucial predecessors of the
euthanasia programmes for the murder of mentally
ill people in Germany. The T-4 ‘euthanasia’
programme
Aktion T-4, named after the Berlin
address of its coordinating office (Tiergartenstrasse
4), was established in 1939 to ensure the ‘genetic
purity of the German population’ by killing or
sterilising German and Austrian citizens who were
disabled or mentally ill (Cocks 1997). Eminent
German psychiatrists were actively involved in the
T-4 euthanasia programme at all stages, including
selection and execution. Again, propaganda was
used to promote the programme.
Under the T-4 programme, hundreds of
euthanasia forms, completed by two doctors at the
mental institution or hospital in question, were
sent to Berlin for approval by one of fifty experts,
including several professors of psychiatry. The
patients were then collected from the institutions
in the now infamous grey buses, and brought to
six psychiatric institutions in which gas chambers
had been installed (Grafeneck, Brandenburg,
Hartheim, Pirna-Sonnenstein, Bernburg and
Hadamar). Psychiatrists supervised the transport
and the execution of their patients. The presence
of physicians and other health professionals in the
euthanasia centres gave a false sense of security to
the victims, who did not realise their fate until the
very end. Faked death certificates were intended
to disguise the deaths as natural in order to hide
the victim’s fate from their family and the public
(Strous 2007).
Between 1939 and 1941, 80 000 to 100 000
mentally ill people in institutions were killed,
including 5000 children (Lifton 2000). Figures
for murders committed under the T-4 programme
outside institutions vary, from estimates of 20 000
(according to Dr Georg Renno, the deputy director
of one of the euthanasia centres) to 400 000
(according to Frank Zeireis, the commandant
of Mauthausen concentration camp) (Cocks
1997). Hitler ordered the cancellation of the T-4
programme in August 1941, following protests
from the Catholic and Protestant Churches.
Although public opposition ended these quasi-legal
killings, they continued in secret in asylums and
hospitals until the end of the war. Psychiatrists
and doctors often poisoned or starved mentally
ill hospital patients to death (Breggin 1993).
(Although the 1933 Law for the Prevention of
Hereditarily Diseased Offspring did not require
these patients to be killed, it did permit doctors
to kill them.) However, equipment, including gas
chambers, was moved to the concentration camps
and staff from the mental hospitals, including
psychiatrists, advised and staffed the camps.
Medical observers from the USA and Germany
at the Nuremberg Trials concluded that the
Holocaust might not have taken place without the
involvement of psychiatrists in the T-4 programme
(Breggin 1993).
The psychiatrists involved
Among the German and Swiss psychiatrists actively
and enthusiastically involved in the T-4 programme
were four presidents of the German Psychiatric
Association: Ernst Rüdin, Werner Villinger,
Friedrich Mauz and Friedrich Panse. Although
none of these four was subsequently punished for
their involvement, at least three other professors of
psychiatry were eventually captured. Karl Brandt
(Fig. 3), Hitler’s personal physician and Professor
of Psychiatry at Würzburg University, and Paul
Nitsche, Professor of Psychiatry and Neurology at
Heidelberg University, were both executed following
the Nuremberg Trials for crimes against humanity
(Faith 2010). Professor Werner Heyde of the
University of Würzburg hanged himself in prison
awaiting trial in 1964, having evaded capture for
20 years. Unfortunately, the German Psychiatric
Association and its successor organisation refused
to acknowledge the involvement of their members
for 65 years (Focus 2010).
Although psychiatrists were not the only health
professionals involved in abuses of mentally ill
people in Nazi Germany, many reports indicate it
was not a minority activity among them. Indeed, it
is likely that a majority of practising psychiatrists
in Germany at the time supported the Nazi regime
and a large proportion identified their patients for
the T-4 euthanasia programme. Similarly, many
American psychiatrists and academics, such
as Robert Foster Kennedy, supported Hitler’s
euthanasia campaigns. In an editorial in the
American Journal of Psychiatry (Kennedy 1942),
Kennedy warned that American mothers might
respond with ‘guilt’ over the killing of their
mentally ill children. The editorial suggests a
public education campaign to overcome emotional
resistance to such euthanasia.
Psychotherapy in the third reich
Under the Nazi regime, psychiatric patients were
subject to ruthless programmes of sterilisation
and eventually murder. By contrast, the regime
did not have the same attitude towards patients of
psychotherapists. Indeed, ‘Aryans’ were naturally
expected to be emotionally sensitive and could
reasonably receive psychotherapy. Hence, there
was a great incentive for patients, and families
of patients, with psychiatric disorders to be
treated by psychotherapists to avoid the dreadful
consequences of receiving a psychiatric diagnosis.
In 1933, the General Medical Society for Psycho-
therapy was created in Berlin and it quickly became
one of the major organisations in Central Europe
for teaching and research in psychotherapy (Cocks
1997). At the time, many German doctors and
medical students supported National Socialism,
not least because its plans to prevent foreigners,
Jews and women from practising medicine
promised to reduce competition for scarce jobs.
Psychotherapy in Germany flourished from 1936
under the auspices of the German Institute for
Psychological Research and Psychotherapy and
later, the Göring Institute.
The Göring Institute: the sanction of a name
Psychotherapy was surprisingly well tolerated
in Nazi Germany. Indeed, it was encouraged by
the regime. Psychotherapy was able to expand
as a professional discipline and it was subject to
much less oppression and restriction than many
other disciplines (such as psychiatry, history
and even physics). For example, a Luftwaffe
officer could take up to 2 years’ leave to study
psychotherapy. This was largely because the
principle base of German psychotherapy became
the Göring Institute, led by the psychiatrist and
student of Kraepelin, Matthias Henrich Göring
(Fig. 4). Dr Göring was reported to be a shy, gentle
man with a stammer. However, he was cousin
of Reichsmarschall Hermann Göring (Hitler’s
Deputy, Head of the Luftwaffe and founder of the
Gestapo), and the Göring name therefore protected
the Institute and psychotherapists from excessive
interference by Nazi bureaucrats. By 1941, the
Göring Institute had 240 members, including 100
doctors (although very few were psychiatrists).
However, Jews were banned as patients from 1938.
Psychoanalytic psychotherapy
As the Third Reich expanded, psychoanalysis
moved from Vienna and became centralised in
Berlin. Of course, psychoanalytic psychotherapy
had been established by a Jewish psychiatrist
(Sigmund Freud) and had many Jewish practition-
ers. In an article entitled ‘The Role of the Jew
in Medicine’ published in the newspaper
Die
Stürmer in 1933, Julius Streicher, the ‘Jewbaiter of
Nuremberg’, stated: ‘Freud’s aim […] was to strike
the Nordic race at its most sensitive spot, its sex
life’ (Cocks 1997: p. 59). This view was described
as a Jewish ‘poisoning of the soul’.
Psychoanalysis was considered a mercenary
perversion of the work of the Aryan German creators
of ‘depth psychology’, Novalis, Schopenhauer and
Goethe. Psychotherapists could do little to protest
in this environment and by the mid-1930s Freud’s
work was being burned in German universities and
Jews were banned from the executives of medical
societies (and later from the medical profession
altogether). As a ‘Jewish science’, psychoanalytic
psychotherapy was aggressively repressed by
the Nazi regime. Most Jewish psychoanalysts in
Germany emigrated, although 15 who did not
were tortured and murdered in Nazi concentration
camps. However, other forms of psychotherapy,
including Jungian and Adlerian psychotherapy,
became well established in Nazi Germany (despite
the fact that these variants were based on Freudian
psychoanalysis). Psychotherapy was actively
practised and supported by the Nazi government
throughout the war, but a distinct ‘German
psychotherapy’ was never created (Cocks 1997).
Political abuse of psychiatry in the uSSr
Political abuse of psychiatry has been defined
as the misuse of psychiatric diagnosis, detention
and treatment for the purposes of obstructing
the fundamental human rights of certain groups
and individuals in a society, especially political
dissidents (van Voren 2010).
From the 1960s, Soviet psychiatric hospitals
were used by the authorities as prisons in order
to isolate thousands of political prisoners from
the rest of society, discredit their ideas and punish
them both physically and mentally (van Voren
2010). Psychiatry, unlike many areas of medicine,
allows doctors to deprive people of their liberty to
protect them from coming to harm themselves or
to protect society. Although this form of detention
is carried out on the basis that these individuals
are mentally ill and unable to reason, the power
that detention gives psychiatry can be perverted
into a form of social control. Psychiatric detention
often allows society to by-pass cumbersome
legal procedures such as proof of guilt in public
courts. This became particularly popular in the
USSR from the late 1940s as a more convenient
alternative to sending dissidents to the Gulag (the
system of Soviet prison camps in Siberia).
One of the first Soviet psychiatric hospitals to
imprison political dissidents was in the city of
Kazan (van Voren 2010). It came under control of
the Soviet secret police in 1939. The psychiatric
detention of dissidents became much more
common from 1950 and the practice gradually
expanded to involve hundreds of mental hospitals
throughout the Soviet bloc.
‘Sluggish schizophrenia’
Throughout this period, Soviet psychiatrists
diagnosed ‘sluggish schizophrenia’ in political
dissidents (Metzl 2010). This disorder was based
on ideas developed by Andrei Snezhnevsky (1904–
1987), director of the Institute of Psychiatry of
the USSR Academy of Medical Sciences and, until
his resignation was requested, a Corresponding
Fellow of the Royal College of Psychiatrists in
London. Snezhnevsky was actively involved in the
detention of political dissidents.
The diagnosis of sluggish schizophrenia was
based on the idea that people who opposed
Communism were mentally ill since there was no
other logical reason why anyone would oppose
the Soviet system. Although psychiatric detention
of dissidents was instigated by the Soviet secret
police, many Soviet psychiatrists sympathised with
the idea that dissidents may be deluded: why else
would someone abandon their happiness, family
and career for a belief that contradicted what most
Soviet people claimed to believe? The concept
of sluggish schizophrenia obviated the need to
diagnose on the basis of such ‘delusions’. Antisocial
behaviour, anxiety, poor social adaptation, ideas
about reforming society, religious convictions and
confrontation with the authorities could be used
as diagnostic features of sluggish schizophrenia.
Clinical features also included the capacity to
behave normally for considerable periods, thereby
allowing the diagnosis to be made in people who
showed no overt signs of mental illness or people
who did not express politically dissenting opinions
at the time of examination. Patients with sluggish
schizophrenia were considered to be able to
function almost normally in social circumstances.
Anti-Marxist reactionary science
In October 1951, several leading Soviet neuro-
scientists and psychiatrists were charged with
practising ‘anti-Pavlovian, anti-Marxist, idealistic,
reactionary’ science (Lavretsky 1998). The
defendants had to admit in public to their wrong-
doing and several were dismissed from their posts.
Some were also imprisoned and tortured. Many
of their accusers were scientists themselves and
several were subsequently promoted.
On 29 April 1969, Yuri Andropov, head of the
Committee for State Security (the KGB), began
the creation of a network of mental hospitals
to defend the ‘Soviet Government and socialist
order’ from dissenters. This involved ‘measures
for preventing dangerous behaviour (acts) on the
part of mentally ill persons’. Under this policy,
psychiatrists could fabricate a diagnosis and
detain political dissenters indefinitely without
any court proceedings (Possony 1975: pp. 28–30).
The majority of dissenters who were detained
were examined at the Serbsky Central Research
Institute for Forensic Psychiatry in Moscow.
Some victims of the Serbsky Institute
Between 1954 and 1987, Viktor Rafalsky was
three times committed to psychiatric hospitals,
for belonging to a Marxist group, for writing
anti-Soviet prose and for possessing anti-Soviet
literature. By the time of his final release he had
spent a total of 24 years in detention. Between
1957 and 1963 Alexander Esenin-Volpin, later a
Professor of Mathematics at Boston University,
was also detained in mental hospitals on three
occasions, for writing anti-Soviet poems. He was
detained on a fourth occasion in 1969 but released
and permitted to emigrate to the USA following
protests by mathematicians and other Soviet
scientists. Vladimir Borisov was detained in
mental hospitals for a total of 9 years in the 1960s
and 1970s as a human rights activist and leader of
the Free Interprofessional Association of Workers.
Whistle-blowers
In January 1971, the Soviet psychiatrist Semyon
Gluzman wrote a psychiatric report that refused
to diagnose a political dissident as having a mental
illness. For this he was eventually sentenced to
serve 7 years in a labour camp. Later that spring,
Gluzman was instrumental in the smuggling to
the West of case reports on the use of psychiatric
hospitals in the USSR to detain political dissidents.
But when the practice was exposed at the World
Psychiatric Association (WPA) meeting in
Mexico in November 1971, members of the Soviet
delegation were said to have outmanoeuvered
the leaders of the WPA and no action was taken,
possibly owing to a reluctance to alienate Soviet
members. However, the first voices had been
heard and by the late 1970s protests were more
widespread among psychiatrists in the USSR.
In 1977, the Russian journalist Alexandr
Podrabinek completed a book titled
Punitive
Medicine (
Karatel’naya Meditsina ). Circulated
unofficially in the USSR, it contained lists of people
detained in Soviet mental hospitals and the names
of over 100 medical staff and doctors who took
part in detaining political dissenters. The work
appeared in English translation in the USA a few
years later (Podrabinek 1980). Podrabinek had
also been instrumental in setting up the Working
Commission to Investigate the Use of Psychiatry for
Political Purposes. Between 1977, the year of its
establishment, and 1983 the Commission reported
details of 50 dissidents and non-conformists who
were wrongly given a psychiatric diagnosis. This
information was instrumental in convincing
psychiatric associations in the West of political
abuses in the Soviet psychiatric system. However,
senior members of the Commission were sentenced
to periods of up to 8 years’ imprisonment and/or
internal exile by the Soviet authorities.
Reaction in the West
Opposition in Britain (including the creation of the
Campaign Against Psychiatric Abuse) led the Royal
College of Psychiatrists to establish the Special
Committee on the Political Abuse of Psychiatry
in 1978. These activities were denounced by
Communist governments. During its 1977 World
Congress, the WPA made a declaration that a
psychiatrist must not take part in compulsory
psychiatric treatment in the absence of mental
disease (Declaration of Hawaii). The declaration
did not specifically identify detention of political
dissidents as its primary objective. Similarly, the
terms of a WPA Review Committee, created at the
Congress, were subsequently widened to include
any unethical practice by psychiatrists – not just
detention of political dissidents. Furthermore, the
Committee was to examine only specific abuses by
individual psychiatrists, not systematic abuses by
governments. A British resolution put to the WPA
Committee condemning the abuse of psychiatry
in the USSR was passed by only the narrowest of
margins (90 to 88 votes). The USSR’s All-Union
Society of Neurologists and Psychiatrists resigned
from the WPA, along with other Soviet bloc
members, prior to a threat of expulsion in 1983.
Thankfully, the ascent of Mikhail Gorbachev
in the USSR in 1985 and the political freedoms
that followed ended the period of widespread
political abuses of Soviet psychiatry. Still, it was
not until 1989 that a delegation of US psychiatrists
was allowed to interview victims of alleged
political abuses of psychiatry. The All-Union
Society of Neurologists and Psychiatrists was
controversially readmitted to the WPA in 1989,
on the understanding that it cooperated sincerely
with investigations of political abuse of Soviet
psychiatry. The USSR (and the Society) dissolved
in 1993.
Psychoanalysis in the uSSra
Psychoanalysis shares several common themes
with Marxist theory. Marxists suggest that there
are no economic accidents or coincidences and
that all social and political events are deliberately
determined to oppress and exploit the worker. This
mirrors Freud’s views of the ‘illusion of psychical
free will’ – the illusion that our random thoughts
and impulses arise from free will rather than being
the expression of clearly defined subconscious
rules. ‘Class consciousness’ and ‘revolutionary
will’ are popular Marxist themes which have
common ground with Freudian psychoanalytic
theory. Similarly, the idea that everything should
be conscious, planned and intellectually controlled
is similar to Marxist ideas that behaviour and
belief are socially determined (primarily so that
the bourgeoisie could control and exploit the
worker). Nothing should be spontaneous, random
or unconscious. Marxists in Russia recognised
that psychoanalysis was a tool that could be used
to address this. In 1912 Freud wrote to Jung: ‘In
Russia [Odessa] there seems to be a local epidemic
of psychoanalysis’.
The founders of psychoanalysis had been
intimately concerned with discussions of
Bolshevism and Marxist politics. Freud’s parents
spent several years in Russia and Freud had a
number of Russian friends and acquaintances,
many of whom were Jewish exiles. In 1909,
the first Russian translations of Freud’s books
appeared. Alfred Adler’s wife, Raisa Epstein-
Adler, was a Russian Jew with radical socialist
views who published frequent articles in the
Russian journal
Psychotherapy in the 1920s.
The Russian Ministry of Education officially
established the Russian Psychoanalytical Society
in 1922 under the leadership of Otto Schmidt,
who ensured that Freud’s books were published
by the State Publishing House. His wife, Vera
Schmidt, became head of the Detski Dom, which
was also known as the Solidarity International
Experimental Home. Attached to Moscow’s
recently founded Psychoanalytic Institute, the
purpose of this residential school/home was to
‘help model the future “new man”, the builder of
communism’ (de Mijolla 2005). Stalin’s youngest
son Vasilii was a pupil. The Psychoanalytic
Institute was founded and financed directly by the
Ministry of Education.
The rise and fall of psychoanalysis
Psychoanalysis had a major influence on medical
practice in Russia following the revolution due
to the influence of Leon Trotsky. Trotsky had
personal experience of psychoanalysis while in
Vienna in 1908 and he was friends with Adler. In
1931, Trotsky sent his own daughter to a Berlin
psychoanalyst. Unfortunately, psycho analysis
became increasingly unpopular as Trotsky’s
influence declined in the newly formed USSR from
1924 to 1927 and the Russian Psychoanalytical
Society collapsed.
One of the most famous figures in early Russian
psychoanalysis was Sabina Spielrein (Fig. 5). She
was treated for psychosis in Austria and became
the lover of Carl Jung before becoming an analyst
herself and treating Jean Piaget. She devised the
concept of the death instinct. She returned to
Russia in 1923 and became a staff member of the
Psychoanalytic Institute in Moscow. Her work,
like that of all psychoanalysts in the USSR, was
gradually suppressed and she and her daughters
were murdered in a massacre of Russian Jews
following the Nazi invasion in 1941.
As psychoanalysis declined in Russia with
Trotsky’s fall, it was replaced by ‘paedology’,
a school of psychological theory based on the
‘Construction of the New Mass Man’, although
this was led by ex-psychoanalysts (Etkind 2012).
There was little psychoanalytic research published
in the USSR in the 1930s as the Stalinist regime
became increasingly rigid. Pavlovian ideas became
dominant and psychoanalysis was regarded as an
elitist Western practice. Paedology was prohibited
in 1936 and replaced by ‘collectivist pedagogy’
which reinforced obedience to the leader and
aggression to outsiders. Marxist psychology
became heavily influenced by theories developed
by Karl Kautsky. In 1906, Kautsky had suggested
that human beings have a ‘social instinct’, with a
natural tendency for altruism and self-sacrifice,
submission to the will of society, fidelity to the
community, obedience and truthfulness to protect
the collective. Clearly, these ideas had great value
in a totalitarian regime such as Stalin’s Russia
and they were actively promoted. Furthermore,
according to Marxist theories, illness without
physical cause could only have a social cause.
Hence, psychiatry in Russia gradually adopted
social and moral norms as criteria of sanity, and
political dissent became a symptom of psychiatric
illness. Despite its great initial influence,
psychoanalysis disappeared from Russia from the
1930s until collapse of the totalitarian regime in
the 1980s.
thomas Szasz
The controversial psychiatrist Thomas Szasz was
born in 1920 in the Hungarian city of Budapest,
son of a Jewish businessman (Stadlen 2012). By
1938, Hungary had sided with Nazi Germany, and
the Szasz family moved to the USA. Szasz died on
8 September 2012.
A prominent and outspoken adversary of
coercion (compulsory detention), Szasz denied
that mental illness exists. In his books
The Myth of Mental Illness (1961) and
The Manufacture of Madness (1970) he criticised the ‘Free World’
Advances in psychiatric treatment (2014), vol. 20, 52–60 doi: 10.1192/apt.bp.112.01033059Psychiatry and the dark side
as well as the Communist states for their use of
psychiatric diagnosis to deprive people of their
liberty. Szasz argued that there are no objective
methods for detecting the presence or absence of
mental disease and that so-called ‘mental illness’
is simply voted into existence by members of
organisations such as the American Psychiatric
Association. Szasz regarded psychiatric diagnosis
as a way of controlling people whose behaviour
does not conform to existing social norms.
He dismissed psychiatric diagnoses as moral
judgements rather than scientific categories. He
believed that mental health legislation is used
by the state and psychiatrists as a form of social
control supported by the fraudulent claim that
psychiatry is based on science. In
Ceremonial
Chemistry (1974), he posited that mental health
legislation is used to target social scapegoats (such
as drug addicts and ‘insane’ people) in the same
way that witches, Jews, Gypsies and homosexuals
have been persecuted. Contrary to popular belief,
Szasz was not opposed to the practice of psychiatry
if it is non-coercive.
Maverick, crank or pioneer?
Although Szasz was often dismissed as a crank
by other psychiatrists, a variety of sources
have supported his beliefs, especially following
publicity of the misuse of psychiatric detention
against political dissidents in the former USSR.
Furthermore, seminal research on literary
sources by Fulford
et al (1993) has suggested
that the concept of disease employed in the USSR
was similar to that still used in the UK and
USA. Indeed, the case that psychiatric diagnosis
is strongly supported by objective scientific
research was promoted in each jurisdiction (in the
Communist East and free Western democracies)
despite the rather arbitrary nature of psychiatric
classification. Szasz himself stated that the
activities of the Western psychiatrists condemning
their colleagues in the USSR for their abuse of
mental health legislation was ‘an exercise in
hypocrisy’ (Szasz 1970).
Discussion
Does the past offer any solutions to prevent
abuses of mental health legislation and diagnosis
of mental illness for political purposes? In reality,
few professionals in a dictatorship would dispute
instructions to detain an individual from a senior
state official. Soviet psychiatrists were coerced
with the threat of imprisonment themselves if they
failed to follow the repressive orders of the state.
However, a lamentable lack of coercion appears to
have been a feature in Nazi Germany, where many
psychiatrists enthusiastically complied with their
role in the eugenics programme.
In the analysis of abuses of mentally well
political dissidents by totalitarian regimes there is
a certain degree of naivety. Although life in a Soviet
psychiatric hospital would be most unpleasant for
all inmates by current standards, before the 1950s
many Soviet political dissidents would have been
shot or died of starvation in Siberian work camps.
The WPA could be criticised for its lethargy
in failing to take punitive action against the All-
Union Society of Neurologists and Psychiatrists
and its individual members. However, it is prudent
to observe that the WPA could not have had any
significant influence on these totalitarian regimes
by expelling their associations or trying individual
psychiatrists for political abuses.
Thomas Szasz argued that a diagnosis should
not be simply voted into existence, especially as it
may then be used to deprive people of their liberty.
In light of this, political and legal restraints need
to be placed on psychiatrists’ powers to detain
people on the grounds of mental illness, not least
of which is multidisciplinary consensus that a
person has a mental illness and should be detained
and the right to demand judicial review in open
court. Although legal challenge is unlikely to
prevent state-sponsored abuses of mental health
legislation, secrecy and the lack of transparency
in these proceedings could draw international
attention to potential abuses.
Activities which are now discredited, such as
the detention of political dissidents and forced
sterilisation, had vocal adherents who could
produce apparently plausible scientific reports to
show their effectiveness. There was highly visible
support in the media from respected medical
and political leaders. This raises concerns about
the ability to detain people under the Dangerous
and Severe Personality Disorder Programme in
the UK, by which patients are not required to
have been convicted of any offence, nor do the
proceedings require any public hearings in court
(although in practice most of the 200 or so patients
subject to these proceedings are likely to have
been diverted from the courts) (Buchanan 2011).
Regrettably, detention of people with ‘dangerous
severe personality disorders’ was politically
inspired (Feeney 2003). Although it is unlikely
that there is currently abuse of the system for
detaining such people, there remains a worrying
potential for this within the system.
references
Breggin PR (1993) Psychiatry’s role in the Holocaust. International Journal
of Risk and Safety in Medicine, 4: 133–48.
Taken from:
[1] https://www.cambridge.org/core/services/aop-cambridge-core/content/view/5A5950F52D74D0B5FC5418642C5211D1/S1355514600011378a.pdf/div-class-title-psychiatry-and-the-dark-side-eugenics-nazi-and-soviet-psychiatry-div.pdf
